Risk of Electronic Health Records

[messengerhot]

It is my day off and on the laptop all day and I saw this article about EHR. Question: Are you comfortable with doctors who uses electronic health record system? I was totally clueless about it until I read this http://www.aaos.org/news/aaosnow/aug12/managing9.asp.

"In a case in Oklahoma, critical information about a patient’s condition was available on the hospital computer but misfiled and not in the patient’s paper chart. Assuming he could rely on the paper chart, the physician neglected to check the computer data, resulting in a misdiagnosis that led to serious harm. The court ruled that the physician had a duty to look in both the paper chart and the EHR, effectively doubling the chart reviews that physicians must do."

Misdiagnosis can lead to so many bad things and worse the patient may even die because of this OMG :0!

[iris lilies]

I don't mean to sound cavalier,but there are plenty of medical errors made, digital data won't create them.

There's probably a strong case to be made that digital records will cut down on medical errors. It's not my field and I can't make the argument, but in general,digital records cuts down on all sorts of errors such as the misfiling you mentioned. They bring up their own issues, however.

[SteveinMN]

How they keep the records makes no difference to me. Actually, I think EHR has a slight edge here for two reasons:

- assuming you stay in-network, every provider you see has access to your same records. No worries about records releases not being executed in time for your visit -- or having to delay your visit until the records arrive so the provider isn't flying blind.

- Before EHR, providers either used longhand or dictation for notes and findings. Both are prone to transcription errors made when transferring the information. Sure, typos still can be made. But they were made before, too. At least EHR removes a layer or two of opportunities for errors.

[rodeosweetheart]

I think they are terrible. An absolute invasion of our privacy.
My dad worked for the Senate back in the 80's. He just showed me a letter from the government saying that his personal information was hacked in the recent Chinese hacking of govt. databases.
If they can't keep their own employment records safe, why would they keep our medical records safe?
It really angered me that my 88 year old, cancer patient, World War II vet--he served as a 16 year old kid under an altered birth certificate-- has to put up with this distressing and dangerous development.
Now we are all going to be at risk.

[Ultralight]

I think we are transitioning to something of a "post-privacy society."

[Tammy]

I don't have the stats in front of me, but within a year of transitioning to an electronic medical record, our medication errors in my department were only about 25% of what they were with paper records.

[bae]

I have found them to be life-saving in the field. The paramedic can pull up patient records for our "repeat customers" on-scene, I can enter new info into the system as we gather it, the medical director on the other end of the sat-phone can see what's up from the telemetry we send, and so on.

It has reduced errors tremendously (previous systems relied on notes scrawled on the back of gloves and scraps of paper getting transcribed onto the incident forms, which then got entered into the older system... you can imagine the reliability of the data....)

You have to look at the whole system, it's alarmist to just shout "OMG, there was an error in this one place because the data was...*electronic*.... and someone could have died." I've *seen* people die because we had poor paper-based information. It wasn't the fault of the paper though, it was the process.

[Alan]

I think it's very efficient. Apparently every doctors office, emergency room and first responder, including my volunteer fireman/EMT part-time employee has access to my entire medical history.
Whatever happened to HIPAA?

[bae]

I think it's very efficient. Apparently every doctors office, emergency room and first responder, including my volunteer fireman/EMT part-time employee has access to my entire medical history.
Whatever happened to HIPAA?

We are bound by HIPAA, and follow it.

[Miss Cellane]

The problem in the OP isn't digital records--it is the fact that there are two sets of records. That's a disaster waiting to happen, and sadly, it did.

Example: I'm responsible at work for keeping certain procedures and manuals updated. We have certain clients that are very picky and make changes frequently. The company has electronic files of these on the intranet, available with a few mouse clicks to anyone who needs them. I bust my butt keeping them updated.

But some co-workers don't like using the electronic files. So they print out the manuals or procedures. And never check for updates. So, within a month or two, their print copy is outdated. And they get things wrong. And there's a few who copy the file to their desktop, so they "don't have to click so many times." They, too, refuse to check for updates. And they get things wrong.

I've tried emailing people with every change. I've tried attaching files with the pages that have been updated to the emails. Nothing works. We still have people using outdated procedures. And as a result, I have to check and double-check work to make sure the most recent procedures have been followed. Multiple this by 10 other people in my position, all dealing with co-workers who refuse to do things the right way, because they love their printed paper copies.

We could go back to paper copies only, and I'd spend half my day printing up pages that have been changed and inter-office mailing them to people who might or might not remember to update their binders.

So, for the hospital in question, instead of doing double the work in maintaining two sets of patient records, and making health care professionals do double the work in reading two sets of records, why not just have one set of records?

[Miss Cellane]

I think it's very efficient. Apparently every doctors office, emergency room and first responder, including my volunteer fireman/EMT part-time employee has access to my entire medical history.
Whatever happened to HIPAA?

HIPAA restricts access to your medical information to those who have a need to know it. The list you've given seems reasonable to me.

[ToomuchStuff]

Digital records are required now by the affordable care act. If you don't use the standard system, there are now fines you face (if I understand correctly, it started in October of 2015 for the fines).

However, something that everyone seemed to miss about your story, is the electronic records were misfiled. I don't know how they were misfiled, but say they are accidentally linked to someone else's chart, then how is a mistake there, any different then a mistake in the paper records?
If it was misfiled, while the Dr. could have found it, WOULD he have? (how was it misfiled, would it have been found in time to make the difference)

[Miss Cellane]

Digital records are required now by the affordable care act. If you don't use the standard system, there are now fines you face (if I understand correctly, it started in October of 2015 for the fines).

However, something that everyone seemed to miss about your story, is the electronic records were misfiled. I don't know how they were misfiled, but say they are accidentally linked to someone else's chart, then how is a mistake there, any different then a mistake in the paper records?
If it was misfiled, while the Dr. could have found it, WOULD he have? (how was it misfiled, would it have been found in time to make the difference)


I double-checked the article and it was the paper file that had records misfiled, not the electronic one.

[SteveinMN]

The company has electronic files of these on the intranet, available with a few mouse clicks to anyone who needs them. I bust my butt keeping them updated.

But some co-workers don't like using the electronic files. So they print out the manuals or procedures. And never check for updates. So, within a month or two, their print copy is outdated. And they get things wrong. And there's a few who copy the file to their desktop, so they "don't have to click so many times." They, too, refuse to check for updates. And they get things wrong.
So the problem isn't really the electronic information system/knowledgebase. The problem is people: workers who believe their convenience outweighs working from a common process (the electronic file). That doesn't speak poorly of EHR. That speaks poorly of management which is lax to enforce the rules.

[freshstart]

How they keep the records makes no difference to me. Actually, I think EHR has a slight edge here for two reasons:

- assuming you stay in-network, every provider you see has access to your same records. No worries about records releases not being executed in time for your visit -- or having to delay your visit until the records arrive so the provider isn't flying blind.

- Before EHR, providers either used longhand or dictation for notes and findings. Both are prone to transcription errors made when transferring the information. Sure, typos still can be made. But they were made before, too. At least EHR removes a layer or two of opportunities for errors.

agreed, my team of doctors communicate through the same EMR system, they can read each other's notes, send emails, my med list is always updated at every visit so they can all see who is prescribing what, test results are in there. I had a crappy cardiologist who kept refusing when I told him the other docs really felt I needed to come off a med, he swore they never contacted them. I used the same EMR in my job so I knew where his emails were, I asked if I could show him and funny, there they were! I honestly think by the vast number in there, he did not know or care that he had EMR "email". I showed him how he could press a button and see the last doc's notes. Time to change docs when you are your own tech support!

In some ways, data is more protected. Before our hospital began using an EMR, a list of who was being operated on, what was being done and at what time was faxed to every unit. We were not a surgical unit, had little need for this info. We had a receptionist who worked there for years and her mom who on another unit, the types who "know" everybody. Our receptionist would call her mom every evening with the list and talk about the people they knew, neighbors, church members, etc! And then if it happened to be someone we all knew, she told us. She would then look up their scans and test results and say, "OMG, he has 'pick a cancer she knew nothing about'. Pre-HIPAA but still, pretty bad.

Now you only get access to the patients you need access to. You can do a workaround and read another patient's notes but you leave a trail like Hansel and Gretel and will be asked to leave. Paper charts were not secure in the least, they were on a revolving rack at the front desk of each floor. As long as you looked vaguely professional, you could have at it. SS# was used for everything. Now only my director has that info.

The only thing I didn't like about EMR was I used to dictate my notes while driving, shortening time spent on documentation. But the basic assessment used in the EMR is much more complete and useful than the narratives we used to dictate.

I think as long as you keep your laptop with you and not in full view on the front seat of your car, that info is pretty safe. The company spends a lot on security measures. You cannot go sit in Starbucks and transmit private healthcare data over the free wifi.

Perfect? No. Better, more thorough? IMHO yes

[messengerhot]

Okay so it turns out that my doctor has been using an EHR (https://www.youtube.com/watch?v=5K-UrwVTlt8) for years. I never knew! XD
My doctor said almost the exact same things that you've posted here. That he's had less problems when he moved to paperless. My doctor's really nice to explain the software to me since he saw that I was bothered with it. I can understand it better now. Thank you.

[catherine]

I agree that EMR has many benefits that enable better communication, not worse. But it's a bit of a generational thing--a lot of older doctors don't like EMR because it's not how they've always done things, so once they're retired, like all other technology, it will just be standard procedure, and fewer mistakes and greater efficiencies should result.

[freshstart]

actually docs and agencies are being forced by Medicare to make the switch to an EMR. If not in place by 2015, they lose 1% of reimbursement, 2% next year and then it gets stricter.

[Gardnr]

HIPAA restricts access to your medical information to those who have a need to know it. The list you've given seems reasonable to me.

AND, when I look into your record I am tracked in your record date/time. I would be immediately terminated if I did not need to know about your visit on 11/13.

I completely understand your concerns. That said, errors are significantly reduced as stated by Tammy. The tough thing comes when you sign security access for a provider outside of that data network. My state has a datasharing network for full access. Each patient must sign to allow access.

I believe we are still many years away from 1 patient/1 record that truly is reached by all providers and ERs across the country (for when we travel and get injured).

I also believe this is the lesser of the evils. My 2 cents.

[Gardnr]

I agree that EMR has many benefits that enable better communication, not worse. But it's a bit of a generational thing--a lot of older doctors don't like EMR because it's not how they've always done things, so once they're retired, like all other technology, it will just be standard procedure, and fewer mistakes and greater efficiencies should result.

I am seeing them retire-out here. They are not making the jump to EMR's.

[freshstart]

most of my doctors are setting up patient portals now, you can make appts, and this must be a huge adjustment to the office- email the doc, I assume the nurse triages these. But I cannot imagine the time suck that must be, a good thing but not easy for them by any means because I think people are more likely to email than to make that phone call.

[rodeosweetheart]

Gardnr, I hear you on the retiring out vs. going with the new records system. A lot of the older doctors in my parents' neck of the woods have done this, do not wish to practice medicine this way. It happened to my mom--her doctor retired, so now she has no doctor. I said, mom, don't you want to get a new doctor, and she said, no way, I know where to find him. Not sure exactly what she has in mind, but it is her business, and at 90, if she wants to retire out from the medical system, I think it is her right.

Still, I wish she had a doctor to go to if she needed something like antibiotics.. .

[freshstart]

or if something happened like a fall and she had pain. But she could use a doc in the box for minor stuff

[rodeosweetheart]

She has a plan to go to the ER. Her old doc moonlights there. That is probably what she meant, she knew where to find him! They are extremely rural and she is extremely tough. When my dad cut his toe off falling off his tractor she threw him and the toe in the car and drove the 40 minutes to the ER.

A fall would definitely be horrible and is my worst fear for them at their age.