Medical Mystery
I get a little behind in my WSJ reading, but I saw something from a few days ago about how insurance companies are helping (both with manpower and money) doctors' offices go fully electronic with records.
I am truly conflicted about this. On the one hand, I don't really want my medical life story passed around by my different doctors, not to mention the entire world if there was a breach of security. Who wants this out there?
25-year-old female arrives, certain she has "gangrene." After brief but hysterical conversation, she recalls that she had been wearing her green flats from Payless a lot lately. Led to questions about anxiety. Suggested a visit to a therapist.
Then again, when I take my four year-old to the pediatrician, the conversation starts off fine. She's doing well, yes, making progress; therapy has been great; integrated education has been great. Stomach problems? Yeah, still. Have you seen a gastroenterologist? Yes! We finally got an appointment and went. Great, who'd you see? Uhhhhhh. I think his first name was Joe, or something? Where was his office? I think it was at NYU ... no, wait, Cornell Hospital. Though maybe that’s the same hospital? Sorry, I think so, but…Okay, no problem, when did you go? Uhhhhhhh....
The doctor politely moves on. Has she been tested for allergies? Uhhhhhh (repeat of above).
Now, my daughter has yet to be in a true medical emergency. But if I can't remember key facts with a pleasant doctor in a pleasant setting, how the heck am I going to remember key facts in the emergency room at 3:30 in the morning? My middle daughter has a lot of minor medical issues, but even with my other kids ... I honestly can't remember which immunizations they’ve received, even though the doctor patiently repeats them to me each time he gives them out. I can't tell you how mortifying it is to have the doctor ask if they've had their flu shots this year, and to only be able to sit there, puzzled. It hasn't helped that we've recently moved to a new town and are seeing all new doctors.
My point is, having access to this stuff electronically could certainly save lives, save time, and probably save taxpayer money. Yet, I don't want my "stuff" out there.
What's the solution?
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Comments :
Re: Medical Mystery
In principle, why should electronic records be any more vulnerable to breaches of security than paper ones? Encrypted electronic files are probably a lot more secure than your average doctor's safe--and the files at your average doctor's office aren't generally even stored in a safe, are they? And why should your privacy be any more compromised if the records are electronic than if they're on paper? I'm sure there's an obvious answer to these question, but they're not occurring to me.
May '10
Re: Medical Mystery
Wow, something I know about. I've written software for medical applications. The law regulating access to patient medical data is called HIPAA, and it is generally taken pretty seriously. In theory there are ways to make electronic records quite secure, but as Claire mentions, the system is only as secure as the people using it. We are regularly dealing with hospital and clinic staff who share their passwords, or leave their workstations logged in, etc. The weakness in most secure data systems is the users.
A few years ago the IT director of a major hospital stated that he was unconvinced that we could keep the social security numbers of their patients secure. During a break in the meeting I walked around the floor and collected the names and SSN of several patients just by glancing over the desks of the staff who had gone to lunch.So much for security.
We are under regular pressure to make patient records more accessible to clinics and doctors outside the hospital, in the interest of better patient care. It's a tug-of-war between the medical teams and the hospital data security officer.
Re: Medical Mystery
Wow. Thanks, GA, for those snapshots from the front line.
Ursula, theoretically, as GA has described, it's easy to keep that stuff private -- or at least contained within the hospital. And having the data reside on one card means that it doesn't have to appear in a million other places, which cuts down on privacy risk. It would be a much more efficient -- and probably lifesaving -- system if we all had our records complete and ready to go, saved digitally.
There's pushback, too, from doctors. One reason medical records are so analog and old fashioned is because doctors know that malpractice lawsuits often rely on diving into those paper notes, searching for "mistakes." A nation of digitized, searchable medical records makes trial lawyers salivate. So it won't happen -- doctors won't let it happen, understandably -- until we get some real tort reform.
Which is too bad. Because the increased privacy-breach risk seems much smaller to me than the possible benefits.
May '10
Re: Medical Mystery
I've had the digital medical record experience as a dependent while my husband was active duty. The VA also has digital records. I think a big issue with digital medical records is the volume of data that must be safely stored and easily accessible. Most doctors, I believe, have some form of digital record keeping software, but they aren't part of a larger system that other docs, hospitals and medical professionals can access. As I understand it, the VA doesn't have a dedicated location where all the data is stored on a single server. Instead, there are locations by region that stores the info. There's a little lag time, say if your in DC and your VA records are in TN, but it's relatively efficient. However, active duty, dependents and those eligible for VA care are few in number. Even with only a few million records, the DoD and VA are struggling to create compatibility between their respective systems. Then there's the concern about who can see it. Do employers or insurance companies have access to any of those records? Can they use your info to limit coverage or prevent a promotion?
May '10
Re: Medical Mystery
I think there is a very wide spread of opinions about this among doctors. In addition to Rob's point about tort reform, apparently there is a fairly steep learning curve -particularly for older physicians less facile with computers. The initial investment of time and money is significant. And not all systems between hospitals are compatible. The Boston Globe ran an article on this in May.
May '10
Re: Medical Mystery
I neglected to note above that there are many physicians who think these systems are wonderful and don't know how they got along without them! Sharing information within the system is much easier. Tests, x-rays, scans, prescriptions etc are all available at the touch of a keystroke. Patients don't have to hand carry charts. Etc etc