My brother is a surgical resident. A few weeks ago he was complaining about the difficult Electronic Medical Record (EMR) software his hospital is using, particularly the unintuitive user interface. Then I read an article in the New York Times about the business opportunities that are growing in the world of electronic health records. According to this article, two brothers, who have already developed a software EMR package for small-practice doctors’ offices, are waiting for the Obama stimulus package to essentially kick in, as the medical community will eventually have to migrate to digital patient records, or pay the penalties for failure to do so.
To me, there are two primary issues: privacy and accuracy. In extolling the benefits of the EMR (Saves lives! Lowers costs! No more pesky paper!), what will prevent the doctors’ offices, hospitals, and health insurers from abdicating responsibility over the care and quality control of those records? I realize that the e-document movement is permeating all levels of our lives, from the personal to the professional, but I cannot help but feel that an attorney’s e-discovery litigation case papers are better protected than patient information in a hospital.
Further, not everyone knows that HIPAA entitles you to your entire medical record, doctor’s notes and all (which is why, from what I understand in talking to several medical residents, doctors are usually instructed to take care in how they write about the patient in the medical record, for subpoena purposes and patient record requests; it probably is not a good idea to write “this patient is an idiot”). But in the same DHHS website, HIPAA privacy rules seem to have a series of caveats. A Washington, DC public interest research center has the same concern: Apparently, the DHHS proposed rules required that privacy breaches need not be reported to patients unless the provider or insurer felt that there was a “significant risk” of harm. So then the discretion for the standard of “significant risk” is left to a large impersonal corporation or a doctor who does not have the time to return phone calls? Not good. DHHS is currently reconsidering that medical breach notification rule, but this caveat that the covered entities determine whether “significant risk” exists, does not appear on the DHHS’s website summary pages.
Accuracy is another issue, and I believe it will be a growing concern as records are increasingly kept in digital format. With the health care companies pushing the doctors and hospitals to get patients in and out of the hospitals as quickly as possible, the quality of time spent with the patient will inevitably be reflected in the patient EMR. Case in point: I visited the ophthalmologist a couple years ago for a routine check-up. I advised the technician that I had scar tissue on my left cornea from an old boxing injury. The technician then inserted the eye pressure gauge into my left eye and the instrument tore into my cornea. The doctor treated me for this second injury but my medical record has no indication of this new injury from the doctor’s office. How do I know? When I mentioned the injury to my GP in a routine checkup, he had no idea what I was talking about. I obtained the medical record myself and added notes for my own records, indicating the date and type of this new injury; I may need this information for future eye care.
Another example: my GP’s EMR for me does not include the list of drugs to which I am allergic (it also does not include any reference to the eye injury from above). I have called his office, but I have yet to see that information added to the EMR. This information is in his paper record on me (I know because I filled out the “patient information form” upon my first visit years ago), but the problem with the EMR is that it can be replicated to any doctor in the country with one phone call, and the information will be inaccurate – even though (or because?) it is digital.
So the government will monitor the transition to EMRs, a "cost-saving" and "patient care" measure, but just who benefits here?
Johanna Blakely-Bourgeois, Pratt SILS