Friday, November 5, 2010

”New era” electronic health records not so promising--Part 1

We should take a good look at these schemes the state and federal governments have for embellishing the already gargantuan systems of electronic medical records that you see in use in hospitals, clinics and doctor's offices. The State of New York is making a big pitch for a big “new era network”, a multi-million dollar program of advanced electronic medical records which supposedly would let one doctor pull up the medical records of another doctor's patient and work on him right off, easy as pie. It would open your medical records and mine to the eyes of others and would needlessly keep on file every detail of our medical history for posterity. That's the substance of a story in the Albany Times-Union October 27.

I think this is mindless record keeping. We can't afford it. The jobs this would create won't go to ordinary working people. The promoters haven't worked the kinks out of the privacy issues at all. Nobody wants their hospital records open to others. The promoters claim the promise of more information flowing to doctors and care centers is “like a public utility—a sort of highway system for medical information.”

“Better information helps doctors do a better job” said the executive director of NY eHealth Collaborative which went in on the proposal with the NYS Department of Health. It's a $129 million plan to the federal government to create the country's largest network for medical records. Now I ask you: Do we need this?

Sharing medical records doesn't happen now and it may not happen soon, despite the shrill publicity.

Here's why. In the patient wards inside Ellis Hospital you see the nurses clicking on their computer consoles, morning, noon and night. They keep up to the minute information on the patients in their care. Endless facts and trivia go into the entries on the screen, I was told, like whether the bed rails were up. They do their progress notes and charting. I don't think the nurses share the screens with one another. The data isn't for outside eyes. The patients can't see their own records, nor can other professionals without using access codes. That's because the system in use in the hospital is going to be different from another system used by a doctor in his office who serves patients on the unit. And the doctor's computer isn't accessible to other professionals. The whole system is built for defense, protection of patient information and protection of the hospital in this case.

That's what I was told. The hospital has the nurses tapping away for hours at their computers in the hall rather than do direct patient care because the hospital worries about lawsuits. And it wants to be sure all the little things are done. What if someone missed doing a test or procedure? We'll catch it. What if a reading is challenged? We have the data on board. Records are kept for the benefit of the hospital and possibly the insurance carrier, not for the patient or competitors or other outsiders.

This whole system seems to be designed to not give access to others. It would be foolish to keep things entirely secret, but careless to let information flow without patient approval. It doesn't seem likely a doctor will share his patient's records without an okay, and he won't be able to share without modifying the system. Of course that's what the state is proposing to achieve in the new generation computer service.

We need to keep an open mind about electronic medical records and the huge systems some people envision for the future. As I see it, the article in the Times Union amounts to public relations for the statewide Health Care (hospital) industry, the state Health Department, electronics data systems corporations and many others in the field. Why should we be interested?

These systems have serious drawbacks. They are extremely expensive. They take away from spending that is needed badly by the institutions and agencies that do direct care for people, in health and mental health. They are not needed in today's care system. No one is going to get better with the added information these systems are to contain. No one's life is going to be saved with them. As patients, we don't need them to keep track of every moment of our hospital lives with data. Most of the data to be kept is useless for future reference. They are a luxury we cant afford.

Our NAMI families should take a good look at what the new systems are doing. We want personal care, not record keeping. All the data that is needed in the ordinary course of events for a patient's care is already being gathered and it soaks up much of the time and cost of mental health care for our family members in the hospital. We should not pass along this information without being better judges of it. Of all the things that are needed for better care, this is not one of them.  (Roy Neville)