Sunday, February 27, 2011

Speaking of medical records

I didn't realize the government was pushing all this technology on to hospitals and doctors but they are. They are spending billions of stimulus dollars to get away from pen and paper. They have a long way to go, only 30% of doctors are using electronic records. Apparently the system works for hospitals but not independent practices. Hospitals can afford to go electronic. Doctors who are independent it is a bigger step - even with stimulus money.

Where I am treated, starting a year or so ago, they went electronic. First they had two years worth of medical records put into the system. Then everything going forward is electronic. You are never greeted by a nurse with a big medical file (mine was getting big enough to get require a hand cart to lug around) but now they carry a laptop. In addition, now they are working backwards to get earlier records into the system.

I think this is all great. They can see what is going on with a patient much easier. They can pull up test results and even view images from tests right away. I realize that proportionally it is a long of work for the independent practitioner but in the long run, patients will get better care. Patients will no longer have to get medical records back and forth from different places they are treated. I know many people who get different treatments in different places and then they have to get reports back and forth to different places. I have enough problems getting places without having to remember anything.

HOWEVER (yes a big fat pause here), the biggest push for these electronic records are the insurance companies... They claim it is because it saves on unnecessary tests and hospitalizations, etc as the information is shared between doctors. Medicare and Medicaid are going to require doctors to report electronically. But what about regular health insurance companies - they should not have access to the information.

This is the scary part: By mining its patient data, Kaiser, for example, was first to identify a link between the pain-relief drug Vioxx and a higher risk of heart failure, well before Merck pulled the drug off the market in 2004.

I don't think I mind that the information is electronic so we aren't buried in paper ( see my post about this a few days ago) but I think I do think I mind insurance companies accessing it even if it isn't tied to a patient's name. So Kaiser dug through the data and found out that people who took Vioxx had a higher risk of heart failure, but what if they started going through the data and saying things like 'people who are on this drug are more likely to die, so we don't want to insure them any more'. So if you are on something like Tamoxifen, that means you had breast cancer. Or if you are on Avastin for a brain tumor, what if they didn't want to insure you? Keep the insurance companies away from medical records.

I think in the long run, paper is expensive and a vertical way to keep and use medical records. Insurance companies are not supposed to know what is wrong with you but somethings are pretty obvious when they pay bills for brain MRIs or EKGs. But should they be allowed to mine this data to make decisions about coverage? Or make any decisions on care? This is the scary part. I guess I just don't trust them any more. They aren't doctors, they are out for the bottom line. Its not the patients that matter, its the money.


Anonymous said...

I think that Kaiser is an HMO, a health provider. See today's NYT article about computers and patient care by Abraham Vergaese (sp?), and how mining data can show critical links of cause and effect. Yes, patient records should be 100% confidential, but using all records to look for data is also critical in advancing treatments. Robin

breast reconstruction surgery Los Angeles said...

I think it is not a bad idea if the records can also be electronic.There would be faster and easier access to records and also better maintenance of the same.

electronic medical records said...

Some study says, EMR will also protect us if we use the system well and are meticulous about our usage. The EMR record can document that patients were notified of test results and were given instructions on when to follow up with us. Anyway, thanks for sharing. I enjoyed reading it.


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