Keyose Blog - Personal Health Records

Advance health care directives are instructions given by an individual specifying what should be done for his or her health in case he or she is no longer able to make decisions. These are legal instruments that are usually witnessed or notarized.

These directives are very important in case you (or someone under your care) are unconscious or have an advanced dementia. It is stored in a legal or offical repository (notarized). It uses to include the five wishes:

1. Which person you want to make health care decisions for you when you can’t make them.
2. The kind of medical treatment you want or don’t want.
3. How comfortable you want to be.
4. How you want people to treat you.
5. What you want your loved ones to know.

A user have suggested us that Keyose could be a good place to store your  advance directives. Of course as Keyose is anonymous its legal value on those questions is close to “zero”. But as a doctor I think it could be a good idea to do the following:

- include your advance directives in your Keyose record (but never include identificative information about you in the record… that is very important for your privacy!)

- include some brief information about how to obtain the legal document or the telephone number of your representative in your Keyose card. It will help the healthcare profesionals to obtain that key information faster.

Of course be aware of the privacy threats of your Keyose card in this issue. In case someone steals your Keyose card containing personal information about you (or in a wallet with other personal identificative documents) he will be able to access to the public area of your personal health record, that is accesible with your public password (very important in case you are unconscious), but never to your private one protected by your private password that only you know and is not printed in your card.

The number of people travelling internationally is increasing every year. According to statistics of the World Tourism Organization, international tourist arrivals in the year 2005 exceeded 800 million. In 2005, the majority (402 million) of international tourist arrivals were for the purposes of leisure, recreation and holiday (50%).

International travel can pose various risks to health, depending on the characteristics of both the traveller and the travel. Travellers may encounter sudden and significant changes in altitude, humidity, microbes and temperature, which can result in ill-health. In addition, serious health risks may arise in areas where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services are not well developed and clean water is unavailable.

All people planning travel should know about the potential hazards of the countries they are travelling to and learn how to minimize their risk of acquiring these diseases. Forward planning, appropriate preventive measures and careful precautions can substantially reduce the risks of adverse health consequences.

Although the medical profession and the travel industry can provide a great deal of help and advice, it is the traveller’s responsibility to ask for information, to understand the risks involved, and to take the necessary precautions for the journey.

Key factors in determining the risks to which travellers may be exposed are:

• destination
• duration and season of travel
• purpose of travel
• standards of accommodation and food hygiene
• behaviour of the traveller
• underlying health of the traveller

Destinations where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks for the health of travellers, unless there is pre-existing illness. This also applies to business travellers and tourists visiting most major cities and tourist centres and staying in goodquality accommodation. In contrast, destinations where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services do not exist, and clean water is unavailable may pose serious risks for the health of travellers. This applies, for example, to personnel from emergency relief and development agencies or tourists who venture into remote areas. In these settings, stringent precautions must be taken to avoid illness.

The epidemiology of infectious diseases in the destination country is of importance to travellers. Travellers and travel medicine practitioners should be aware of the occurrence of any disease outbreaks in their international destinations. New risks to international travellers may arise that are not detailed in this book. Unforeseen natural or manmade disasters may occur. Outbreaks of known or newly emerging infectious diseases are often unpredictable.

The duration of the visit and the behaviour and lifestyle of the traveller are important in determining the likelihood of exposure to infectious agents and will influence decisions on the need for certain vaccinations or antimalarial medication.

The duration of the visit may also determine whether the traveller may be subjected to marked changes in temperature and humidity during the visit, or to prolonged exposure to atmospheric pollution.

The purpose of the visit is critical in relation to the associated health risks. A business trip to a city, where the visit is spent in a hotel and/or conference centre of high standard, or a tourist trip to a well-organized resort involves fewer risks than a visit to a remote rural area, whether for work or pleasure. However, behaviour also plays an important role; for example, going outdoors in the evenings in a malaria-endemic area without taking precautions may result in the traveller becoming infected with malaria. Exposure to insects, rodents or other animals, infectious agents and contaminated food and water, combined with the absence of appropriate medical facilities, makes travel in many remote regions particularly hazardous.

Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should take place at least 4–8 weeks before the journey, and preferably earlier if long-term travel or overseas work is envisaged. However, last-minute travellers can also benefit from a medical consultation, even as late as the day before travel.

The consultation will determine the need for any vaccinations and/or antimalarial medication, as well as any other medical items that the traveller may require. A basic medical kit will be prescribed or provided, supplemented as appropriate to meet individual needs.

Dental and —for women— gynaecological check-ups are advisable before travel to developing countries or prolonged travel to remote areas. This is particularly important for people with chronic or recurrent dental or gynaecological/obstetric problems.

Assessment of health risks associated with travel Medical advisers base their recommendations, including those for vaccinations and other medication, on an assessment of risk for the individual traveller, which takes into account the likelihood of catching a disease and how serious this might be for the traveller concerned. Key elements of this risk assessment are the destination, duration and purpose of the travel as well as the standards of accommodation and the health status of the traveller.

For each disease being considered, an assessment is also made of:

• availability of prophylaxis, possible side-effects and suitability for the traveller concerned;
• any associated public health risks (e.g. the risk of infecting others).

Collecting the information required to make a risk assessment involves detailed questioning of the traveller. A checklist or protocol is useful to ensure that all relevant information is obtained and recorded. The traveller should be provided with a personal record of the vaccinations given (patient-retained record) as vaccinations are often administered at different centres. A model checklist, reproducible for individual travellers, is provided.

Medical kit and toilet items

Sufficient medical supplies should be carried to meet all foreseeable needs for the duration of the trip.

A medical kit should be carried for all destinations where there may be significant health risks, particularly those in developing countries, and/or where the local availability of specific medications is not certain.

Contents of a basic medical kit
First-aid items:

• Keyose card and a printed copy of your Keyose personal record
• adhesive tape
• antiseptic wound cleanser
• bandages
• emollient eye drops
• insect repellent
• insect bite treatment
• nasal decongestant
• oral rehydration salts
• scissors and safety pins
• simple analgesic (e.g. paracetamol)
• sterile dressing
• clinical thermometer

Additional items according to destination and individual needs:

• antidiarrhoeal medication
• antifungal powder
• antimalarial medication
• condoms
• medication for any pre-existing medical condition
• sedatives
• sterile syringes and needles
• water disinfectant
• other items to meet foreseeable needs, according to the destination and duration of the visit

Any traveller with a chronic illness should carry all necessary medication for the entire duration of the journey. All medications, especially prescription medications, should be stored in carry-on luggage, in their original containers with clear labels. With heightened airline security, sharp objects will have to remain in checked luggage. Recently, airport security measures have introduced a restriction on liquids in carry-on luggage; it is therefore necessary to check with current airport security measures. A duplicate supply carried in the checked luggage is a safety precaution against loss or theft.

The traveller should carry the name and contact details of their physician on their person with other travel documents, together with a printed copy of his Keyose record with informacion about the medical condition and treatment, and details of medication (generic drug names included) and prescribed doses. A physician’s letter certifying the necessity for any drugs or other medical items (e.g. syringes) carried by the traveller that may be questioned by customs offi cials should also be carried.

Travellers should be advised to have a medical examination on their return if they:

• suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, chronic respiratory disease
• experience illness in the weeks following their return home, particularly if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs
• consider that they have been exposed to a serious infectious disease while travelling
• have spent more than 3 months in a developing country

Travellers should provide medical personnel with information on recent travel, including destination, and purpose and duration of visit. Frequent travellers should give details of all journeys that have taken place in the preceding weeks and months.

Note. Fever after returning from a malaria-endemic area is a medical emergency and travellers should seek medical attention immediately.

Adapted from a original document of the World Health Organization.

As described recently in the medical journal Family Physician adverse drug events are common in older patients, particularly in those taking at least five medications, but such events are predictable and often preventable.

About one in three older persons taking at least five medications will experience an adverse drug event each year, and about two thirds of these patients will require medical attention. Approximately 95 percent of these reactions are predictable, and about 28 percent are preventable.

Keeping a well organized and updated record of the current medications of a patient is a key element to minimize those events. Keyose is an unvaluable tool when dealing with that task.

With Keyose you can update the list of treatments quickly (close to real time). You and your doctors will be able to access to that information from everywhere.

Therefore, the Medications section in your Keyose health record is very important, specially when you take more than 4 drugs.

It is recommended to review and update the list of your medications each 6 months, and everytime you change or introduce some new treatment or a new disease is diagnosed.

A medical researcher, Hamly, described in 1995 a set of simple questions you should ask to your doctor each time you review the medication list with him:

1. Is the indication for which the medication was originally prescribed still present?
2. Are there duplications in drug therapy (i.e., same class)? Are simplifications possible?
3. Does the regimen include drugs prescribed for an adverse reaction? If so, can the original drug be withdrawn?
4. Is the present dosage likely to be subtherapeutic or toxic because of my age and renal status?
5. Are any significant drug-drug or drug-illness interactions present?

The Keyose’s team hopes that our tool serves to minimize drug adeverse effects for you and your family.

Our users are constantly suggesting improvements or new ways of using Keyose. Some of them ask to be able to add some test’s results in their Personal Health Record (as X-rays, CTs, blood analysis, densitometries and so on).

We are working hardly so in short time you can upload images to your Keyose profiles, but in the meantime we would like to help you to improve your PHR.

The first advise is crucial. And it is something I use to recommend to my own patients: take into account that in medicine more information is not equal to better healthcare. In an emergency setting your doctor needs the most important information, because time is critical.

So don’t upload all that huge amount of reports and tests you have been storing during the last 20 years. Take your time to select and resume the most relevant informtion (and most updated one). Talk with your most trusted doctor if you need, so he helps you deciding which information is more important. The time you invest in obtaining a good selection will be well used time.

Once you have selected the tests to be added, and until the keyose’s service for uploading images is available, the next step is to find the reports of those tests.

A MRI or TC comes with a little report from the radiologists that have studied the test, where the findings are descripbed in words. If a X-ray or electrocardigraphy was done by your doctor the findings are often described in the medical report.

Even is not always needed to include all the text in the radiologist’s report, but just the section titled: “Conclusion: No pathological findings.” or similar.

In the case of blood testing the same is applied. In general it is not needed to copy all the values within the normal ranges, but only those that are out of range (usually marked with a star-asterisk). For instance, if you have a test with hemogram, blood biochemical parameters and urine analysis and all the values ar normal but a high cholerestol (300 mg/dL for example) you can summarize that information in a way like this:

Analytic October 6, 2006: Cholesterol 300 mg/dL, hemogram normal, urine normal, biochemical normal.

This will help much more your doctor as he can go directly to the significant results.

As you have selected the significant tests and have summarized them we recommend you to add them at section “Personal History”. Add them just below the list of your main diseases.

The order is the key point. The better way to organize the information is by grouping by type of test (x-rays, blood tests, MRI …) and next by inverse chronologic order (it means the last tests in first place).

Following those simple advices you will get a efficient and useful Personal Health Record!

Here is an example of how to do it:

Personal history

Hypercholesterolemia under treatment with statins (1999)

Acute myocardial infarctation required stent (2001)

Chronic bronchitis under treatment with inhalated medication (2004)

—-

X-Rays:

03/02/07: Chest X-Ray: Vascular redistribution (cephalization).

20/05/06: Chest X-Ray: Normal.

Blood tests:

05/08/07: Total Cholesterol 180, HDL 20. Hemogram normal, biochemicals normal, urine normal. PSA normal.

05/06/99: Total Cholesterol 320, HDL 15. Hemogram normal, biochemicals normal.

A Keyose’s user has had a great idea. You can add some contact phones to call in case of an accident into your Keyose card. In such a way if somebody finds you unconcious, they will know not only your allergies and blood type but also they will be able to phone your family or friends as fast as possible.

We explain you step by step:

1. Login into your Keyose account.
2. Go to “See my card” option.
3. Click on the card’s area where your allergies appear, just below the Blood type.
4. Now you can edit the card’s text!
5. Add something as “In case of emergency phone: + 34 91 555 45 32 / +34 696 555 555″.
6. Print your new Keyose card.

Don’t worry about privacy. The text you type into the card will not be stored anywhere and will be deleted from the computer as soon as you print the card. Is like you write it by hand but much more elegant!