Joey Wahler (Host): It is important to arrange ahead of time, so we're discussing proxies and access to medical records for your children. Our guests from Woodlawn Hospital, Brooke Nice. She's Health Information Management Director and Dr. Jerrod Feldman, a Pediatrician. This is Woodlawn Health Doc talk. Thanks for joining us. I am Joey Wahler. Brooke, Dr. Feldman. Welcome.

Brooke Nice, RHIA, BSHIM: Thank you for having me.

Jerrod Feldman, MD: Good to hear from you.

Host: Great to have you both with us. So first for you, Brooke, what exactly for those unfamiliar, in a nutshell, is a medical proxy as it relates to a platform like MyChart, which some joining us are probably familiar with.

Brooke Nice, RHIA, BSHIM: Yeah, I'd love to answer that for you. So proxy access allows those such as parents, legal, guardians, spouses, other types of individuals that have healthcare power of attorney, for example, to log into their personal MyChart account and then connect to the medical information for the patient they are caring for and represent.

Host: And Doctor, from your experience, why is a medical proxy for children so beneficial on your end?

Jerrod Feldman, MD: I've had experiences with parents who were very happy to be able to go back later and look at instructions that we might have put in the charting regarding an issue with a patient or be able to review things like data such as growth charts in percentiles or instructions that were given. And they can also use it to message, so they can reach out and leave a message that they want to schedule an appointment or ask when maybe they should follow-up with someone, or just a general question that it's much easier to access and do it more on their schedule and not have to worry about trying to catch a phone when somebody's calling and connect when they're at work.

Host: Gotcha. And so Brooke, who exactly can become a medical proxy?

Brooke Nice, RHIA, BSHIM: So there are multiple different types of proxies that we do allow. So biological parents, adoptive parents, permanent guardians, for example, with proper authorization, from the patient or legal guardian, especially for minors. Other accepted proxies could include maybe a neighbor, an adult child for a parent, grandparents, stepparents. Those are all different types of examples of proxies.

Host: And so, Doctor, it sounds as though before we go any further, it's not so much important who the proxy is, as long as someone is, right?

Jerrod Feldman, MD: Absolutely. We have some wonderful grandparents who are very involved in their grandchildren's life and parents are busy at work and it allows them to be basically performing a vital function there, whether that be, through the proxy and accessing the medical record or even just bringing the kids to appointments, but it's definitely helpful when this system gets set up so that we can have a seamless way of communicating and passing along information.

Host: Because sometimes the information you're dealing with, am I right Doctor, means having to make a split decision, right?

Jerrod Feldman, MD: Oh, there's lab results. There are various different imaging results from x-rays, things like that. So, it helps us interact with the families and I found in my use of this system that it's very useful when we get a result or something that we be able to forward that information to a family member, and then they can reply and let us have an update on how the patient's doing or have more available access to get information back to us as the condition of the patient changes.

Host: And so Brooke, what do parents need to become a proxy?

Brooke Nice, RHIA, BSHIM: So for parents to become a proxy, there's proper authorization forms that we have to have filled out. This is to protect the patient's privacy and our federal and state requirements. Depending on the type of access that they're requesting and the age group of the individual or the patient, determines what type of forms we have to have filled out.

Host: And Brooke, there are two proxies specifically for the ages of 14 through 17. Right?

Brooke Nice, RHIA, BSHIM: Correct. So this age group is protected separately, depending on, the type of access so they can consent to certain treatments without mom or dad's or legal guardian's authorization. And so in that case, we do have two different types of access. There's a limited access, and that does limit the ability to see things like medications, appointments, some very protected information if that age group is consenting to treatment on their own, with the full access, that limited access goes away. So they're able to see the entire chart, the medications, those extra protections, that we put in place.

Host: Dr. Feldman, anything to add there?

Jerrod Feldman, MD: I think it's something that as long as the parents are able to call the office, ask questions, it's a simple enough procedure. It just takes some stepwise, work to get through it. And I've had a lot of people that have been signing up recently and it's really been a nice benefit to the parents and the practice really appreciates it too because it makes it easier for the nurses to navigate some of the information flow.

Host: And speaking of which Doctor, maybe talk to us please about the fact that you know as well as anyone, both of you do, that many patients and their loved ones, they have an aversion to filling things out, right? Whether it be old school paperwork in-person, or stuff ahead of time online. What would you say to those who say ah I'll worry about it when the time comes?

Jerrod Feldman, MD: To be honest with you, this process actually may make their lives better in the sense of how this all works because we've even been able to use this for things as simple as school notes because protected health information has a lot of regulation and it's very difficult for us to forward that information.

And it's not just as simple as providing a note to the school. We have to provide it to somebody who, in this case being the proxy, we can attach it to their MyChart account and send it to the parent and then they can take it to the school. And we don't have to worry about trying to get confirmation of guardianship, things like that, every single phone call. This sort of is more of a blanket coverage. So, it actually makes their lives a little bit simpler and easier.

Host: And along those lines, Brooke, I guess one key here is the fact that electronically nowadays, this enables a patient's record, a minor's record to travel with them, so to speak, so that if anyone such as parents or guardians isn't present, they don't necessarily need to be right?

Brooke Nice, RHIA, BSHIM: They don't necessarily need to be present. Now, part of that is the access to the MyChart. So in that age group of 14 to 17 year olds, with the full access, the teen can actually have access to their own MyChart account. So they can travel with their chart. Your age group of zero to 13 year olds, they can't have access to their own MyChart.

So that's where that proxy really comes into play, where if you have a grandparent who has proxy access and they go on vacation with their grandparents often, this becomes beneficial in case there's an emergency while they're on vacation, they have access to those types of records.

Host: Gotcha. So Brooke, is there anyone that cannot become a proxy?

Brooke Nice, RHIA, BSHIM: There are. So temporary custody situations cannot have proxy access. We can't monitor these types of access. And so we cannot allow that access.

Host: So, it needs to be a stable, ongoing situation in terms of guardianship. Yes?

Brooke Nice, RHIA, BSHIM: Yes, that is correct.

Jerrod Feldman, MD: So from my standpoint, it's often a situation of we have a number of children we take care of who are in the foster care system, and unfortunately, a foster care parent is a temporary guardianship and would not fit under a proxy.

Host: Understood. How about, can you talk on the adult child proxy and how it might help an aging parent Brooke?

Brooke Nice, RHIA, BSHIM: Sure an adult child can become a proxy for an aging parent in two ways. So the first way is the parent can actually go into their MyChart and through the Sharing hub, in the MyChart app, they can invite their family and friends to be proxies. As long as those family and friends are over the age of 18. They can send them the link, they can sign up and it's pretty seamless.

Now, if the patient's are like my parents and are technically challenged, we can also have them fill out the forms and then we can send that link, directly to that proxy.

Host: And Dr. Feldman, I wonder how often do you run across a situation where an adult child proxy comes into play?

Jerrod Feldman, MD: I think this is one of those situations where, if they can be present for things like appointments or speak to the doctor, it's really useful, but that isn't always possible given busy schedules and whatnot. So if it's something where a person can be a proxy and go back later to look at lab results with the family member, or look at their office visit information, or what is the follow-up appointments, things like that, it gives them a wonderful bit of access to be able to be involved but not have to be present physically for everything that happens, and I think that's a really useful thing in this busy day and age.

Host: Absolutely. And a couple of other things. One being, as you two know, so much of good healthcare nowadays is about prevention, screening, doing things before it's too late, and it seems as though, Brooke, this falls into that category in a sense, right?

Brooke Nice, RHIA, BSHIM: Absolutely having proxy access, just like Dr. Feldman stated, makes things a lot more seamless. When you have adult children that maybe live out of state, but they are still involved in their parents' healthcare, this allows them to still maintain that knowledge of what's happening with their parents and their providers without actually being at those appointments.

That information is right there at their fingertips. I know when I go to the provider, and even just in my own MyChart, you know, you go over a lot of information and sometimes you don't remember everything when you leave, so you can access it right then.

Host: In summary for both of you, what's the main takeaway you want for those joining us today? Doctor?

Jerrod Feldman, MD: I think it's really important to be able to have some of this information later. Appointments can be a little confusing or it's a lot of information possibly to take in at once, and it's really helpful as a caregiver to be able to go back and revisit some of that information. And likewise, it also gives a little bit of access to be able to communicate back with the provider's office.

And I think it helps in a lot of different ways, and I feel like in our office, we're already seeing a lot of the benefits, even though we've been only in this system for a few months, we're already seeing increasing amounts of benefits we hadn't predicted.

Host: Brooke.

Brooke Nice, RHIA, BSHIM: Sure. I think the biggest thing from my perspective in protecting patient's information, is, although there are forms that have to be filled out, you fill them out one time and that it's all you have to do with that. And then you have access to these medical records. Whereas if you were to come and get physical copies of medical records, you have to fill out a form every single time to get physical copies.

This way it's at your fingertips. You can have multiple people involved in your care and have access to your records without having to jump through all of the other hoops that we require as we're protecting the patient's information. So, it becomes very seamless. Even though at the beginning there's some forms to fill out.

Host: And finally here, Brooke, since, as you know, some of this can be confusing at times to people, what's a good place to start for those joining us, saying, okay, I am ready to do this. What's a good place to reach out and get started?

Brooke Nice, RHIA, BSHIM: Absolutely. We welcome all of the questions. So please call the medical records department. Our phone number is 574-224-1140 and we're open eight to 4:30 Monday through Friday, and we are here to help those navigate this new process.

Host: And Doctor, I guess the bottom line for you is anything that helps for you to just get to work doing what you do best, which is helping and healing, that's a good thing, right?

Jerrod Feldman, MD: Absolutely. I think that being able to retain the information from the office visit, go back and revisit things is always a useful tool to have in the, tool belt. And I think once parents get a little more comfortable with this technology, it'll be secondhand.

Host: Yeah, it's amazing nowadays how you can have records sent so easily electronically through things like MyChart, where it used to involve faxes and things that now seem kind of prehistoric, right?

Jerrod Feldman, MD: Absolutely. It's definitely become a really beneficial item. I could give many examples of patients who are seen at multiple other providers and I was able to communicate through MyChart actually. And through the system, a specialist out of state for a very complex patient, and there was multiple different providers in the conversation, and mom was included in that because she had MyChart.

Host: And that's exactly what we're talking about. That's what this is all about. Well, folks, we trust you are now more familiar with proxies and access to medical records. Brooke, Dr. Feldman, keep up all your great work and thanks so much again.

Brooke Nice, RHIA, BSHIM: Thank you.

Jerrod Feldman, MD: Have a good day.

Host: You too. And for more information folks, please visit woodlawnhealth.org. If you found this podcast helpful, please do share it on your social media. I am Joey Wahler, and thanks so much again for being part of Woodlawn Health Doc talk.