Thursday, June 01, 2006

Warning Signs

Warning Signs:

The recent announcement that a VA employee took home secure data files on a laptop, which was later stolen in a “random burglary” is not good news for the development of EMRs and RHIOs. It points out that if something can go wrong, it will eventually despite all precautions. On face value one might ask why or how this employee was able to copy or download such a large data base for use at home. This may have been an “accident” waiting to occur.

It makes a strong case for not having a centralized data base of patient information. This case makes responsible physicians raise their eyebrows in regard to securing confidential information. In fact it has made me reformulate my own thinking as to whether I want to continue to promote the concept of RHIOs or data sharing initiatives.
Having been a strong proponent for RHIOs the past 18 months, do I want to continue my leadership role in this area? Is there an elephant in the room?
The major reason some providers would like EMRs and RHIOs is to streamline much of the bureaucracy; which has sprouted like weeds in the health care industry in the past 25 or more years since medicare came into existence, and managed care came along, and all the other paper work IPAs, U/R, Quality assurance people are asking. They tell you they want this information in the interest of the consumer and cutting costs. Do you really believe this? If so I have a bridge for sale that spans the East River in New York City, cheap!
I am using an EMR at present…the main advantage is legibility. There are many many disadvantages.
The flaw is not not having an EMR or RHIO, it is the system that has evolved that would require such a complicated circuitous solution. It’s taken two years of meetings, multiple committees, redundant IT organizations, certification committees, one ONCHIT that lasted 18 months. By developing EMRs and RHIOs we are enabling a very dysfunctional system to continue, grow and get more out of control.

There are few individuals or organizations that truly have the best interest of patients at heart. That leaves the physicians as lonely guardians of patient privacy and confidentiality. Congress in it’s infinite wisdom and all the expertise of politicians passed HIPAA. HIPAA is largely a non decipherable arcane explanation of what we all know intuitively, and what all medical staff members already know or have been told. How many millions of privacy notices have been passed out to patients from every insurance company, provider, pharmacy, home health care provider, physical therapist any other provider in the past two years? How much money did that cost? Does anyone think that 100 pages of bureaucratic language really protects your paitent’s medical secrets?
Physician providers are being criticized for being laggards in adopting EHRs. I suspect it is not all about funding, but a fundamental distrust of applying “business logistics” to a medical record keeping.
Playing the devils’ advocate I can now see a new ATM button to dispense RXs using a smart card that has all the patient’s data encrypted on it.
Stop the insanity!!
I have been proud of the work I have done the past year attempting to develop a RHIO, however, prudent thinkers reevaluate what they are attempting to do. My stop button has been pushed. To all others involved in this endeavour, be careful that you think you are creating a system that can be controlled. It’s like the genie, once it’s out, it’s over. Medicine is spawning another parasitic industry that will siphon health care dollars into silicon chips and software.


At 7:55 PM, Anonymous said...


The PHIN Consortium federated model, with patient data encrypted, distributed, and tagged by biometrics index, requiring authentication and authorization to gain access will halt any loss of data from electronic terrorist. Physical security that disallows taking disks home would secure loss due to stupidity. The VA problem demonstrates a lack of control.


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