Eric Swirsky, JD, MA
The history and evolution of the health record.
In the ’60s and’70s we had the rise of third party insurance companies, which made more money available than ever for billing health care because before then people didn’t have insurance from their employers. People paid on a fee for service basis. You go to the doctor, you paid for the service. Once we had the rise of institutional very large insurance companies and employers providing this, it opened up the gates to a lot more spending in health care, and we saw the industry boom in the ’60 and ’70s. HIT or health information technology at the very early stages was leveraged to help with that, and so even today we see that these systems they manage billing very, very effectively.
Not only has it changed the way that things are billed, but it’s change the way that doctors interact with the record, and we see things such as cutting and pasting in the record. Whereas before things were written in more of a narrative style where you could really feel and hear the words of the patient and the patient’s description of a conditon. Now when we look in the record it’s much different. We can see notes that are identical to other notes just with certain values that are changed. There’s a certain cookie cutter type of feel to the note, or the note is a jumbled mixed of acronyms and abbreviations and values that, really, to the untrained eye are meaningless. Where if you look at a physician’s record from the 1800s, you get a very, very good idea of what was going on, even for the lay person because the clinician is describing in detail what is happening with the patient, what he or she has observed, he usually.