The current administration is pushing for a nationwide, interoperable health information technology (HIT) system. HIT, which encompasses EMR, was specifically allotted over $2 billion in the stimulus package—and that is to launch the program. Full implementation could reach over $100 billion. This program would support the electronic sharing of clinical data among hospitals, physicians, researchers, and health care stakeholders.
The concept of EMR has been around for several years and has been successfully implemented on much smaller scales such as within a county or university hospital system. However, what is being pitched to the country now is a nationwide electronic records database. Proponents and opponents alike feel strongly about their respective positions.
Opponents of EMR argue:
- workflow disruption;
- cost of software plus maintenance;
- security breaches;
- loss of patient-physician confidentiality;
- loss of patient privacy rights; and
- no ‘opt-out’ provision.
Proponents argue:
- efficiency/improve coordination of care;
- facilitate health and clinical research;
- reduce medical errors;
- quality improvement; and
- cost reduction.
Logistical problems:
- cost;
- lengthy transition time from paper to EMR;
- interoperability (discussed below);
- true de-identification;
- security breaches; and
- ability to restrict access to a limited number of individuals.
The government is not out right mandating medical practices to implement EMR; however, a medical practice will in essence be penalized for not implementing EMR by receiving a reduced reimbursement amount under Medicare and Medicaid. This maneuver is typical of the federal government—bribery? (i.e. federal monies for roads and bridges).
Additionally, there are many versions of HIT software programs, which create interoperability issues. Interoperability is a term of art that means health professionals working in different areas can access the same patient’s records. Some programs are very cumbersome and require numerous passwords to access various screens. Even with federal interoperability standards provided by the Department of Health and Human Services, achieving the objective of an efficient nationwide EMR program is problematic.
Of course, there is the issue of who should pay for the software? Stakeholders at the table are willing to share in the cost however, a majority of the cost may be passed on to the consumer as is typically done with any cost increase of a good or service. The government also has golden carrots in the form of grant funds and tax incentives to assist medical practices in making the transition from paper to electronic records.
The strategy for a nationwide electronic medical records database does not include an opt-out provision for the patient. The reality is that your medical records would be shared with over 600,000 entities that are linked to the network without your consent.
Additionally, as with any electronic database, there is the inherent risk of security breaches and in this case, a breach would expose the most intimate details to a person’s life—medical history, social security numbers, and addresses. Even with tailored security laws to protect identifiable health information from misuse, when a breach occurs the information is no longer secure. The argument for efficiency and cost savings seems weak in contrast.
Practitioners that already employ some type of electronic records database are split on the efficacy: a repeated complaint is the loss of patient privacy and loss of available time with each patient due to the extensive process required to input data. Additionally, computer systems crash and when this occurs, a practice essentially comes to a standstill. On the flip side, physicians that practice in a variety of settings such as a hospital, clinic, and nursing home appreciate the option to access an individual’s entire medical history from a computer in any given venue.
An example of abuse that can occur with an electronic medical records database made national news in July of 2009. Three employees of a hospital in Little Rock, Arkansas that treated a local television anchor after she was slain illegally accessed her medical records ‘out of curiosity.’ A physician from the hospital, an account representative and the emergency room secretary all plead guilty to HIPAA violations. The number of people with access to your medical information is off the charts.
Several countries precede the U.S. in implementing some version of EMR such as Canada, the United Kingdom, Denmark, New Zealand, and Australia.
Canada for instance has noted an increase in the adoption of electronic health records in hospitals and medical practices. However, an increase in security breaches with extortion attempts by traffickers of illegally accessed information has also been noted.
The questions remain, what is the true benefit from EMR? How does one measure a ‘quality improvement’ in healthcare—by reduced cost and increased earnings of the medical industry or by improved patient care, which encompasses protection of patient privacy rights or some combination? ANH-USA advocates for the latter – hands down.