Tuesday, February 19, 2008

Electronic Health Records: Solution or to cause more Problems?

"By 2010, the goal is to have half of the population with an electronic health record," said Richard Alvarez, president and chief executive officer of Canada Health Infoway, an independent, federally funded agency that works with provinces and territories to invest in electronic health-record projects, typically by funding half the cost. By 2016, he wants every Canadian to have one.
Convenience might seem an obvious first benefit, but those who tout electronic health records say the advantages extend far beyond that. By having quick access to medication histories, laboratory test results and images, doctors can provide the right treatment quickly, especially when it comes to dangerous drug interactions.

"Isn't it ironic that I can pay my hydro bill online from Australia," said Dan Strasbourg, Canada Health Infoway's director of corporate communications, "yet if I present at a Toronto ER unconscious, the physician can't even access my medical history housed at my physician's office a few blocks away?"

Think about it, if this succeeds, the next generation may never hear about/understand the figure of speech of "doctor's handwriting."

But this raises concerns over privacy and security. More often we are hearing in the headlines about breaches of “secure” data with stolen company laptops with personal information or hackers getting customer credit card information. Take a look at this scarry chronology of data breaches. This isn't to say that the private sector would not be good enough to handle this, as we know government screw ups happen often enough. But let us consider this for a moment, who would own our health record?

Clearly we would need someone to create the software, so we would need to contract it out to a company or a government department (who will then contract it out through RFP or whatever). I’m going to be really cynical now. I really do not see how this will be possible for half the population to have this by 2010. It will take at least two years before the government(s) and doctors will be able to decide on a format, because of course, in Canada, all provinces and territories would want a say and in typical Canadian fashion, the electronic medical record should be equal to all Canadians, except of course, any 'special' province who will want to do it their own way anyway. And who will have the contract of creating the software (public or private?). You would need it in both official languages. Of course there will be some NGO or special interest group who will insist that the medical record should be available in someone’s mother tongue. As a discussed here, language accommodation for immigrants in medical situations can be a mater of life and death.

What about accessibility? Would I be able to see my health record, but who will have the authority to be able to make edits/changes to it? Would someone be able to pay someone to hack in and change their chart to say their knee for example is much more severe and get knee surgery in one year (ha!) instead of two or three. *sigh* (Is this the Canadian Health Care System we're fighting for?)

Consider this. We have so much advancement in communication technology in our lives (cellphones, crackbabies, online banking, email, facebook, MSN messenger, digital photos, web forums), yet our communication relationship with a doctor is still done the same old way? Walk in, sit down, sometimes change into a paper dress, doctor listens, sometimes takes notes on your chart, hands out a prescription (sometimes a computer print out nowadays) and sends you on your way. Medicine has made considerable advancements, but very little changes to the way a doctor first interacts with the patient.

But is this a good or bad thing? A paper file does not require a network upgrade or version 2.0 nor will it be subject to a system crash or virus. Then again, not having a family doctor myself since 2000, I've been mulling over the idea of tracking down all of the walk in clinics to which I've visited. I've made some inquiries and it will cost me $25 (for the first three pages) to get my own medical file, and 5$ for each page thereafter. As a woman, I go to the doctor more often a man, and as a student, I've lived in three cities in five years. At a university doctor’s office, I may have one file, I've may have seen five different doctors over my tenure. I will likely cost me over $200 to access all of my records! The record won’t even go to me; it will go to another doctor’s office. While I have nothing to hide or embarrassing in my health records, what about someone who does not want to be discriminated against because of what’s in the medical file?

What concerns me? A wee look over at how Wikipedia defines the Ideal characteristics of an electronic health record (EHR):

The data from an electronic health records system should be able to be used anonymously for statistical reporting for purposes of quality improvement, outcome reporting, resource management, and public health communicable disease surveillance

Just like Facebook right? Sounds innocent enough, especially from a public health perspective. How can you judge how much funding should go for cancer, if you don’t know your population? But there is just something about it that makes me uneasy. Will I have control over who gets my medical information? What about the insurance company? Certainly, this is not as much of a problem in Canada, as it is in the US. Do I trust the state? Do I trust a private company? Do I trust myself? (keys, cellphone, wallet…usually all in the same spot, usually I can find them when I need to).

In Britian this initiative was considered a major IT disaster

This isn’t to say that I don’t think this isn’t a good idea (triple negative?). To be clear, I think this is a terrific idea, but I am uneasy if the costs outweigh the benefits. Should we try it? Absolutely! But after the gun registry fiasco and the headlines about breaches of secure data, I hope Canadians will pay attention and voice their concerns and we carefully consider the research already out there.

In any case, this will be good news at least for Elaine Benes would will finally be able to see her chart.


Blogger Scott Smith said...

February 19, 2008

I read with great interest your article on privacy and accesssibility with electronic personal health records and thought you would find MMR of interest. MMR has contracts with organizations covering more than 30 million lives to provide our services.

Contrasting MMR to other popular EMR products, MMR is delivering the most user-friendly, convenient and versatile web-based Personal Health Record available today. Using our proprietary patent pending technologies, complete patient information including actual lab test results, radiology reports and images, progress notes and all of a patient’s charts can be uploaded or faxed with annotated voice notes and comments directly into the user’s password-secured account. Users do not need to install any special software or use any special hardware to use our service.

MMR also has integrated other advanced features, such as multilingual translation, a drug interaction database of more than 20,000 medications, calendaring for prescription refills and doctor appointments, and private voicemail for a doctor’s message and other personal uses.

There also is a special “Emergency Log-In” feature that allows a doctor to access a user’s account to view their most important medical information in the event of a medical emergency. To ensure individual privacy, specific data, such as prescriptions, allergies, blood type and copies of actual medical files or images, are pre-selected by the user for inclusion in the online read-only Emergency Folder.

In addition, MMR also includes an online ESafeDeposit Box feature that enables users to securely store any important document in a virtual “lock box” and access them anytime from anywhere using an Internet-connected computer or PDA. These documents can include Advanced Directives, Wills, insurance policies, birth certificates, photos of Family, Pets and Property, and more. MMR is clearly one of the most complete user-friendly Personal Health Records available today (I can provide details).

I would encourage you to visit MMR and set up a complimentary account. Simply go to www.mymedicalrecords.com and sign up using registration code MMRMEDIA. I would be interested in your experience and hope that you will include us in any further discussions of Personal Health Records. I could also send you more information by email or snail mail (the latter allows me to send a bit more than I’d want to clog your email with). Recently, we sent out a release about MMR Pro, which will better enable physicians to put patient records into secure, online accounts.

Scott S. Smith
Director of Public Relations
11000 Santa Monica Blvd. #430
Los Angeles CA 90067
Ext 123 (Cell: 310/254-4051)

Tue Feb 19, 04:32:00 PM EST  
Anonymous Speech Privacy said...

In this digital world everyone is going for electronic means. If the same thing continues the next generation will not get aware of the value of the speech. so, we should promote the right to speech privacy system to encourage the next generation.

Wed Feb 20, 05:30:00 AM EST  

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