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ElectronicHealthRecords10Concerns

Advocatesclaimfederallycertifiedelectronichealthrecords(EHRs)will

transformhealthcaredeliveryinAmerica.However,concernsinclude:

1.Computerizedmedicalrecordsgivegovernmenthealthofficialseasyaccessto

privatedetailsoftheconfidentialpatient-doctorrelationship.

Electronichealthrecords(EHRs)recordeverything.1RequiringEHRstobe

interoperableacrosstheUnitedStates(abletoworktogetherandlinktogether)

givesoutsidersandstrangerseasyaccess.Outsideaccessisauthorizedunder

federallaw.Specifically,becauseofthefederalHIPAA2privacyrule,2.2million

entities,3includingstateandfederalgovernment,haveaccesstoprivatehealth

recordswithoutpatientconsentandoftenwithoutpatientknowledge.

2.Thefederalgovernmentispaying$20billiontodoctorsandhospitalstobuy

expensivegovernment-certifiedonlineEHRsystems.

Federalincentivepayments4underthe2009HITECHAct5onlycoveraboutathird6

oftheEHRsystemcostsandnoneofthehiddenadministrative,trainingand

othercosts.BeginningJanuary1,2015,physicianswillbepenalized7byMedicare

fornotusingcertifiedinteroperableEHRs.

3.Toreceivefederalincentivepayments,doctorsandhospitalsmust

demonstrativemeaningfuluseofEHRs.

Meaningfuluse(MU)ofEHRsforcliniciansandfacilitiesissimilarbutdifferent.

ProfessionalMUincludese-prescribing,reportingqualitymeasurestothe

federalgovernment,implementingoneclinicaldecisionsupportrule,

maintainingactivemedicationslist,andrecordingsmokingstatus.Stage1and2MUrequirementshavebeenissued.ProposedStage3iscalled tooharsh.

8

4.EHRsinterferewiththepracticeofmedicineandhaveharmedpatients.

EHRshavebeencalledclunky,9frustrating,user-unfriendlyandinefficient.The

federalmandatetousecomputerizedmedicalrecordshasledto reduced10

productivity,alterationsinmedicaldecision-making,atleastsix deaths,1122new

medicalerrors,12misdiagnoses,

13anddoubled

14pediatricfatalityrates.Doctors

arereducedtodataclerksthatengagelesswithpatients.

5.Patientengagementgivesindividualsafalsesenseofcontroland

encouragespatientstofeedmoredataintocomputerizedsystems.

ThePersonalHealthRecord(PHR)15orcollaborative

16healthrecordhasbeen

touted17asgivingpatientsaccesstotheirowndata.However,thePHRismerelya

subsetoftheEHR(overwhichpatientshavenocontrolduetoHIPAA).Inaddition,

PHRsencouragepatientstofeedthesystemmoreprivateinformation.

Meanwhile,technologyallowsoff-sitemonitoring18andgenetic

19sequencing

allowspatientprofiling20downtotheDNA.

6.EHRsarepartofalargerresearchagendatostatisticallyanalyzeeveryones

patientinformationandusethefindingstorationalizehealthcarerationing.

TheHITECHmodificationstoHIPAAprovide2.2millionentitieswithpatientdata

forstudyandpredictive21analysis.Proponentsclaimalgorithmscanbecreatedto

theoreticallysee22thingsinthedatathatpeoplecannotseeandthiswillleadto

cures23forcancer.Failuretodosowouldbeblamedoninsufficientdata,and

datawithholdingincludingrefusaltosharegeneticdatawouldbeacrime.24

7.WhenEHRresearchfindscures,doctorsmayberequiredtoprovidecertaintreatmentsorfacefinancialpenaltiesandprosecution.

DecisionSupport(DS),25standardizedtreatmentprotocolsbasedondataand

algorithmsembeddedinaphysicianscomputer,willpushdoctorstoprescribe

one-size-fits-alltreatments26ratherthancustomizedcare.Notusingthestandards

couldbeconsideredfraud,wasteorabuse.27DoctorsusingDSarelesstrusted.28

8.EHRshavecapturedtheinterestofinvestors.

Privateequityfirms29(thekindthatonlyacquirecompanieswithatleast$100

millioninrevenue)arebidding

30

onEHRcompaniestoexpandtheirportfolios.

9.Congresscanacttoprotectpatients.

RepealingHITECH,defundingit,oratleastrepealingthepenaltiesitimposesfor

failuretouseinteroperableEHRswouldbeeffective31inprotectingpatients.

10.Statescanacttoprotectindividualsfromharm.

Blockingastatehealthinformationexchange(HIE),refusingtoconnecttothe

NHIN,refusingastatehealthinsuranceexchange(HIX),and notallowing32state

datastorageoranalyticswouldprotectindividualsfromharm.

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1AfterThePPACA-WhatShouldCongressDo?Dr.MarciCook.

http://www.youtube.com/watch?v=JSr_hfH_YYE

2SummaryoftheHIPPAPrivacyRule .DepartmentofHealth&HumanServices.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

3ModificationstotheHIPAAPrivacy,Security,andEnforcementRulesUndertheHealthInformation

TechnologyforEconomicandClinicalHealthAct .DepartmentofHealth&HumanServices.

https://www.federalregister.gov/articles/2010/07/14/2010-16718/modifications-to-the-hipaa-privacy-security-and-enforcement-rules-under-the-health-information

4AnalysisoftheHITECHActsIncentivestoFacilitateAdoptionofHealthInformationTechnology,RobertHudock/PatriciaWagner,EpsteinBeckerGreenHealthCare&LifeSciencesClientAlert,4/09.

5HITECHAct.CCHF.www.cchfreedom.org/files/files/HITECH%20ACT%202009%20-%20LAW(1).pdf

6PhysicianAdoptionofElectronicHealthRecordSystems:UnitedStates,2011 .NCHSDataBrief,Centers

forDiseaseControlandPrevention,July2012.http://www.cdc.gov/nchs/data/databriefs/db98.htm

7SpecialReport:Tacklingpopulationhealthmanagement:ItboilsdowntoHIT. MGMAConnexion

magazine,October2012.http://www.mgma.com/WorkArea/DownloadAsset.aspx?id=1372070

8

Proposedmeaningfulusestage3criticizedashastyandtoostrict .AmericanMedicalNews.http://www.ama-assn.org/amednews/2013/01/28/gvl10128.htm

9AMajorGlitchforDigitized Health-CareRecords.WallStreetJournalOnline.http://online.wsj.com/article/SB10000872396390443847404577627041964831020.html?mod=googlenews_wsj

10PubliccommentonStage3DefinitionofMeaningfulUseofElectricHealthRecords.

http://www.regulations.gov/#!documentDetail;D=HHS-OS-2012-0007-0178

11FDAonHealthITAdverseConsequences:44ReportedInjuriesand6DeathsinTwoYears,Probably

Just'TipofIceberg'.HealthCareRenewal.http://hcrenewal.blogspot.com/2010_02_01_archive.html

12Roleofcomputerizedphysicianorderentrysystemsinfacilitatingmedicationerrors .NationalCenter

forBiotechnologyInformation.http://www.ncbi.nlm.nih.gov/pubmed/15755942

13Electronicmedicalrecordsdrawfrequentcriticisms, AlexiMostrous,TheWashingtonPost,10/25/09.

14UnexpectedIncreasedMortalityAfterImplementationofaCommerciallySoldComputerized

PhysicianOrderEntrySystem .AmericanAcademyofPediatrics.

http://pediatrics.aappublications.org/content/116/6/1506.full

15PersonalHealthRecord.Wikipedia.http://en.wikipedia.org/wiki/Personal_health_record

16JohnMoore,@john_chilmark.Twitter.

https://twitter.com/john_chilmark/status/275630867739713536

17BlueButtonProvidesAccesstoDownloadablePersonalHealth Data.OfficeofScienceand

TechnologyPolicy.http://www.whitehouse.gov/blog/2010/10/07/blue-button-provides-access-

downloadable-personal-health-data

18APillThatTells WhenItsTaken.PopSci.http://www.popsci.com/bown/2012/innovator/proteus-

digital-health-feedback-system

19HealthcareExecsMustPrepareforBigData .InformationWeekHealthcare.

http://www.informationweek.com/healthcare/clinical-systems/healthcare-execs-must-prepare-for-

big-da/240008670

20VisitUsattheCareContinuumAlliancesVoiceonPopulationHealth .WebMDHealthServices.

http://www.webmdhealthservices.com/blog/index.php/2012/09/27/visit-us-at-the-care-continuum-alliances-voice-on-population-health/

21CanComputersPredictMedicalProblems?VAThinksMaybe. Nextgov.

http://www.nextgov.com/health/2013/01/can-computers-predict-medical-problems-va-thinks-maybe/61000/

22WhatITManagersNeedtoKnowAboutHadoop .HPInputOutput.

http://h30565.www3.hp.com/t5/Feature-Articles/What-IT-Managers-Need-to-Know-About-

Hadoop/ba-p/1416

23Acureforcancer?Thisbigda tastartupsaysitcand eliver.TheWashingtonPost.

http://articles.washingtonpost.com/2013-01-17/business/36384178_1_big-data-breast-cancer-cure-cancer

24Whydataisthekeytobettermedicineandmaybeacureforcancer .Gigaom.

http://gigaom.com/2012/11/27/why-data-is-the-key-to-better-medicine-and-maybe-a-cure-for-cancer/25ClinicalDecisionSupport.AgencyforHealthcareResearchandQuality.

http://www.ahrq.gov/clinic/pcc/decsupport.htm

26ProsecutorsSeeMedicalResearchasEmergingTrendinHealthCare-RelatedFraud.MainJustice.

http://www.mainjustice.com/2012/11/07/prosecutors-see-medical-research-as-emerging-trend-in-

health-care-related-fraud/

27WhatisFraud,Waste,orAbuse ?OfficeoftheInspectorGeneral.http://oig.ssa.gov/what-abuse-

fraud-and-waste

28ClinicalDecisionSupportaTurnoffforPatients,SaysStudy .InformationWeekHealthcare.

http://www.informationweek.com/healthcare/clinical-systems/clinical-decision-support-a-turnoff-

for/24014768129ThomaBravoinvestsinelectronichealthrecordcompanySRSSoftware,AltAssetsPrivateEquity

News,January3,2013.

30AllscriptsSaidtoGetBid sfromBlackstone,Carlyle.Bloomberg.

http://www.bloomberg.com/news/2012-10-08/allscripts-said-to-get-first-round-bids-from-blackstone-

carlyle.html

31TheEffectsofSequestrationonHealthIT.HIMSSBlog.http://blog.himss.org/2011/11/23/the-

effects-of-sequestration-on-health-it/

32SenatorStephenH.MartinofVirginia:proposedlimitationsonuse,storage,sharing,&processingof

electronicmedicalrecorddata .HealthCareRenewal.

http://hcrenewal.blogspot.com/2013/01/senator-stephen-h-martin-of-virginia.html