Sunday, January 15, 2012

Large EMR's: The Back Story

I was surprised to see the backstory of EPIC Systems of Verona, WI, appear in the New York Times this morning. EPIC is one of the "biggie" electronic medical record systems that boasts 260 customers covering some 127 million patients' medical records by 2013. The article covers how the company was started and makes sure to mention the fact by Judith Faulkner, EPIC's CEO, that “to the best of our knowledge, in the 32 years we’ve been in business, there has never been a breach of Epic’s data by a hacker.” (Seems like a glove was just thrown down to this reader.)

Still, Ms. Faulkner adds:
“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.
Balance? Hmmm.

So far, there appears to be huge skewing of information provided to health care administrators rather than doctors these days. For instance, when a doctor wants to know how many procedures their group has performed according to data they themselves entered into the Electronic Medical Record, they meet resistance. (This is not a small issue for doctors increasingly held accountable to MGMA benchmark productivity standards for their income.) Trust is a critical issue in medicine and doctors must feel they trust the data being given to them. The Electronic Medical Record systems of tomorrow should foster this kind of data transparency for doctors, not provide statistics from inaccessible data warehouses.

Doctors are eager to use their data for their patient's benefit. And yet they see these proprietary systems that carefully-control access to information as impediments to care rather than as facilitators of decision making. To date, this end-user still has yet to see any electronic data flow from one institution's EPIC data pool to another. Perhaps this capability will be realized some day, but for now, we still must request paper records from fellow EPIC institutions manually. While this limitation may be part of the "balance" to which Ms. Faulkner alludes, to doctors on the front line of care provision, this "balance" currently feels quite skewed away from patients and doctors.

Doctors are the largest and most influential contributors to the electronic medical record data and the cost of medicine. We see how these systems affect our patients first-hand. Unless change comes quickly to permit doctors to be involved in decisions based on the data they themselves provide the system, restricting their access to aggregated data assessment might become the greatest electronic medical error in the foreseeable future.

After all, how else will we ever be able to credibly challenge the potential for a critical programming or statistical error that could ultimately affect 127 million lives?



Anonymous said...

Tim Hulsey, MD said...

Wes, I don't believe you seriously thought the EMR was for physicians or patients OR that it was meant to improve medical care. It was meant for administrative purposes and data gathering and control!
Repeat to yourself: EMR is the devil's spawn... Emr is the devil's spawn... EMR is the devil's spawn.

Anonymous said...

@Dr. Hulsey, this patient begs to differ. I just got some routine blood work done. I was notified by email that the reports were available at the med center website. I mosied over, logged in and pulled up the reports. Then the really good stuff happened. I was able to pull up in EASILY readable format my history of all previous reports on this test. Uh, oh...big difference. Pretty good indication that I've got to make some changes. And it didn't require a call to the doc or from the doc.

Tim Hulsey, MD said...

Anonymous said... " I mosied over, logged in and pulled up the reports."
Now, just imagine you were a candidate for political office in your state. Could someone who worked for your opponent also "mosie over" check out your health status and publicize what should be private. Only if they have a 12 year old with computer skills!
Is there info in your medical record you don't want revealed to all your friends? Don't forget that the EMR contains not only your health information, but also information about where you live, who's in your family, your social security number, where you work– a lot of stuff you don't want made public. Convenience comes with a price. Is it a price you want to pay?
The concept of an easily accessible digital medical record that you could pull up on you iPhone is great, but implementing it in a secure fashion is the problem. Digital data is NEVER secure.
In truth, privacy is not really a priority for the government, the source of the forced implementation of the EMR. They just can't come out and say it yet. Soon, all pretense of privacy will disappear in a hail of "Oh, sorry! We'd like to keep your medical records private, but it's not possible, but we can't get rid of them, now."

Anonymous said...

@Dr. Hulsey, I am well aware of the risks of banking online, shopping online, paying taxes online and owning a cell phone. Just as I am aware there are risks with most medical procedures and medications. I think I stick with the advances. Good luck with battling the "devils spawn".