Monday, October 09, 2006

Your Distributed Medical Record

With the increased sophistication of implantable medical devices, an interesting area of health care law is likely to be tested: who holds and is responsible for your health care data?

This issue came to light recently as we have struggled to integrate electronic information downloaded from pacemakers and defibrillators into the patient’s medical record. As I have discussed before, the Center for Medicare and Medicaid Services has agreed to reimburse physicians for the evaluation of data from pacemaker and defibrillator interrogations. But the patient uploads their information to a “server” owned by a company (usually the manufacturer of that device or their designated company). The server then compiles the information for the physician to review. Easy enough.

But CMS requires the graphical information be preserved from the EKG portion of the interrogation to verify billing. As such, this graphical information does not easily transport from one computer system to another. So it stays on the company’s server.

But sometimes we might need that data later, especially in the case of a medical malpractice claim or to verify a bill. Years later, could we get this interrogation data? Perhaps, if we had stored an electronic or paper copy of the original interrogation locally and saved it on our server. But more and more, it seems the medical device companies will also have this data as backup. So I ask, who is responsible for protecting your medical data?

I believe this issue will become more and more common as the era of the electronic medical record takes hold. Your Electronic Medical Record (EMR) will soon be housed in more than one location - a distributed electronic medical record, if you will. But the issues of responsibility for that data, especially in terms of potential liability claims, will remain murky.

Sounds like the old “file-sharing” system like that of the original Napster music sharing web-site – a modified “peer-to-peer” model of the Electronic Medical Record, eh? But will the individual patient be like the Music Industry executives and prevent our “copyrighted” (well, at least private) sensitive medical information to be similarly restricted in its distribution?

I doubt it. The era of EMR “file-sharing” has arrived.



Moof said...

Medical records - all facets of medical records - is what I'm studying for my HIT degree, so this post really caught my attention.

I believe that we're going to go through quite a bit of this - "who's responsible for what?" - and - "what should be kept, and by whom?" - for a long while yet before we come to what I believe is going to be the ultimate answer to a lot of these questions: chipping individuals.

It's not a great answer, and it's going to be fought tooth and nail on several fronts, however I think that, in time, it will be seen as the only logical way to keep a lifetime of medical (and other) information about an individual. It can't be lost (or not easily) ... and with our advancing technologies, we're able to store more and more data on smaller and smaller chips. Depending on where it was placed, it would always be available to medical, law enforcement, and other professionals - even when the individual can no longer communicate.

The "Brave New World" we read about decades ago -(or at least a part of it) - is on the threshold of becoming reality.

Dr. A said...

Interesting idea. I never really thought about EMR file sharing. Who's information is it? Unfortunately, no one will be proactive on this. The solution will come about following some kind of lawsuit down the road.

DrWes said...

I assume by "chipped" you mean placing an RFID tag inside each of us, like is already being piloted at Hackensack Medical Center in New Jersey.

But I don't think those little chips will store all the information on each of us. But a unique identifier? Maybe. Or perhaps your embedded password as a "key" to access the data accross multiple databases...

A bit George Orwellian, isn't it?

And Dr A-
It sucks we always have to rely on the lawyers to determine our path, but I suspect you're correct. Proactivity is not the governments' or doctors' forte, we tend to be reactive, eh?

Empress Bee (of the High Sea) said...

ahhh, i have an opinion here too! seems i am on a roll tonight!

my hubby, Charlie, has a Medtronic pacemaker installed in December. We live in two states. Both cardio drs. offices have medtronics personnel inhouse. he can also get checked over the phone.

since we are mobile i rather think medtronics should keep this info and make it available to whatever cardio dr. we go to see.

even if we were NOT mobile i still think medtronics should keep the info. the pacemaker will not change, the cardio dr. may change.

get what i'm saying or am i too dumb to make this understood? sorry i don't know any technical terms. but my dear Charlie is doing well guys!! thanks....bee

DrWes said...


I guess you could say your husband already has an RFID tag (of sorts) in his chest. His pacemaker contains a unique serial number than can "identify" him on Medtronic's database. And LOTS of medical information ALREADY resides on his pacemaker - check it out next time his pacemaker is checked - you'll probably find the date the device was implanted, who implanted it and where, the serial numbers of the leads, pacing threshold information of the leads at implant, etc., etc.

It doesn't take a leap to see where things might be going in the implantable medical device industry...

But if sensitive information could be placed on the pacemaker memory (say, HIV status) and housed at Medtronic, who would you want to have access to that information? How would you control access?

Empress Bee (of the High Sea) said...

right doc. bee