I'm already leery on the misuse of the HIPAA requirements to begin with in regards to medical records. Digitization isn't the be all to end all, especially in this day and age. Just because the technology is there, doesn't mean that it should be used for every little thing under the sun.
Keep the medical records offline. In this day and age, everything is hackable. Lets make this one important thing not.
Thanks for raising this issue - you've covered it well. I wanted to focus on one thing you wrote - that a lot would depend on the contractors selected for this idea. Private contractors should only be involved in setting up the system. The records should be kept by the federal government. They have a much better track record with the privacy of personal information that any private corporation. They are also more efficient in their operation - I know many will scoff at that statement, but just think of the IRS and the Social Security systems. They have managed to keep sensitive information private for decades, and they already maintain detailed records of the income of the vast majority of the population. Compared to private contractors, they are hacked much less often. I believe that private firms add an extra layer of costly bureaucracy empowered to make arbitrary decisions about personal health in order to maintain a profit margin. I know people worry about Big Brother, but why would they trust Google more with their private health records?
You make some good points John. I think having Google handle the matter of computerizing health records is a bad idea. I wonder if the American public will have any say so in the matter?
We shall see...
I am most appreciative that you stopped by to provide futher commentary and add to our lively discussion. Thank you John!
Having a record of what groceries I buy or if I smoke is quite a bit different than my medical history. I smoke in public, and when I buy groceries in public there are usually people nearby (who I never force to sign confidentiality forms when they see me pulling an item from the shelf), and strange, unknown cashiers ring up my purchases.
As for security: how secure is anything on the Internet? What people post on facebook, myspace, or online journals is obviously intended for public viewing (albeit it might be regretted later). Hackers have an uncanny ability to get "private" data, and keep pace with the latest "progress." The good guys are usually one step ahead of the bad guys, but only after the bad guys have exploited a vulnerability. A common example would be software patches released by Microsoft. Those patches are released not because Microsoft has been testing their software and found vulnerabilities, but because those vulnerabilities have been taken advantage of by malicious entities. Any information on the Internet is potentially available to anyone in the world with an Internet connection (even those who still have to suffer from dial-up syndrome).
It's well-known now that employers will Google prospective employees. Instead of finding embarrassing pictures or weblog entries, some employers I'm sure would love to get a hold of a person's full mental health and medical history. Oh, I'm sorry, do you think that couldn't happen? You don't think there would be a "black market" or even a "white market" where that information could be obtained? My apologies for wasting your time then, dear readers. Please feel free to have a nice cup of tea and bury your head in the sand.
Regarding the issue of efficiency and helping prevent medical mistakes: I'd have to say if it really worked out that way, it would be a wonderful, glorious, magical way for health professionals to improve care and save lives. Unfortunately it's not reality. It's apparent that doctors often don't review information already within their possession ! For instance, recently I switched doctors and went through the hassle of having my medical records transferred from one hospital to my new doctor. I went to see him a second time, after my records had been transferred, and he hadn't even yet looked at them! I was telling him about my acid reflux and an endoscopy I had done that discovered three ulcers. Only after I asked him if he'd looked at my records yet did he start looking while I was talking about it.
Obviously a doctor having information at their fingertips is not the problem. How efficient was I to have my medical records transferred? I thought it was a good idea at the time, that it would improve efficiency and smooth the transition to a new doctor. And don't anyone tell me it was an isolated incident, because I wouldn't believe them. This was no back-woods country doctor with which I was dealing. And I only gave one example although I could cite several more.
There's an ample amount of things that can be done before deciding to place all of one's medical records online, they're simply not being done. And doctors apparently don't have time or are too lazy to review patient data already in their possession.
Here's something ridiculously simple to prevent mistakes: Quality Assurance. When I worked in a production/manufacturing environment, a second pair of eyes would check quality, thereby preventing many mistakes. The best and most quality-conscious production worker can make a mistake, but having a second pair of eyes frequently prevented human error. Sometimes the problem was obvious yet still overlooked, and sometimes not so obvious. A different perspective and a second set of eyes can often find things another person would miss.
I wouldn't mind at all having two doctors in the examination room with me instead of one. And although I know that's not realistic because of the shortage of doctors, it's a solution that would truly prevent more mistakes than digitalizing everyone's medical history.
The problems isn't lack of information, but human error, so let's look at other work environments where human error has to be addressed and see if we can learn anything about preventing mistakes. Not this smoke and mirrors business that wouldn't accomplish much of anything. Let's talk about real progress and innovation, and engage human creativity to solve our problems, and have an honest discussion about why mistakes are being made.
I want to thank you for making such a robust and meaty commentary in response to this topic. You have made some excellent points which made me give pause and think.
I do think that to change the system for the better...allowing doctors to have that information in a speedy way will save lives. Some docs just need to get with the program but just because some doctors are faulty in not reviewing the digital information they have, doesn't mean we don't provide the tools for them. Two docs to give us a physical, gyne exam, or flu shot? I am not with you on that one. They already have technology to allow for second doctor's opinions and even help...with video conferencing. So this is already happening but it doesn't negate the need for computerized medical records.
At any rate...I am most appreciative of your well thought out and articulate response to this topic. I will definitely keep you informed as to new discussions/debates I may create for this site.
:At any rate...I am most appreciative of your well thought out and articulate response to :this topic. I will definitely keep you informed as to new discussions/debates I may :create for this site.
Merely Me, thanks for saying such nice things about my comments. And my input is so welcome, please do feel free to "keep me informed," although I can't guarantee I'll always have something to say.
Merely,
Sorry it took me so long to stop by, but I have been a bit under the weather. It's odd that I'd missed this news article, as I listen to NPR almost every day. Colour me out of it and smack me with a silly stick.
That said, I saw the film "Milk" eight days ago. Harvey Milk was the first openly gay man elected to office. His message was to other LGBTG was to "out" themselves. That way, people would be able to put a face to those that might be discriminated against.
Today, the invokation of the first openly gay Episcople Bishop, spoken by request of the new president, was not broadcast, nor even heard by those in Washington. He has suffered death threats, but is at peace.
I am lucky, in that I don't care who knows about my records. I am fat, sober, Bipolar II, BPD, PTSD and a load of other crap to boot. I'm also forty-three, so am not ashamed of my teenage bout with Venereal Warts, my long-term hospital stays and my daily struggle with a mental diagnoses.
I understand the fears of many about on-line records. I just may be in the small minority that agrees with you. Go for it. The longer we keep mental health in the closet, the longer it can be a source of bigotry, ignorance and shame.
I am mad and I'm proud.....Do you have time to hear about my ruptured ovarian cyst?...
Hey there!
I am so happy to see you here...thank you for going out of your way to add your thoughts to this discussion.
I absolutely love your comment. Yes...one way to end the stigma of mental illness is to be more open about it. Yet still...I am not even sure that will stop others from using that information to hinder people from becoming employed or even getting insurance. It is a very difficult issue and...I fear that there are no black and white answers. But I do know that technology presses onward so we need to prepare ourselves for what that might mean.
The problem is...nobody can foresee right now...the extent of the problems we may face as a result of this progress.
I applaud your courageous honesty and sure...I would love to hear about your ruptured cysts!
You totally rock and I am honored that you stopped by to comment...thank you!
I agree that the good outweighs the bad with respect to computerized and accessible records. Both positions are probably right, in that records (and everything else shared beyond one persons mind) can "get out." Therefore, I think that the effort to make medical records more accessible must be accompanied by rules and laws to, at least, legally protect the individual from discrimination with respect to job, ability to get insurance, and so on. Much of this is already in place, but apparently the laws have loop holes that need to be mended. The intent is to save money while providing better service and giving reasonable privacy and legal protection. All these goals should be considered as the technical aspects are put in place. But to simply say No, we can not go there because something might leak is to say lets all get rid of this thing we call the inter.....(gone)
Your comment really nails it...the laws and rules will be so essential for this plan to take effect in a safe way. I really don't think the government is gonna have some free for all where they let everyone see your health records. Maybe I am naive but they will have reasonable safeguards in place and rules and laws to protect our privacy.
I believe the potential risks are worth the gains of saving time, money, and lives.
Thank you so much for adding your thoughts to this discussion. I hope you come again.
My personal feeling is that the administration is trending towards less concern with privacy concerns in the interests of expediency--i.e., finding ways to cut costs and install a common denominator of health care, similar to what one might find in socialized medicine in places such as Great Britain. It sort of runs contrary to the intent of recent laws such as HIPPA. It may be the direction...time will tell if it was good or bad.
Questions (not rethorical): What did people think at first about doctors keeping paper records for each visit? Why was it started? And perhaps most importantly, In hindsight, was it good at all?
That may be one way to figure out if this is better or worse.
Digitalization already started by now (not sure exactly when it did), so we better get this conversation out there fast!
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Two big concerns I have are the privacy issue where a person's ability to gain employment or health insurance is concerned and identity theft.
Matters of health insurance will apparently be addressed under this administration in some form of universal coverage. Forty million people without health insurance is atrocious. So is the cost of health care.
A person's confidential medical records should not be used to deny them employment or health coverage, solely on the basis of possible higher costs to the company for medical coverage, or the possibility, that in the future, they may not be able to work satisfactorily. That can happen to anyone, at any time.
Identity Theft, is a reality. Until a better system is found to safeguard our unique information, the emphasis should be on relieving the extreme burden of clearing one's name or credit which currently exists. No, I haven't been victim of this..., yet.
Digital Health Records are a work in progress and because of the promise of technology,efficiency and savings, will not be stopped. As with anything new, there will be problems and solutions.
You have made some excellent points Paul and you have concisely detailed what elements to this plan need to be carefully thought out. I am not sure what the results will be with all of this but I do believe it will happen. Maybe in our lifetime? :>) I don't think it will happen in the projected five year plan.
Thank you for your thoughts!