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Submitted for the 2012 Health Design Challenge
Prepared by: Gaurav Mathur MD
November 2012
unifiedrecord.tumblr.com
Unified Health Record
I. Proposal
II. Printable instruction sheet
III. Patient smartphone instructions
IV. Unified Health Record sample patient summary
Gaurav Mathur [email protected]
609.558.1754
Unified Health RecordSubmitted for the 2012 Health Design Challenge
Gaurav Mathur MD ! [email protected] ! 609.558.1754
Proposal
Currently, a patient’s health records are spread among multiple health care providers using dif-ferent brands of software for varying needs. Unfortunately, this disrupts collaboration among clinicians, resulting in fragmented care. Most patients attempt to remember all of their health information, knowing that their care depends on it, but cannot keep up.
The unified health record is a simple tool that allows patients and clinicians to label commonly accessed information in electronic health records that are otherwise complicated and hard to navigate. Because its implementation yields surprisingly comprehensive results, this proposal lays the groundwork for a fundamental shift in how medical records work.
Background
Every health record application, no matter how incompatible, can print to paper, which is the current compatibility standard. Many patients obtain copies of their health records and save them in desks, drawers, cabinets, and binders. However, more and more patients now use smartphones to scan those records, and optical character recognition software can make their content searchable. Even better, clinicians increasingly make encounter notes available to their patients electronically, with projects like OpenNotes demonstrating higher patient satisfaction and better care. Patients could combine their records into a single file or folder of scanned documents and images, a unified health record, which they would own and control. Cloud computing allows the patient instant access in an emergency, and patients could share the data with clinicians of their choice. Both patients and clinicians could search and analyze their health information in much more sophisticated ways than are now possible.
Search 2.0
Even though patients can bring all this disparate informa-tion together, search alone is still a cumbersome solution. Medical records are lengthy, and it is unreasonable to ex-pect people to search for ‘hypertension’, ‘BP’, ‘blood pressure’, ‘HTN’, before moving on to ‘diabetes’, ‘DM’, ‘DM2’, ‘hyperglycemia’, and so on. When searching for a list of health problems, that list must be available immedi-ately, and it’s not possible to search every potential dis-ease. Certain things must be labeled.
Unified Health Record labeling
Hx! Health problemRx! MedicationPx! Procedure or surgeryVx! VaccinationAx! Allergy or reaction !! Critical@! Contact information
It turns out that a large percentage of health information fits into a few basic categories, and cli-nicians viewing medical records start with a summary of these: health problems, medications, surgeries, allergies, and vaccinations. Therefore, we can take a giant step toward a universal standard by simply labeling these common items in medical records that are already in use.
This proposal uses existing medical chart abbreviations like ‘Hx’ and ‘Rx’ for the clinical labels because they are short, easy to remember, can be integrated anywhere that plain text fits, and do not have duplicate meanings that could cause confusion. Similarly, ‘!’ is used in many lab reports to denote critical values, and ‘@’ is easily understood to denote a contact. In other words, the unified health record features an intuitive language with which clinicians are already familiar.
Other Strengths
1. It is easy to learn. A simple one page visual instruction sheet is included in this submission, which is all that is required to train a health care provider, patient, or software developer on how to use the unified health record.
2. Everyone can participate. A developer can integrate these labels into a health record and stamp health problems with “Hx” as metadata, and so on. Clinicians can use them by just writing the labels, even if the software doesn’t officially support them. Patients can also use them by la-beling information in files, folders, and even apps, such as personal health records.
3. The simplicity and quick learning curve mean that training and usage are essentially free. The cost for developers to integrate these labels into their software is also minimal.
4. It encourages, but does not mandate, a consistent and familiar layout while making it possible to analyze and present information in different ways. An example is included in which an app searches the many files and folders in a patient’s unified record to create a detailed health summary. There is no way to create such a summary today except by compiling it manually, and it is incredibly useful in many situations, from emergency care to simply filling out forms.
5. In many nations, mobile phone text messages serve important functions in public safety, poli-tics, and payments. These labels could also be used in SMS for health communication.
6. If the patient shares his or her unified health record, it will allow increased collaboration be-tween many clinicians who may otherwise not communicate, resulting in better care.
Summary
Steve Jobs once commented that design is not just what a product looks like and feels like. He said, “Design is how it works.” The unified health record is a complete rethinking of how medi-cal records should work, with a focus on communication, collaboration, and patient ownership. Using these labels will encourage patients to scan their records and empower them to participate in their care. When enough patients control their health records, there will be a market for soft-ware services and apps that can search, organize, and share that information. Thus, we can hope that a unified health record is the first step toward a single, truly universal patient health record.
Unified Health Record ! Gaurav Mathur MD
Hx
Health problem / problema de saludIllnesses, symptoms, injuries, infections
Rx
Medication update / actualización medicinaPrescribed, vitamins/OTC, alternative...
Px
Procedure-surgery / procediemiento-cirugíaC-section, biopsy, tooth extraction, pacema...
Vx
Vaccination / inmunizaciónVx MMR, Vx HiB, Vx Flu vacc l deltoid...
Ax
Allergy or reaction / alergia o reacciónAx Penicillin-rash, Ax dilantin, Ax...
@
Clinicians’ contact info / contactos de clínicosTelephone, email, fax, title, specialty, address
!
Immediate attention / atención inmediataContact the patient or primary physician.
Unified Health Record
Distribute freely under a Creative Commons license. Designed by Gaurav Mathur MD. Learn more at unifiedrecord.tumblr.com
Instructions:
Make any health record universal by ena-bling search. Just label the information as you write, like “Hx asthma”.
Patients can use smartphones to capture high quality images of their health records, and unify the charts from doctors, hospitals, dentists, chiropractors, homeopaths, and others. Clinicians are encouraged to provide these files electronically.
When the patient scans the printed record, it will be a searchable file, possibly one of many. A simple app can search them all and display important information that other cli-nicians can use.
1/11/12
Vx flu vaccine given
Vx_Vx flu vaccine given 1/11/12 Vx MMR 8/13/11Vx chickenpox 7/12/11Vx HepA 7/12/11Vx Hepatitis A vacc... 1/12/11Vx Rotavirus 10/2/10
Rx--------------------------
Health record software developers: Integrate labels as metadata, so that “osteoarthritis” in the problem list prints as “Hx osteoarthritis”. Search “@” and “!” as part of a word. Search all others as whole word. Use these labels for all Latin alphabet languages.
----------------------Sample patient encounter note1/11/12
Vx flu vaccine given. ------------------------------------
--@-
Smart-labeling your health results
Designed by Gaurav Mathur MD. Learn more at unifiedrecord.tumblr.com
When storing and writing your health information in an app, use the Unified Health Record smart la-bels to tag information you might need later.
Then, search the app or search the whole device.
Photoscanning: Use your smartphone camera to capture documents and images. Copy, paste, and label into other apps.
Hx Health problemRx MedicationPx Procedure / surgeryVx VaccinationAx Allergy / reaction ! Critical@ Contact information
Use unified health record labels in any apps, such as email, calendars, remind-ers, task lists, notes, and personal health records
(PHR’s).
Unified Health Record labels
Search your entire device
Hx Health Problems / problemas de salud Date
Hx hypertension 4/29/2010
Hx pain in right shoulder 7/01/2008
Hx arthritis 10/2007
Hx gastroenteritis, most likely viral 8/1998
Rx Medication updates / actualización medica
Rx took advil for shoulder pain x 2 days 10/10/2011
Rx increased metoprolol to 100 mg a day 6/30/2010
Rx multivitamin once a day 5/2005
Px Procedure - surgery / procediemiento - cirugía
Px shoulder arthroscopy - Dr. Smith didn’t find any problem. 8/13/2012
Px surgery age 12 - appendix removed
Vx Vaccination / inmunización
Vx got Td booster 3/10/2009
Vx - scanned copy of childhood vaccinations from Dr. Jones
Ax Allergy or reaction / alergia o reacción
Ax nauseous from vicodin 10/14/2011
Ax Penicillin 3/10/1982
@ Clinician contact information / contactos de clínicos
@ Dr. Smith orthopedics - 555.555.6789 7/4/2011
Call my wife for emergency 555.555.1234, [email protected] 7/1/2001
! Critical comments / atención inmediata
none
Unified Health Record: sample patient summary and layout
Distribute freely under a Creative Commons license. Designed by Gaurav Mathur MD. Learn more at unifiedrecord.tumblr.com
Gender: Male DOB: 1/10/1971Age: 41Tel: 555.555.4321
Address: 742 Evergreen Ter, Springfield 12345Email: [email protected]: not reported
Religion: not reportedGuardian: selfMarital status: marriedLanguages: English
Labs and imaging Encounters Plan of care
This summary allows the patient or clinician immedi-ate access to the most im-portant information.It is generated by searching for labeled information in the unified health record. Clicking an attachment links directly to the document or images. Any health record can use this layout for consistency.
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Simpson, Homer
