The government offers physicians incentives and rebates if they convert their practices to have electronic health records. These systems are very expensive, requiring new equipment and training for the specialized programs. This system sends all patient data to the insurance companies, and in turn, the government. Sending off private data like this destroys patient privacy and the doctor-physician relationship.
At MediBid, your data is private and secure. Patients who place requests save money by dealing directly with the physician of their choice, who will provide affordable medical care without any of the hassles or restrictions of insurance.
Data equal power; Patients and their physicians should own them
By Craig M. Wax, DO Dec 25, 2011
The race is on to dive headlong into the dark, unknown electronic health record (EHR) sea. The theoretical goal is to integrate all providers, patients, and payers for the betterment of patient care. But data privacy, integrity, and protection are vital to all data management schemes.
My tale of four health record systems begins with standard paper charts. Our office had used paper charts for 10 years. It cost about $2,000 per year for paper, charts, copying, cabinets, storage space, and associated costs.
This system was reliable and readily available, despite an occasionally temporarily misplaced chart. Charts either were in the cabinets or the patient rooms, at the front desk, or in the referral area. All charts were available at the time of patient care for instant documentation. Staff training was minimal.
By 2004, the writing was on the wall that the federal government and insurance companies wanted to control our patient and provider data. He who controls the data controls the industry and the costs, earnings, and dividends.
Two and a half years ago, we spent $20,000 for computers, network supplies, and a server to try the process first-hand. We took this action after 5 years of investigating and planning. As for the potential $44,000 in EHR incentive money from the Centers for Medicare and Medicaid Services, beware of politicians promising gifts.
We decided on a server-based EHR for reasons of data control and privacy. Little did we know about the money, time, and liability costs related to network setup, routine maintenance, and data crisis management.
Fortunately, our office manager insisted that we print out all data and maintain paper charts for the duration. Doing so cost us time, money, and aggravation, but it kept our data safe. This is our standard practice even today.
We saw patients and entered data at the time of care. Doing so detracted from attention to patients and connectedness in the exam rooms. We were staring at a screen and typing while patients wondered whether we were listening or cared. It was all in the name of progress though, right?
New exam room interruptions came from staff members looking for EHR technical support from me. Many hours per week—including weekday and weekend nights—were spent in the pursuit of correcting errors, maintaining the system and all its parts, and trying to persuade the EHR vendor to fix bugs in the software. We were now beholden not only to patients, the standard of care, staff, insurance, lawyers, and federal government edicts; we also now were beholden to hardware companies, software companies, support companies, Internet service providers, consultants paid by the hour, and even the electric company.
Our troublesome EHR experience continues 2 years later. Now we are trying to get the software vendor to correct its software in time for us to attest to stage 1 of meaningful use. It turns out that, for its own financial reasons, the vendor is relying on programmers at another company in India to make the fixes. The back-and-forth takes an inordinate amount of time and always will. That is, as long as our EHR software company is viable and remains in business.
We have been using an Internet-based EHR program for e-prescribing that is less expensive to use and maintain than some other systems but brings other issues to mind, not the least of which is, who owns the data? Also, what format are the data in? Can the data be exported and used elsewhere?
With an Internet-based program, if you lose power or your high-speed Internet connection, your goose is cooked, so to speak, until your connection is restored. Most of the support for our EHR is provided via email and online chat. Both options are worthless if your Internet connection is in question. If the EHR is not available, you can enter the office visit data later, at your own time and expense, but be sure to check the date and time entries so that you are credited correctly and not accused of billing fraud. Under the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act, physicians could be fined millions of dollars for fraud or data breach.
According to the Department of Health and Human Services, more than 30,000 healthcare data breaches affecting more than 7.8 million people were reported to the Office of Civil Rights from September 23, 2009, to December 31, 2010. Need I say more? When was the last time you saw a report of data theft from a private office using paper charts or a private electronic system? Even if data theft occurred with such systems, how many people would be affected by the theft?
I continue to have severe reservations about my patients’ data—which I am medically, legally, morally, and ethically responsible to protect—living across the country or world on some company’s servers. Worse, the data are subject to hacking, computer storage errors, and human administrator mistakes.
In addition to being stolen, data can be sold vendors to other companies that use different platforms or go out of business, leaving patients and physicians flat. We already had this experience at our office in 2008, when the e-prescribing program we liked was sold to a different e-prescribing vendor that couldn’t or wouldn’t meet our needs.
A FOURTH SYSTEM
Three health recordkeeping systems currently are available: paper charts, computer server systems, and Internet/cloud-based systems. Each has their risks and benefits.
Perhaps a fourth health record system should exist. Patients could carry a chart of sorts on an electronic card. Each physician, hospital, and ancillary provider treating the patient could read the card, add to the patient’s history, and keep a copy for their own records. This system would allow patients to be keepers of their own information, which would travel with them.
Of course, many details would need to be worked out before the idea would be ready for actual use. The expense involved may be a large business concern, because the data no longer would be in the domain of the insurance companies; the data would be owned and controlled by the patients and edited by their physicians.
We must put control in the hands of independent physicians and patients. Organized medicine is willing to let government take over, sold out to private insurance companies. But who will best protect private patient data? Patients and individual physicians will do it.
Data ownership is all about power. If we give away confidential patient data to government and insurance, the battle is indeed over, and we’ve all lost. If we keep our patient data sacred and private, whether in paper or electronic records, then patients and physicians win. It is that simple.
The author is an osteopathic family physician in private practice in Mullica Hill, New Jersey. He thanks Charles J. Smutny III, DO, FAAO; Jane Orient, MD; and Joseph Fallon, MD, for their editorial comments during the development of this manuscript. From the Board columns reflect the opinions of the authors and are independent of Medical Economics. Send your comments to email@example.com [firstname.lastname@example.org]
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