At your doctor’s office, big changes are underway that promise to give you more power, better treatment, and higher-quality healthcare. But you might not have even noticed.

During your visit, does your physician seem to pay more attention to a laptop or tablet than to you? Or has a “medical scribe” become part of exams, tapping away like a court reporter? Have you received—and maybe ignored—an email invite to sign up for an online “patient portal?”

Most U.S. doctors are moving from paper to electronic medical records. By itself, a change in the dismal field of recordkeeping may seem ho-hum. But what’s important here is that electronic medical and health records open the potential power of digital information—fast, easily accessible, and quickly shareable among the various doctors treating you—to help you and your doctors make better healthcare decisions.

When did this happen?

You’ve had the right to get all of your medical records since 1996, thanks to the federal Health Insurance Portability and Accountability Act (HIPAA). But back then records were kept on paper, and you’ve probably never been inclined to collect all of your files from all of your doctors over the years.

The first electronic records were offered by large medical institutions in the early 2000s. But the practice didn’t really gain traction until passage of the American Recovery and Reinvestment Act of 2009 and the Affordable Care Act of 2010, which provided billions in funding and mandated the digitization of all medical records.

Since then Medicare and Medicaid have spent more than $38 billion in incentive payments to coax hospitals and doctors to buy and actually use computerized medical record systems. Nevertheless, most doctors say digital recordkeeping has had negative impacts on their practices.

Why would I want my records?

Information is power, and full and easy access to your health and medical information gives you the ability to take charge of your care, rather than passively leaving everything up to the doctors, who may not completely understand your preferences. Patients actively involved in their own treatment can work with their physicians to share and make better decisions, and are more satisfied with the results.

“To become an active participant in the conversation about their own health, patients need to have their records, so they know what’s going on,” says Jan Walker, associate professor at Harvard Medical School and co-founder of OpenNotes, an advocacy group for transparency in medical records.

How can electronic records lead to better decisions?

“The records generated by your routine and specialist visits today can impact your future treatment, so you want to familiarize yourself with their contents, check and correct their accuracy, and ask your doctor questions about anything you don’t understand,” says Archelle Georgiou, M.D., a consumer advocate and author of Healthcare Choices, 5 Steps To Getting The Medical Care You Want And Need.

Ready access can reduce unnecessary or duplicative tests. For example, in 2016, when Georgiou’s optometrist found a spot on her retina, it set off alarm bells for possible malignant melanoma. An ophthalmologist and retinal surgeon recommended a diagnostic retinal angiogram.

Luckily, Georgiou had a copy of a retinal scan taken in 2013, which showed the same spot, unchanged and thus not indicative of cancer. No further testing was warranted, thus sparing her the unnecessary cost and needless stress of waiting for test results.

What’s the benefit of digital?

Electronic records can give you fast access to imaging studies, test results processed by labs, and other records. They can also reduce delays in retrieving and sending copies from one doctor to another, though records systems do not yet seamlessly transmit digital files to other systems sold by competing manufacturers.

“You want medical records at your fingertips in an emergency,” says Harlan M. Krumholz, M.D., a cardiologist and health care researcher at Yale School of Medicine. “Or, if you want a second opinion, you can immediately show that doctor the relevant electronic information on your phone.”

Speed is especially critical when you’re facing a major threat or chronic condition (such as cancer, heart attack, diabetes, neurological disorders, or trauma), and time is of the essence in deciding which treatment is best and coordinating care among several healthcare pros.

Do all doctors make records available electronically?

Unfortunately, no. And their digital inefficiency creates a lot of speed bumps for patients and other providers.

Only 54 percent of office-based physicians have adopted “basic” electronic record systems, according to the latest (2015) data from the National Center for Health Statistics (NCHS). Doctors complain that dealing with computerized recordkeeping is the least satisfying part of their jobs, according to a 2018 survey by the Physicians Foundation, a nonprofit that works to strengthen the doctor-patient relationship.

“Physicians are not contrary to electronic medical records that enable them to provide better care. We’re into that,” says Ripley Hollister, M.D., a family practice specialist and a board member of the Physicians Foundation.

But Hollister says a secure patient portal software system, plus IT support, increases costs for a small practice. The bill for an electronic health records system can run as much as $160,000 for a solo practice, and more than $230,000 for a group practice with five doctors. Electronic recordkeeping also eats up 28 percent of a doctor’s day, which robs time that doctors and patients would rather see spent with patients. In the Physicians Foundation survey, 56 percent of doctors said electronic healthcare records have reduced efficiency, and 66 percent said they have detracted from patient interaction.

Major medical centers, on the other hand, are gung-ho and have taken the lead in providing secure online record access to their patients. The American Hospital Association says 96 percent of hospitals had a certified electronic healthcare records system in 2017. But one study last year by Krumholz and eight other researchers found widespread noncompliance with consumers’ right to get their medical records under HIPAA and state regulations after a medical student posing as the granddaughter of a patient requested records at 83 top hospitals in 29 states.

“The regulations are clear that people should have easy access to their digital medical records, at minimal cost, in a timely way,” says Krumholz. “But it’s still not easy for people to get their records, even at the best hospitals.”

What records can I get online from providers who do have electronic medical record systems?

A “basic” system has the following capabilities: patient history and demographics; patient problem lists; physician clinical notes; comprehensive list of patients’ medications and allergies; computerized orders for prescriptions; and the ability to view laboratory and imaging results electronically.

But that doesn’t mean online portal access to all those functionalities has been turned on. “A doctor might turn on your medications list but not your pathology reports or clinical notes,” says Walker. Right now, OpenNotes estimates that about 38 million US patients have access to portals where clinicians’ notes have been turned on.

How do I get them?

Just ask. Healthcare providers have to give you copies of your medical records, whether they store them electronically or on paper in one of those wall-size filing cabinets. Many doctors and medical centers with online patient portals will email you invitations to sign up for their portal, which gives you electronic access to at least some of your records.

If you can’t get what you need electronically, ask for old fashioned paper copies. “It’s not so important that records be electronic,” says Walker. “If that means handing you a print copy on your way out after a visit or mailing them to you, the most important thing is that people get their records somehow—on paper, electronically, via email, or as a PDF.”

Don’t forget to get your records from hospital emergency rooms, urgent care facilities, and drugstores that offer vaccinations and other simple care, and send copies to your primary care physician, who otherwise won’t know what treatments you’ve received.

What records should I get?

Ask for access to, or copies of, your “entire medical file,” which should include your vaccination history, prescriptions, allergies, lab and other test results (blood work, pap smears, EKGs, stress tests), pathology reports, imaging (X-rays, MRIs, ultrasounds), and records from outpatient procedures (endoscopy, colonoscopy).

Request especially any notes doctors made during your visits—the so-called “clinical notes”—which might not be available online. Don’t settle for just the “after-visit summary,” which is less detailed than the clinical notes. Also look for doctor-to-doctor letters, emails, and notes from any specialists who had been or are still treating you.

Can I get these records for free?

The law allows a reasonable fee for copies; be ready to fight for fairness. For example, the study by Krumholz found that 48 of the 83 hospitals studied charged more for records than the $6.50 the federal government recommends for electronically maintained records; one wanted as much as $541.50 for a 200-page record.

What do I do with all this stuff?

Divide your records into two categories: archival records from your years or decades of past treatment, which are essentially history; and current and ongoing treatment records.

Save the archival stuff—physical papers and film (X-ray and other imaging) copies—in a safe place in the unlikely event you’ll need to dig up something from there in the future.

For the more recent history of records related to current and ongoing treatment:

• To reduce misunderstanding and help you remember the next treatment steps, review and check the clinical notes to refresh, confirm, clarify, and correct your memory about what was discussed.
• If there’s something you don’t understand, email your doctor through the secure messaging feature of the patient portal—if available—to ask him or her to further explain it; add the response to your file.
• Review your blood tests and compare your results with the normal range listed on the report. Test results that fall outside this range may be a warning sign of current or developing trouble, which may be treatable inexpensively with lifestyle changes. Discuss these out-of-range results with your doctor.
• Bring together in one place all of your electronic records from your various healthcare providers, so everything is at your fingertips. One location should be an online cloud storage service, such as Google Drive or Dropbox, which enables you to access relevant records on your smartphone or other mobile device, and send or show them to your doctor while you’re being examined. Also back up these files to an external hard drive or DVD.