Comments on: What you need to know about e-health records

Drive to digitize medical records could impact every American. What does that mean for your health care and privacy?

[inachu1]

More reasons to stay off the grid for all the snoops out there.
Will not submit to a system that can not guarantee total privacy.
Better to use nonstandard communication protocols and unheard of file formats to keep data private.

[ddspell]

I agree about using non-standard protocols, however, that goes against what the government wants to establish. My position is that patients should have a flash drive encrypted with all of their files with a fingerprint necessary to access. When the patient goes to a doctor or hospital, the data can be transferred and used while the patient is there. Before the patient leaves, any data collected, modified or created would be transferred back to the flash drive. These special medical flash drives could be kept on the person in a wallet or purse so that in the event of an emergency this data could be provided to emergency personnel. Keeping the data offline and out of any doctor, hospital or insurance company's database would be the most secure process.

[flitcraft33]

Gee, I wonder if insurance companies will misuse this information in underwriting? But then I also wonder if oil companies are colluding on price and where the tooth fairy is......

[man_w_balls]

too many implications for misuse! Why not allow each person to keep their own medical records, and take them to the doctor with themselves in person? Because the human being treated is the only one who those records should be concerned with in the first place.

[blusky08]

AMEN!
Two other considerations:
1) If you want a second opinion, every doctor you visit will rely too much on previous doctors' notes.
2) Perhaps you don't want medical personnel to see your entire medical record, especially for sensitive or psychological conditions (for example, your dentist, a quick clinic physician or friends/family who may work for medical facilities). People should be allowed to choose the specific information that is released.

ALSO: Many physicans, especially older, do not seem to comprehend computerized medical charts. A paper chart is simple and quick to flip through multiple pages. I am hearing many people tell me that during medical visits the doctor is unable to gain quick familiarity with the patients history. AND, the doctors/nurses are often mixing up patient data, basing information on the wrong chart, etc! Patients have to be more aware than ever.

As a healthcare consultant for over 10 years, I find the concerns listed here to be common but based on incomplete information. Don't get me wrong, I am not a cheerleader for EMRs, and dozens of organizations have implemented them extremely poorly. But they are necessary to improve the dismal healthcare in this country.

What people apparently don't realize is all of their claims history has been in electronic format for years, in the custody of insurers (does anyone think they have your best interests at heart?). When you apply for health insurance, you give the insurer carte blanche to gather all the medical history it can find on you, accurate or not.

So rather than worry about electronic health information getting into the hands of bad guys (too late), focus on getting it into the hands of those who need it to best care for you. Your paper chart tucked safely away in your physician's office will do you no good when you are brought unconscious to the ER. Emergency personnel won't have a clue that you're allergic to aspirin and contrast dye sends you into anaphylactic shock.

[grinningevild]

This is such a complicated issue - there are so many potential benefits as well as pitfalls. This article highlights some of the major issues but there are so many more. Would it increase costs by making it easier to order multiple lab tests with a click of a button? Could it be used to anonymously data mine for trends to over large populations which would otherwise be missed - ie medication causes heart problems in 1 in 10,000 people, well, you'd need a database with hundreds of thousands of people taking the medication in order to find that trend. Might it be used to data mine for nefarious reasons? Will opting out of medical records really be a viable option? Will forcing adoption of EMR force some physicians into retirement or out of medical practice due to either cost or being a technological luddite? What it boils down to is that if done incorrectly this could be the worst thing to happen to medical care in the United States. On the other hand, if done correctly with reasonable balance of protection vs accessibility and interoperability, could vastly improve health care delivery. What it will not do is provide savings - in either time or money. You'd be hard pressed to find a physician on electronic records who says it saves them time. It makes for better health care, but at a cost.

[jd7wilson]

Thank you for your thoughtful comments. What people don't realize is that whether or not they want it, their health records will become digitized, now or 10 years from now. Yes, privacy is an issue, but so is the standard of health care we will receive as a result of having independent, disparate systems controlling (yes, controlling) our health care. Think about other subjects throughout history where there was no one standard and how much of a cluster that caused - currency (money) in the US, electricity in developing countries, communications systems in developing countries, the list goes on. The word we are looking for is unreliable. So why go digital at all?

You pointed out the reason in your example of someone arriving at an ER in an unconscious state. The potential for good, I think, is far greater than the potential for bad. I work at a pharmacy, and I see way too many people trying to get medications too early, or duplicating therapies. What is extremely aggravating is when someone is abusing a pain medicine. They are putting their own health care at risk. They are putting the pharmacies and doctors at risk - because of the liberal laws in this country, they can sue their health care providers for allowing them access to these meds. On the other hand, there are people who innocently duplicate therapies or take meds that interact, because they see different doctors and go to different pharmacies, so no one is on the same page. Fortunately, because of prescription insurance, some of these situations get caught and can be addressed - a patient's insurance database is sometimes the only common factor in their health care that can act as a watch dog for abuses or mistakes. But even that is not enough, because probably less than half of the abuses and mistakes are caught.

Some people say that prescriptions are only part of the health care picture. That is true. But when you consider that misused prescriptions, either intentionally or unintentionally, affect someone's overall health condition, it becomes apparent that it is one of the most important parts of that picture. But it does no one any good if only the pharmacies can see it. If doctors can pull up a patient's entire prescription profile, and see what the specialist is prescribing and what the psychiatrist is prescribing, then they can make better decisions on the treatment and care of their patients. Some would argue that a patient's primary care physician works closely with specialists and others involved with their patient's health, but the reality of it is that patients are not always forthcoming with their primary care physicians, assuming that they even have one.

Easier access to a patient's health record, by those who need it, will save money and lives. Because it is inevitable to go digital, I would rather see it done right the first time, rather than having different systems that can't talk to each other, and in the end make things worse, costing more money and lives. And by the way, I am not a fan of Obama, and I am a registered Republican, but I do agree whole-heartedly with the intent of this proposed legislation. Hopefully it can come about and accomplish what it is supposed to and still keep patient health information safe.

[DrDubious]

Concerns about computerized medical records and privacy are laughable. The average American long-ago surrender any semblance of privacy with the approval of the Patriot Act and warrantless wiretapping. Privacy does not seem to be a concern of the new Administration. But why should it? Now that almost unlimited powers have been granted to the Executive, why would anyone want to give them up.
My experience with medical privacy, for years, has been that everyone else knows your medical business but you. And you are not allowed to see your own without the permission of your doctor. So why worry about computerization? You cannot lose what has already been lost.

As a Kaiser Permanete (KP) Member, my records are computerized. There are many benefits to it, when seeing a specialist within Kaiser a couple of computer clicks and they have access to my entire history. Another benefit is that when medical test are performed, I can access my KP online account and see the results of the tests before seeing the doctor. This gives you information with which to ask questions instead of hearing the results at the time of the doctors visit. People need to give the system a chance.

[Kimsh]

"interoperability and substitutability" similar to what Apple's online store provides to iPhone and iPod Touch customers.

What the heck? There is nothing inteoperable about anything Apple does. They actively change their softeware to break non-Apple products that seek to sneek in here. Wow, this guy is utterly clueless isn't he. Proposing the ultimate closed system as "interoperable". Very disappointed that CNet printed this without comment. Very sad reflection on the quality of authors.

[Dale Lambers]

The only way to make this work and keep it secure is if the records are portable. Put them on a flash drive and let every individual be responsible for the security of their own information. Yes there are draw backs to this but at least there is no central repository to be raided.

[susiekingfish]

Have you looked into eMed ID? Great franchise.

[wmbath]

my records have been kept by va for years.it not only helped me recieve ssi medical. it is easy to have my records printed up for while i wait. i get my appointments through the mail and also a phone call to remind me

[housedocus]

The problem with medical records is that they are voluminous. Each hospitalization for example, generates hundreds of pages. It makes no sense to keep them. No one will bother going through them. What's needed is an easy to scan summary which gives the doctor the information he/she needs to evaluate the medical problem. Such a template is provided on www.housedoc.us, a HIPAA compliant, on line communications service for doctors and patients. Its user friendly, and available to everyone free of charge. It can be quickly be accessed in an emergency to get the medical and surgical history, medications, allergies, etc.

[bstockinger]

I can't believe that everyone wants to create electronic health records. Our private information is already routinely mismanaged by the health industry even though HIPPA is suppose to protect the patient's private information. Ask you doctor who they share your information with. You might be very surprised. Essentially anyone within the health industry with a operational need may have access to your information. Whatever system is instituted for electronic health records needs have a positive electronic confirmation by the patient otherwise the record should not be shared. The patient should be able to always access their records. The system should also limit who has access to the records. No one should have access to the patient's record without a key from the patient and their doctor. These keys should automatically expire after a short period of time.

[londo58]

you know it is a shame - the VA open sourced their patient record software - why not standardize on it as a baseline -doctors are getting sold expensive software and even walmart is getting into the act

lower the costs for doctors, cap the malpractice/lawsuits and leverage electronic technology - then maybe we can reduce the costs all around - I know I know - cap the pharmacies and drug producers mark up - this is an area I think walmart is helping

[doublebullout]

The VA's system is based on an old-fashioned hierarchical database structure using MUMPS. The open source version grafts on the relational database management tools. If you'll pardon the expression, it's sort of like putting lipstick on a pig.

Make no mistake -- EMR software is expensive in part because of the legal and regulatory complexities of providing medical care. Your doctor has to comply with a mind-boggling array of regulations, guidelines, and standards just to see you for the sniffles, let alone for something really serious like cardiac problems. EMR software has to incorporate all of that. And with the government throwing around billions in grants and incentive payments, the EMR vendors understandably want a piece of the action too.

[doublebullout]

I am an EMR implementation and design analyst, and I never cease to be amazed at the level of misinformation and paranoia that is out there. EMRs do not, and never will, decrease health care costs to the extent claimed. EMRs do not decrease administrative costs. If anything, they increase costs associated with staff training, system maintenance, and upgrade costs because of constantly changing legislation from governmental busybody agencies. If your physician has your record on an EMR system, this does not mean that your record is automatically accessible by the government, health insurers, medical device manufacturers, or even hackers. Moreover, the insurance claims that doctors and hospitals must submit in order to be paid have contained detailed health information for decades. Insurers, including Medicare and Medicaid, already have all this data available to them. Medicare in particular does data mining regularly. That genie left the bottle during the Johnson administration.

[John_ChilmarkResearch]

What boggles my mind in articles like this is the same old tired statements being made. Why can't reporters dig just a bit deeper and go beyond the typical privacy fear mongering and talk about how one's medical records are already being shared - new ARRA legislation actually tightens up HIPAA, something the reporter fails to mention. No, the reporter has done the same as those before them, harping on the same tired statements.

Agree with doublebull that EMR promises are overblown, as well as EMR risks. What is clear though is that the healthcare sector does need to move into the 21st century. Let the fear mongering end and let's just get on with it.

[pmbx]

I'm the developer of PaperCutPro a commercial solution which I implemented in 2001. Our Pediatric practice deployed it provide not only digital medical records but with the intent to eliminate most if not all paper from the office. The software networks three offices which host 30,000 patient visits yearly. As both a physician and the software developer I have an uncommon vantage point. Here are some of my key thoughts.

1. Every piece of paper of any kind that you handle in your office increases overhead, sometimes dramatically. I studied some of the actual performance times of certain office activities. Take for example, the process of signing in, pulling a paper chart, attaching a superbill, putting that chart in the nurses chart rack, then going back to repeat the process. In just ONE or our offices I calculated 80 man-hours a week for this single repetitive function. I could go on with more examples. Does this offer a savings to the patient? No, not really. What it does do is allow patients more face time with the providers and their staff who care for them. Removing paper then can directly correlates with increased quality of care IF that is a conscious desire on the part f staff and providers.

2. Portability of medical documentation CAN be enhanced or made worse with technology. My software specifically uses PDF output s that when I hand a patient their medical records on a CD, ANY other provider anywhere in the world will probably have immediate and unfettered access to the information I have. In addition it is easily searchable!. Images are STANDARD formats such as jpg's, png's, or tiffs which are also easily accessed.

3. Online access is the wave of the future. This is more than simply parents accessing their children's medical information on the web, but would also allow them to inject phone callback requests directly into the database and therefore get their needs directly to the provider. I know that patients hate the phone tree answering machines just as much as I do. Used as an adjunct to email requests from patients, direct requests injections to the provider are allowing for new and exciting ways to interact with patients. That is particularly exciting since I've been practicing now for 26 years and though pure medicine lost its appealing 'shine' a long time ago, I savor the interaction with my kids who are always fresh and invigorating.

In summary, I believe paperless medical information systems, like my PaperCutPro, will for sure make good doctors better, but poor doctors will at best still be poor doctors. Technology will not redeem them.

[donnakayh]

Never mind the hackers watch out for the errors. It takes to government decades to correct any errors in its databases. A typo in your medical records could cost you your life!

If it takes Social Security 40 odd years to "update" dead people, how long will it take to fix an error in 300 million + medical records!