Wednesday, February 20, 2013

When EMR Companies Muzzle Doctors

It started out as a satire about electronic medical records posted as a computer game review by an electrophysiologist in Kentucky.  The problem was, it contained real screenshots of a real EMR that highlighted certain (how do we say it nicely?) quirks of the software.  But this wasn't just any software, this is an electronic medical record that manages information on nearly 40% of all real live hospitalized patients in America, EPIC Systems.   Evidently, those screenshots were (and continue to be) off limits.  They're trade secrets that can't be shared publically, it seems.

So the doctor, fearing legal retribution, had to take the screenshots down.
I wonder what patients think of this behavior by a company that manages their medical records?   Should de-identified screenshots of an EMR software application be trade secrets or is such a move just cyber-bullying of a doctor's criticism by the company?  If this disclosure was against national policy in our era of interconnected EMRs, who was going to tell doctors nationwide that such disclosure was (and is) off limits? 

What should doctors and patients think when a multi-billion dollar company silences one of their end-users in such a fashion?  What might they be hiding?  What rights do patients have to see these screenshots?  After all, isn't it THEIR data that is held within these systems?  If doctors can't criticize the place where their patient's data is stored, who can?  What are the ethical implications of EPIC's move? 
It's now clear what at least one EMR company thinks about doctors criticising their computer user interface publically.  What do you think?


PS: It will be interesting to see how long this post lasts...


Anonymous said...

Like one of my patients said: "it's gonna get a whole lot worser before it gets better..."

Anonymous said...

Although I have published only one chapter in an EP book many years ago, I do remember the insistance of the publisher that I obtain written releases for all pictures & diagrams that were used. I would guess that EPIC's request to have the screen shots removed were for more than just maintaining their copywrite protection however, the law is clear that you either defend it of you lose the right to have it.

medicine for real said...

The New York Times only yesterday ran a story in the business section on the large amounts of time and money spent by a few of the large EMR companies on lobbying washington as soon as the word got out about the money proposed to go to EMR. I think actually part of the problem is that EMR is basically civilian-contracted. Like in Iraq, if you outsource your security you can't be surprised when you can't control it.
It's never a good sign when a company won't let it's users comment freely. I couldn't get the DaVinci robot rep to give me any comments on efficacy or cost when I was doing an article on robot-assisted prostatectomies. I suspect if the news was good he would have been allowed to share.

Anonymous said...

Great questions raised. If I'm a patient, I should be able to post my own record's screenshots, yes? That is -- if I can get access to the screenshots. Good golly what a mess.

Anonymous said...

"Dear Doctor:

The committee for patient safety has announced the next list of core measures that will be required next month to meet the next meaningful use criteria. Failure to comply with these measures will result in medicare reimbursement cuts. Our EMR vendor will be installing another upgrade. Expect system instability during the next several days. EMR consultants will be on site to assist with this transition."

Stark laws are designed to prevent physician self referral but somehow Washington bureaucrats who sit on EMR company boards can design new criteria which require endless upgrade cycles for these companies. Pure hypocrisy.

Anonymous said...

To the anonymous who suggested this has anything to do with copyright protection:

He was clearly using the screenshots to criticize the software. This is the oldest example of fair use and is not protected by copyright.

Anonymous said...

Norton blocked me from accessing the link in your post. Very strange?

Anonymous said...

I use to work at an EMR company. All I can say is that all patients data was/is being processed way, way out in the Middle East! Names, DOB's, ss numbers, etc. Very, very scary.