Tag: "electronic medical records"

Your Medical Records Are an Open Book

Bloomberg is reporting that states hungry for revenue and flush with the power to requisition individual medical records are moving to capitalize on the value of that information by selling the information in them to all comers. Unlike private companies, states and their agents are exempt from HIPAA requirements and therefore do not have to take data privacy especially seriously.

In an experiment, researchers were able to match several dozen people with their supposedly de-identified medical records by combining public record searchers and the information in a sample group of records purchased for $50 from Washington State. Among other things, “an executive treated for assault was found to have a painkiller addiction,” and a “retiree who crashed his motorcycle was described as arthritic and morbidly obese.”

Bloomberg reports notes that states that exclude zip codes, and admission and discharge dates are less vulnerable to records identification. But even “de-identified” data sets contain significant personal information that could be used to identify individuals, especially in rural areas with small populations.

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What If the Exchanges Aren’t Ready?

This is from my column today in The Wall Street Journal.

The Obama administration wants something the federal government has never done before: a computer system that connects HHS, the Internal Revenue Service, the Social Security Administration, Homeland Security and perhaps other departments as well. This is a herculean task with unclear benefits. For perspective, consider that the Veterans Administration converted to electronic medical records in 1998 and the VA and the Department of Defense have been unsuccessfully trying to share records ever since. Even though they have spent millions of dollars on the effort, it now appears that the two agencies are abandoning the goal altogether.

Why Doctors Hate Electronic Medical Records

Unsent letter to the Tech Department:

So today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my username and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.

No wonder almost everyone I know hates electronic medical records! I don’t know anything about computers, and I don’t know what systems other hospitals have. I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it.

HT: Jason Shafrin.

Headlines I Wish I Hadn’t Seen

Research Results I Wish I Hadn’t Seen

  • Female mortality rates increased in 42.8 percent of counties in the United States during 1992–2006.
  • The average physician will lose $43,743 over five years after adopting electronic health records.
  • Cost savings from workplace wellness incentives reflect cost shifting to unhealthy workers.

More on these issues in the Health Affairs blog.

Why EMRs are Backfiring

Doctors used to have to fill out a checklist for every step in a physical exam. Now, they can click one button that automatically places a comprehensive normal physical exam in the record. Another click brings up a normal review of systems — the series of screening questions we ask patients about anything from nasal congestion to constipation.

Of course, you shouldn’t click those buttons unless you have done the work. And I have many compulsively honest colleagues who wouldn’t dream of doing so. But physicians are not saints.

Hospitals received $1 billion more from Medicare in 2010 than they did in 2005. They say this is largely because electronic medical records have made it easier for doctors to document and be reimbursed for the real work that they do. That’s probably true to an extent. But I bet a lot of doctors have succumbed to the temptation of the click…

And then there are the evil twins, copy and paste. I’ve seen “patient is on day two of antibiotics” appear for five days in a row on one chart. Worse, I’ve seen my own assessments of a patient’s health appear in another doctor’s notes. A 2009 study found that 90 percent of physicians reported copying and pasting when writing daily notes.

More on how electronic medical records make some things too easy.

The Down Side of EMR

Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data — their race, their preferred language, and so much more — required by Medicare to prove that we are achieving “meaningful use” of our EMR. What “meaningful use” means no one knows for sure, but our manual on how to achieve it is 150 pages long…

When the clicks don’t get me what I want, I naughtily handwrite a prescription. I skip ordering certain tests I might want because it takes too much time — I’ll do it next visit. I dreaded the arrival of this season’s flu-shot supply — now there were more orders to input!

Anne Marie Valinoti’s editorial in the WSJ.

How Kaiser Manages High Blood Pressure

Kaiser used its electronic medical records to identify 88,000 members in the Denver area with hypertension and created a registry to track those whose blood pressure was still too high. It contacts them to come in for hypertension checks annually. And it uses teams of skilled professionals to help patients with lifestyle changes and medications. Kaiser also offers patients home blood-pressure monitors at cost, or about $35, through its pharmacies and provides free blood-pressure checks on a walk-in basis.

Some 83% of Kaiser Colorado’s hypertension patients now have their blood pressure under control. That is up from 61% when the health system launched the program in 2008.

Source: Wall Street Journal.

Headlines I Wish I Hadn’t Seen

Headlines I Wish I Hadn’t Seen