As the Chief Technology Officer at the largest medical clearinghouse in the United States for the purposes of continuity of care, I spend a lot of time around medical records.

Each day the eHealth Technologies operations department gathers records from all over the country, aggregates them into consolidated data, and delivers them to our customers. As one of the architects and technical developers of our aggregation software I am often called in to consult when we receive files or formats that require special care.

A couple of days ago we got over a gigabyte of records for a single oncology patient. I’m not sure, but I think that’s probably a record for our us.

First a disclaimer. We are a HIPAA facility and patient privacy is paramount. Consequently I can’t discuss specifics about patient medical data, but hopefully the information I can share will prove interesting.

The case in question was for a late stage oncology patient. We gathered records on behalf of one of the top 100 hospitals that added up to 1521 pages of records over a three-year period. Much of this data was faxed to us because none of the participating records sources have the ability to send us a fully electronic record containing all the required data. For complex cases, summary documents are simply too sparse.

Obviously there is simply no way the physician at the hospital is ever going to read, much less process, all this data. To help with managing the data we group it into sections and then order documents by reverse chronological order. We also provide a wide range of other navigation and summarization features that we won’t discuss here.

What did this record look like after we grouped it? Well, here are the numbers!

– request sheets – one page
– pathology reports – 14 pages
– history and physical/Dr. consult notes/progress notes – approximately 350 pages
– operative reports – 11 pages
– diagnostic imaging reports – approximately 75 pages
– labs – around 120 pages
– chemo/radiation treatment reports – about 25 pages
– Other – the rest (!)

If you’re quick with Math you’ve probably noticed that at least two thirds of the data falls into the “other” category. This is data that is needed for reference only.

The next largest category is the H&P/consult/progress notes at 350 pages. For those of us who’ve been in the medical field since the introduction of the EMR it’s easy to assume this data is cloned. Not in this case. Each encounter had different vitals, problem lists, and narrative. There was an absolute minimum of duplication.

In short, medical records for complex cases don’t need to be cloned to get really large.

The eHealth Technologies solution of aggregating and organizing data so that it can be easily navigated proved really useful to the hospital in this case, and gave the physician a simpler way to see the right patient with the right data at the right time.

More importantly, not having to worry about gathering all their records must be a huge relief for a patient whose life is coming to an untimely end.

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