Stagnant Patient Records Are a Public Health Problem

Laszlo I. Madaras, MD, MPH


May 16, 2019

In almost every town in America, at any given moment, patient health records are not available when they are needed most. Some of us have experienced it ourselves: a bad bout of food poisoning on vacation, or a lost prescription while at a conference. Sometimes it's more mundane, such as when we answer the same basic health questions week after week at intake and then in every exam room thereafter.

Despite incredible leaps in technology that allow for safe and secure transfer of information, our health records remain geographically bound, essentially trapped in an electronic health record (EHR) system at our home clinic. This leaves clinicians with huge gaps in their knowledge about the patient in front of them. It may also leave patients on the hook to pay for out-of-network care when they travel away from their medical home.

This is felt even more acutely by those who are already underserved. Migrant farmworkers, for example, are constantly on the move, following the harvest into fields where they're exposed to heat and pesticides. They may drink contaminated water and sleep in substandard housing. Most barely make enough money for food, let alone out-of-pocket health expenses. They may not have insurance, speak English, or know anyone in their temporary community. If there are health services available to them, they may not have the transportation or time off to get there.

What happens when a migrant farmworker gets sick? How does the EHR keep up?

Usually, it doesn't. Migrant farmworkers encounter these same barriers in each new location. Most give up and neglect their conditions, which leads to costly and more complicated treatments in the future, when they can no longer ignore their illnesses.

It also presents an ongoing public health concern. For a pregnant woman, avoiding medical care may mean a higher risk for life-threatening pregnancy and birth complications related to common concerns such as gestational diabetes or preeclampsia.

In the March 21, 2019, issue of the New England Journal of Medicine, we reported the case[1] of a pregnant migrant farmworker who managed to keep up her care. Her clinician enrolled her in Health Network, a virtual case management system operated by the Migrant Clinicians Network. We called the patient, figured out where she was going next and what her needs would be, booked her an appointment at her next location, and transferred her medical records. We repeated this every time she moved.

Health Network is not a permanent solution, but it is a necessary bridge between our geographically stagnant health records and our hypermobile, high-tech society. The next step is to make Health Network obsolete by integrating virtual case management into all of our health systems and ensuring that such a bridge is available for everyone. Then, with safe and secure technology and the political will to move forward, our health systems can finally reflect our modern needs and abilities and protect the public's health.

Moving—whether because of a job, such as the case of the migrant farmworker, or just for a few weeks for vacation—should never be a barrier to healthcare. Our health records need to be as mobile as we are.

Laszlo Madaras, MD, MPH, is chief Medical officer of Migrant Clinicians Network. He is a family physician in Pennsylvania and clinical assistant professor of Medicine at Penn State College of Medicine.

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