Patient health passports—the start of interconnected and engaged care
A few weeks ago in The Doctor Is In I discussed the proposed Primary Care Medical Record which will better connect health records across the province. This is an incredibly exciting opportunity and it is also a massive undertaking. Even working full tilt, it will take time to develop and t
hen to implement. So the question is, what can we do in the interim to make care more connected?
One option is patient health passports. These are living documents patients carry with them that they can edit over time. They include important items about their health to ensure that any physician they see has access to their most recent information. The categories that all patient passports should include are: medical diagnoses, medications list (including supplements and over the counter), allergies, surgical and pregnancy history (if they apply).
This allows patients to have a list they can provide new physicians who are unaware of their health history. After an appointment with a doctor, the patient can update any new diagnoses or treatments which then enables them to show their family doctor at their next visit (if they are are connected to a family doctor). This keeps everyone up to date.
I understand that this might seem confusing to patients-shouldn’t your family physician be sent the information from the emergency department or consultant specialist’s office? Absolutely. But sometimes it takes time for the note to be written and sent, or maybe that hospital isn’t connected to the family physician and cannot send an emergency record automatically. It seems basic that our healthcare system should do this but it is not automatic that healthcare clinics and hospitals can speak to one another digitally.
How patients create this passport is up to them—if they prefer writing it down, they can keep it in their wallet. If they prefer the notes section on their phone, that works too. There are also several free health apps that allow patients to create a digital health passport. As a doctor, I think the best way for patients to complete it is whichever way they are going to find it easiest to update. It is only effective if it has the most recent information available.
When introducing patients to the concept of health passports, here are some important tips that you should make everyone aware of:
Diagnoses should be written down whether they are current or not. For example, if you had asthma as a child but no longer need treatment for it, it is still important to write childhood asthma on the list. This is because your lungs might be more likely to require medication for respiratory symptoms later in life even if not currently taking asthma medications.
Medications should be written out with the name, the dose, and the frequency that you take them. That means if you have been prescribed a medication to take daily but only take it every other day, you should write that down. Because it is important to know how often the medication is being used. The list should include prescribed medication and over the counter medication.
Vitamins and supplements should also be written out in the exact same way medications are to ensure that doctors know what is being taken. Just because something is natural doesn't mean it can’t cause interactions with other medications. We need to know everything someone is taking to keep patients safe.
Allergies should be written with the medication, food, etc. that you are allergic to plus any known reactions. For example, knowing you get a rash vs. have anaphylaxis is important. Make sure if you use an epi pen that you place it on your medication list. If you have a significant reaction to a medication that is not an allergic reaction, such as vomiting when take opioid medications, please write this down. These are called medication intolerances and they are very helpful pieces of medical information to have.
Your surgical history should include surgeries you have had throughout your life, even if it was a long time ago. Having your appendix out at age 8 still is important information even 30-50 years later.
If a pregnancy history applies, it is also important to include. This includes how many times you have been pregnant, how many times you have given birth, any pregnancy related procedures, and any complications.
Physicians having access to this important health information is critical to providing accurate, high quality healthcare. But the patient health passport also serves another important function. It is an opportunity to engage patients actively in their healthcare. As patients put together their passport, they are able to look at what their current health status is, they are able to ask questions if they do not understand a diagnosis or the purpose of a medication. They are able to let their doctor know that despite being prescribed a medication, they have not been remembering to take it regularly. These opportunities are essential to improving the communication between physician and patient and improving the quality of care that patients receive.
Patient health passports are not perfect. Creating one relies on a patient having the literacy skills to develop the document. If language is a barrier, this activity could be challenging. Options for helping this could include the patient using AI to translate the document or starting with printing off the cumulative patient profile with the patient to have a conversation about their health. Along with language literacy, the other concern is health literacy. If a patient does not have a clear understanding of their medications or diagnoses, they might need more support creating this document.
I have attached to this blog post two documents—one is a template for patients who prefer writing down their health passport information. The other is a list of tips and
tricks you can give to a patient to help them write as accurate a patient health passport as possible. I look forward to the day that our digital health systems automatically provide this information to both patients and doctors. While waiting for this to happen though, we can work together with patients to ensure everyone in their care circle is up to date, including the patients themselves.
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