Patient held medical record: solution to fragmented health care in Sri Lanka.

Abstract

Sri Lanka has an extensive network of health care institutions, but there is no registered population for any particular health care institution. Patients are free to select which doctor to consult and which hospital to get admitted. Also there is no established referral and back referral system in practice. This free movement of patients within and between the primary, secondary and tertiary levels of care by patient's choice has given rise to a situation where each episode of an illness or disease process is managed by different doctors in differing specialties. As in most care settings, the patient's medical or health record is held by the health service or doctor that is providing care to the patient for a specific ailment. This leads to a gap in communication between multiple caregivers leading to poor co-ordination of care. These difficulties faced and lessons learnt suggest the use of a medical record that is kept with the patient. Patient Held Medical Records (PHMR) are formal and structured records that are given to patients to enable the continuity and quality of care which he takes with him when he goes for medical consultations. PHMRs aim to improve communication between patients and the multiple clinicians and health care workers who are involved in patient management. The PHMR we propose comprises of a folder, clinical notes, problem list, flow sheet and other optional items. The PHMR can be used as a tool to empower and educate the patients. It will improve transparency and trust and facilitate continuity of care. Increased work load, cost, restriction of freedom in writing notes, confidentiality and retention of records by patients are the disadvantages which need consideration.