Thanks for all the input -- it is very interesting to see how different people think about medical records.
I have a few comments yet:
1. At least in our area patients come and go and come back into our practice as insurance changes and doctors move away. The records shuffle is a constant feature of "PCP" life. It is often impossible to obtain records from doctors who have moved on-- and no one seems to be very interested in trying to track them down and hold them to their supposed responsibility. So much for concern for patients.
2. The only people who want "complete" records are lawyers looking for something to catch you on, insurance and Medicare auditors looking for potentially censurable "upcoding", and Medicare Advantage clerks dredging through the records for potentially "upcodable" diagnoses that didn't make it to the problem list so they can pad their "complexity" portfolio. There are of course the occasional hypochondriac or obsessive-compulsive patients who want every scrap of data, useful or not.
3. The idea of a crystalized data blob (e.g. a collection of PDF files) is attractive, but only as useful as the initial cataloging -- assigning file names, dates, and so on correctly. I assume that James' method of making his giant catalog file by date means "by date within already assigned categories". That in other words, the CBC won't be filed in date order with MRI records. Even sticking with ImportedItems assigned categories (lab, consult, radiology, etc) is not totally foolproof. Despite much training and coaxing, new staff members who are assigned to file the incoming faxes don't always get it right and a lot of items get misfiled. Also, lab and X-ray reports that come in as PDF files from institutions where we don't have an interface are often not filed or even titled accurately. Finding lab and X-ray reports from outside hospitals can be a challenge.
4. It's sort of like trying to find the Epic of Gilgamesh in a pile of Sumerian clay tablets, most of which are records of commercial transactions.
5. All that being said, I think I will ask James to convert my records to PDF in a couple of months -- when I am tired of answering the phone and transferring the records myself after all the staff has left.
