Electronic medical records will turn your doctor's office into a government health care recording studio, monitoring all your medical complaints and treatments. Senior quality of life scores will determine the amount of services you will be eligible to receive, based on costs.
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Electronic medical records will turn your doctor's office into a government health care recording studio, monitoring all your medical complaints and treatments. Senior quality of life scores will determine the amount of services you will be eligible to receive, based on costs.
The government is spending $20 billion in health care over the next 10 years for electronic medical recordkeeping. The stimulus package called for $38 billion to be spent now on health information technology, including incentives for physicians and hospitals The government says it will find it easier to measure the quality of your medical care with this technology.
It should result in $81 billion a year in savings. 72 billion of this amount will be saved from improved efficiency, reduced inpatient stays, and avoidance of redundant care. (Seniors, this is where the waste will be cut for Medicare).
GOVERNMENT BENEFITS
Most of your information, messages, and doctor's orders will be recorded. No hardcopy will be filed or stored. Legibility should result, the government will be able to exchange information between all its departments (including the IRS) you’re your healthcare provider. Useful reports, as lab and diagnostic tests and prescriptions, will be generated from your medical data inventory.
Your data will be accessible from anywhere. There will be great transparency issues of providing access to your medical records.
Prescriptions will be required to be matched with your symptoms appropriately. (This will eliminate off label prescriptions of certain medications you get from your doctor). Off label use of prescription medications are used to treat conditions for which the FDA did not approve. The FDA regulates how drugs are approved, but not how medicine is practiced. Doctors today, can prescribe approved drug for any use they see fit. They must only prove that the standard of care has been exhausted and believe that the off label use will be of benefit to the patient. This will cease.
EMERGENCY ROOMS BENEFIT
Emergency rooms benefit, because access to records and test will be quicker, and more extensive information will be obtained, this will help a poor historian, and files will be compared. Images simultaneously will be available and previous images will be compared with current images.
Where electronic information systems are in full force in hospitals, the residents and staff spend more time on their computers than talking to their patients. Blood tests, and scanning tests are done before looking at the patients. Such unnecessary testing raises the price tag on hospital visits, as an attempt is made to increase patient turnover time, faster discharges, and reducing hospital stays.
Faulty observations and diagnosis occur without a good physical examination and without talking to the patient until tests are substantiated. On this erroneous information, in an emergency, your emergency doctors could treat you based on erroneous information.
Nurse practitioners and physician assistants are now employed to expedite fast track ER visits and discharges. This adds to about $100 an hour for a 16-hour day. The price tag goes up with the resultant increased liability by the physician in charge, whose name is at the bottom of many patient charts, whom he has not even seen.
DOCTORS GIVEN INCENTIVE PAYMENTS
Doctors who use the EMR, will receive incentive payments in the form of increased Medicare and Medicaid payments. This will be dispersed over a five-year period and will be under $40,000 per provider. Doctors who don't provide meaningful electronic records use by 2015 will be subject to penalties. (The word meaningful is unclear and not yet defined.).
NEW SOFTWARE REQUIRMENTS
The software must include handwriting detection for back up notes, which will then be placed in an electronic format. The software must communicate with multiple offices for several doctors to see. Doctors are confused and want to know what qualifies for the federal reimbursement before they go out and decide to buy software.
Templates for chart questionnaires must be made familiar to the staff. They must learn the different ways to sort and manipulate your data. All software must be government compliant (available to all federal agencies). There will probably be laptop PCs in each room, and personal digital assistants to handle the software. The system must be available 24/7 and there must be a backup access within 30 minutes. No paper backup will be allowed. A great deal of training and preventive work will be required to anticipate errors in the system. The staff will be required to become trained to work with information technology personnel to help pharmacies fill orders.
DISADVANTAGES OF EMR
You will never be left alone with a computer because of children, lawyers and programmers.
Information will be placed where it shouldn't, and there will be loss of your privacy and confidentiality. Information will be saved, deleted, overwritten, with warning alerts, and results. Most medical records will contain information about your behavioral and sexual health, your genetics, your family history, your occupation, your comments, and your attitudes.
MALPRACTICE ISSUES
Bizarre and outrageous errors will result. In court, the doctor’s notes will be read to the jury, along with the notes on your doctor’s last 20 patients with chest pain. A doctor with good communication skills with software will be a winner, but a doctor with poor communication skills find himself a loser. His guidelines will be questioned whether they are current and valid. As the doctor’s failures are counted, there will be an increase of approximately 35% in malpractice payments.
Since most young doctors, unlike the established doctors, are brought up on computers, and are groomed on digital systems in academic centers. They seek a local hospital that provides electronic records, allowing them to work efficiently and share and communicate information.
The doctor will never know if his decisions are supported by the system nor will he know how the system will be tested.
FAILURES OF THE SYSTEM
The system may fail to be used properly. Office personnel may never get trained on it, find it too hard to use, not be authorized to use it, or they just will not use it. The shear volume of raw data for each case will require the staff to multitask, putting pressure on their time, and overload system navigation. As an office secretary logs in, how long will the terminal remain active, before the nurse finds time must to use it?
YOUR ROLE AS PATIENT
You, the patient, must voluntarily participate. You will be given thorough disclosures, written disclaimers, full documentation, thoughtful policy, informed consent, be monitored, and then voluntarily sign your life away.
CAN YOU CONTROL YOUR ELECTRONIC FILE?
What’s in this for YOU? Would you like to control your own electronic medical file? You then could give permission to your doctor, your hospital, and your insurer. You could continually update all your medical procedures, prescriptions and tests. Such a detailed record could improve the quality of your health care, prevent dangerous medical errors, and improve the efficiency of medicine. Building your personal electronic medical file can be time-consuming and cumbersome. You would need to make sure the electronic records are up to date and accurate.
If you have a chronic health condition, or you are taking care of a family member, such an electronic record might make a lot of sense. Having a full history, health provider contact information, and a list of current prescription drugs, that any caregiver could find would be invaluable in an emergency.
Well, there are now four online health record systems being offered, at no initial fee
GOOGLE HEALTH will let you connect to vendors who, for a fee, will transcribe your paper medical records into your electronic file.
HEALTHVAULT also has agreements with medical device makers to let patients import data from devices like blood pressure and blood glucose monitors.
REVOLUTIONHEALTH HEALTH RECORDS allows you to input medical data yourself, or will input your records faxed to them directly from your health care providers.
WEBMD PERSONAL HEALTH RECORD allows you to store medical records, family histories and other health data.
MEDICAL IDENTITY THEFT
The doctor’s network, if not secured, exposes you to identity theft. As the doctor’s staff searches queries that are poorly articulated, an overload of bad results can enter your database.
Security issues include password and media discipline. Who owns the information? How do you protect yourself from tinkering hacking, browsing, piracy theft and vandalism?
If you have your identity stolen, incorrect medical information with medical errors will enter your chart and cause you great financial losses.
Medical identity theft is easy to commit because the healthcare business operations are so complex. The theft is lucrative, and might not be discovered for years. You the patient, will only learn about it when you have an incorrect credit report, a receipt of someone else's bill, a denial of insurance coverage, or notification you have reached your financial limits and caps. Such medical discrepancies are discovered only during your treatment.
The thieves are often, billing specialists, nurses, front office staff, temporary help, and even housekeeping staff. Your birth and Social Security are used to obtain credit cards to purchase great sums of goods. Services to an actual patient are entered that the doctor does not treat. Thieves pretend to be doctors, order medical tests and give false diagnoses that are put into your records.
Hipaa — (the Health Insurance Portability and Accountability Act) privacy rules actually work against you. Once your medical information is intermingled with someone else’s, you may have trouble accessing your files. Privacy laws dictate that the thief’s medical information now contained in your records must also be kept confidential.
ERRORS STILL OCCUR
Information errors will occur almost daily. Medication errors, with improper doses and quantity, omission of drugs, wrong drugs or unauthorized drugs being written, timing errors, and numerous errors during dispensing will be frequent. The staff may not clearly identify you. All the medications will not fit on a single screen. They will be login failures. Automatic presurgical orders will be cancelled, and charging will be very difficult and. cumbersome.
When templates are used, there will be no personality to your doctor’s notes. What really is important for you may not be written. There are lists of what you should have, but not what you should not have. Care will be fragmented and services will be charted that are not performed. These templates will not allow focused examinations, nor explanatory notes by your doctor.
OFFICE PROBLEMS
The office site will become a recording studio with no erasures and no rewinds. How do you prevent the staff from wasting time, private Internet surfing, and Internet pornography? Full passwords can be snapped with cell phone cameras. Will the doctor’s staff do business on the side?
INFORMATION ERRORS
By accepting the data on the screen, duplicating orders, linking automatic orders to procedures, automatic disk continuations, the late recognition of the contraindications, and failure to capture information from all the systems available to the staff. It will be difficult for you to correct and incorrect medical entry because the HIV-AIDS allows this incorrect information to remain in the record even after the crime is detected. Doctors stolen licenses, DEA numbers, and signatures will allow criminals to prescribe and Bill.
The doctor may also suffer a loss to his reputation and his finances. The EMR creates many new concerns about piracy, accessibility, and the ease of its use. The nurse might call in a prescription for you, but retrieve it for herself. A billing office worker may steal your information and seek treatment in another office. An insurance card may be stolen and given to a family friend with medical disabilities.
Your information may be used to apply for credit cards and to buy clothing. The doctor may alter his medical records after he has an unanticipated poor outcome. A patient can go to the emergency room using a family member's insurance cards. A person may take prolonged illness to get more time off from work or get workman's comp benefits. A nurse may unlock and steal medications from the cabinet and record it was given to you. A staff worker may look up her husband's record on the computer to see what he is being treated for his sexual problem.
MALPRACTICE ISSUES WILL INCREASE
Ninety percent of your information created, will be stored electronically and will never be printed. Legal discovery in cases of losses will include open or deleted e-mails, data files, program files, temporary files opened or closed, system history files, software, website files medical research files, word processing, voice mail, and chat rooms.
New federal rules required all letters must be preserved, including forensic experts reports, metadata issues, discovery requests for software, storage data disruption, backup tapes for diagnostic tests and films, and need for data preservation. The lawyers will monitor your doctor's compliance with preservation and production of his records. Your failure to utilize EMR systems or records will be challenged. Software vendors will be attacked for misrepresentation, and may be codefendants in a lawsuit.
EMR INCREASES MALPRACTICE CLAIMS
Despite accurate charting, your doctor may be charged with failing to rule out reasonable possibilities. Informed consent may not have been taken, and technical errors may occur. There may be record alteration, fraud, money driven care, and other hot button issues. To prevent this, the staff may turn off delete keys, audit trail problems, or the doctor may close his practice, being unable to provide your records from the system.
Doctors may fail to sign notes without reading them, and may fail to clarify language explaining the lack of his review. He may have canned operative reports, and the EMR may reveal his bad practice patterns. The most common legal allegations include improper performance of a procedure or technique, failure to diagnose, error in diagnosis, inadequate consent, and inadequate communication with you.
Informed consent will require adequate time for you to ask questions and communicate with your doctor. You need to be informed of the nature of your problem, alternatives to treatments, the anticipated benefits of the treatment, the risks and side effects, and the risks of not having treatment.
The doctor must document that he gave appropriate information did advise you of the risks, alternatives, consequences, and expected outcomes of the contemplated procedure. He must document that he has given you a chance to ask questions and have them answered.
COMMENTARY
Technology companies, including physician focused vendors, all scripts, healthcare solutions, quality systems, all will get rich because of electronic record keeping. There are no clear answers on the overall payoff from the wider use of electronic health records for at least another five years. Very few of the hospitals today are effectively using the capabilities of electronic health records.
Challenges face the Obama administration, as it seeks to accelerate the adoption of electronic health records through 2015, even though only about 20 percent of physicians now use them. Studies so far have found there are no savings in hospital computerization, nor has it improved administrative efficiency. Claims that health IT will slash costs and help pay for the reforms being debated in Congress are wishful thinking. Installing the technology does not necessarily mean that the hoped-for gains in quality and cost containment will follow quickly.
Government policies should focus on helping physicians; hospitals and the public health system use the technology more effectively. When you are not aware your medical identity was stolen, insurance companies may simply continue to pay the fraudulent claims without your knowledge. As of now, very few doctors have set up their own electronic record-keeping systems, nor with systems compatible with patients’ home-based files.
Insurance companies and hospitals are pushing to have all your medical history on an electronic database. Vendors of hardware and software, marketing companies, and our government, welcome this and private insurance companies who try to avoid paying so much for your medical care, and especially trial lawyers. who will look at this as a bonanza for lawsuits. Most doctors resist this change.
These electronic records might save filling out duplicate forms, but you still will have more forms to fill out. Do you want to have all your health information in some electronic database? Will it really save your life in the emergency room when you are unconscious or bleeding? Not likely! Your medical bracelet will give you all the information quicker.
Doctors find electronic recording a hindrance. It will make doctors order more superfluous tests because of fear of lawsuits. Your doctor can better understand your medical history by asking you questions directly and listening to your problems.
Will the users of this information act on your best interest or want to monitor your behavior? Confidentiality becomes meaningless. If a record is electronic, you might not want to tell a doctor anything you would not want a blackmailer or spouse to find out.
With 40 million people added to your doctor's appointment schedule, your doctor will not have time to listen to your medical complaints. Your medical visit will be very brief. and your major complaints will be monitored by the government managed electronic medical recording studios. Your complaints will be quickly summarized, electronically interpreted, a diagnosis will be delivered, and your treatment denied. All medical waste will be removed to lower health care costs.
Is this what we all want? What do you think? Your comments are always appreciated.
Visit www.drneedles.com for more information on controversial medical issues.
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Visit www.drneedles.com for more medical information on controversial medical subjects.
Sources:
Physicians for a National Health Program
Industry’s Healthcare Information and Management Systems Society,
2008 Dartmouth Health Atlas ( compiles government health data). Industry’s Healthcare Information and Management Systems Society,
The American Journal of Medicine, Himmelstein, Harvard Medical School 11.20.2009
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