Electronic Health Records and Privacy

Attached two very interesting articles from today's Miami Herald highlighting the issue of EHR usage in South Florida and privacy issues.
I am actually more concerned about the uncontrolled mailing and faxing of medical records between doctors offices and hospitals WITHOUT adherence to privacy rules. Just today I was castigated by a front-desk clerk who took issue that I had the audacity requesting a medical record release before releasing the records of one of my patients.
Using an Electronic Health Record for > 12 years I can attest to the very basic privacy features in EHRs: 1) audit trail- I can document who has accessed a specific record and when it happened,b) prevent access through passwords, c) can encrypt and secure stored files. NONE OF THESE FEATURES are available in paper records!!!
Anybody can open and read a paper record, doors to the record room are often unlocked, and stored paper records cannot be encrypted or secured except with mechanical locks. So why are we talking about privacy issues? Because of the FEAR of the UNKNOWN!!! A fear stoked by those who often do not want to change and prefer to adhere to past and obsolete procedures. Many of my colleagues belong to this group too. I do have hope though that we can overcome this fear because nobody avoids using his/her ATM of computer to manage their financial transactions.
Looking forward to your comments.
Yours
Bernd


Posted on Tue, Jul. 06, 2010
Medical records go online, but at what cost to privacy?

BY FRED TASKER
ftasker@MiamiHerald.com


MARICE COHN BAND / MIAMI HERALD STAFF
Allison Grisham learns how to navigate her medical records with help from Dr. David Seo, a cardiologist at University of Miami Miller School of Medicine.
You're a South Florida resident on vacation in Boise or Bogotá. You suffer stomach pains and visit a local doctor. You whip out your BlackBerry, punch in your access code and show the doctor a list of your medications, allergies, past illnesses, tests, surgeries and advice from your physician back home.
Electronic medical records, or EMRs, are quickly becoming a reality for doctors and hospitals in South Florida and beyond.

If EMRs work, they'll be high-tech marvels -- letting patients access their own medical records on their home computers, helping doctors coordinate tests with each other to avoid duplication, giving medical researchers access to millions of medical records.

Nearly every major South Florida hospital and many doctors are joining a push by the Obama administration to spend $19.2 billion in federal stimulus money to help create a national EMR system by 2014.

Allison Grisham of Miami Beach just got her own EMR from her doctor at University of Miami Hospital, which is spending $100 million on a new Epic brand system. She hopes it can help end medical errors like one she barely avoided a few years ago.

``I was in a hospital once and the nurse tried to give me the wrong medication. We only stopped it because my mother and I refused to let her put it in the IV,'' she said. ``It could have been serious.''

There are drawbacks. Patient advocates worry that EMRs could pose a threat to privacy. Doctors and hospitals say they're not being given enough time to set up the complex electronic systems or enough financial help to pay for them. The systems can cost $50 million to $100 million for hospitals and $15,000 to $50,000 for private doctors.

But the potential pluses outweigh those complaints, many doctors and hospitals believe. The new systems are voluntary, but federal financial incentives for using them and penalties for failing to do so have most medical officials at least resigned to making the change.

Here's what else EMRs will do:

You're a university medical researcher and you suspect a popular diabetes drug is causing heart problems. On your PC, you study the records -- with patient permission, and without their names -- of all the millions of people taking the suspect drug and compare them to those who aren't.

``A researcher could access the records of nearly every patient in the country and solve problems quickly,'' said Dr. Pascal Goldschmidt, dean of the UM Medical School.

Or you're a hospital CEO, and EMRs help you communicate better and faster with other hospitals and doctors around the country -- something most hospitals can't do today even if they have older, simpler electronic medical records.

DUPLICATION

``That would eliminate a lot of duplication,'' said Linda Quick, president of the South Florida Hospital & Healthcare Association. She cited an example: an acquaintance had an EKG from his private doctor, was sent to the hospital next door for follow-up and was given another EKG 90 minutes later.

``Patients will take control of their own records. Exchange of information will be very fluid,'' said Tom Gomez, head of a Florida International University initiative promoting hospital information sharing.

``When we have the whole system, it will be as easy as using an ATM card,'' said Quick.

Still, experts predict years of hard work getting all the new EMR systems -- Epic, Cerner, Seimens and other brands -- to communicate with each other.

``This is going to be complicated,'' says Gomez. ``And we're in the very early stages. It's probably 10 years away.'' There are problems. Private doctors, especially in small practices, say they lack the money and technical staff to implement EMRs -- buying computers, hiring techs to run and repair them, taking time for the training to operate them.

``It's the wave of the future, fortunately or unfortunately,'' says Dr. Tony Prieto, a sole-practitioner family medicine physician in Plantation. ``I agree it's needed. I'm not saying I can afford it.''

Even some big hospitals say the program is moving too fast.

``The goal is noble, but the timeline is unrealistic,'' said Mimi Taylor, Baptist Health South Florida's vice president for IT. ``You have to give hospitals time to do it right.''

Baptist Health's six-hospital, 2,000-doctor system will spend $96 million by 2013 to install a Siemens Soarian system to meet the new federal requirements. An informal Miami Herald survey of 26 South Florida hospitals found every one is putting in a new system or upgrading an old one. In addition to UM Hospital and Baptist Health, hospitals installing new or upgraded systems include Broward's six-hospital Memorial Healthcare System, Tenet's 10-hospital chain, Miami Children's Hospital and Mount Sinai Medical Center.

At UM Hospital, six clinics already have begun offering patients a personal electronic medical record called MyUHealthChart. By July, all clinics on the Miller School campus are to have them. By December, patients will be able to schedule appointments and pay their bills electronically. Even Jackson Health System, with its financial woes, is upgrading its current Cerner EMR system as part of the federal push.

``We have to do it to remain competitive,'' said Fernando Martinez, Jackson's chief information officer.

The Obama administration is using both carrots and sticks to persuade hospitals and doctors to put in EMRs. The president set aside $19.2 billion from the American Recovery and Reinvestment Act of 2009 to subsidize the systems. Doctors who start implementing EMRs by 2011 can get up to $44,000 in extra reimbursements from Medicare or $63,000 from Medicaid.

REIMBURSEMENTS

Hospitals will get bigger reimbursements, although their financial officers can't say how much yet. Local administrators estimate federal subsidies will repay 20 percent to 50 percent of the cost of an EMR system.

The problem, said Prieto, the Plantation physician, is that the expense is up front for the EMR system, but the reimbursement is after the fact.

``I have 26,000 patient charts. I can't imagine what that will cost me.''

The reimbursement ``won't even be close'' to the expense, he said.

``If you're a solo practitioner, you have to go out and buy a new system and educate your staff to use it,'' said Cynthia Peterson, head of the Broward Medical Association. The stick: Doctors and hospitals that don't comply by 2015 will see their Medicare and Medicaid payments reduced by 1 percent in 2015, 2 percent in 2016 and 3 percent in subsequent years.

A Congressional Budget Office report predicts 90 percent of hospitals and doctors will have EMRs by 2019.




Posted on Tue, Jul. 06, 2010

In online medical records, worries about privacy breaches

BY FRED TASKER
ftasker@MiamiHerald.com

If millions of patients across America have electronic medical records they can access 24/7 by punching a code into a home computer or BlackBerry, how safe are those records from identity thieves?
Even today, even without a nationwide data-sharing electronic medical record system, attempts to steal medical records are alarming.

Actress Farrah Fawcett, who died of cancer in 2009, in her final days helped expose an employee of a Los Angeles hospital who was paid to leak her medical records to a tabloid magazine.

Won't putting the records online make them even more vulnerable?

``I would never say a system can't be hacked,'' said Sam Butler, spokesman for Epic Systems, which is creating a $100 million EMR system for University of Miami Hospital. ``But we're not aware that our medical records have ever been violated.''

A typical new EMR system has security programs similar to those for ATM cards or other bank records. Patients get 20-digit personal IDs and must answer questions such as date of birth or mother's maiden name to access their records.

Many users are resigned to some risk.

``Today if you have a paper record, you don't know who sees it,'' said Jacquelyn Liberto, executive director of strategic operations at UM Hospital. ``With Epic it's more secure,'' she said, because nurses or assistants will be able to access only the parts of a patient's records needed for their duties.

In the push for nationwide EMRs, Congress has tightened privacy rules, increasing penalties for leaking information, requiring immediate notification of patients if their records are leaked.

It's not enough, argued a 2009 editorial in The Journal of the American Medical Association that said the law still does too little to protect patients' records and is too restrictive in giving legitimate access to medical researchers.

``The result is that patients' medical records are not well protected, and researchers cannot effectively search for important discoveries,'' the editorial said.

Some patients are afraid insurance companies or potential employers might use their medical conditions to deny them coverage or jobs. Others fear that lawyers might demand to see their records.

In 2003, Florida prosecutors subpoenaed medical records of radio host Rush Limbaugh, who was charged with improper doctor-shopping after he acknowledged he was addicted to painkillers. The Florida Supreme Court gave some of the records to prosecutors but kept others private.

``Electronic records are wonderful tools for research, but there's so much concern about protecting privacy that it becomes a challenge,'' says Liberto.



Read more: http://www.miamiherald.com/2010/07/06/v-print/1716656/in-online-medical-records-worries.html#ixzz0sxiKTTmX