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Electronic Medical Records, the Story So Far

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  • by mrmtampa (231295) on Sunday January 18, 2009 @07:08AM (#26504935) Homepage

    The VA hospitals and clinics have an open source package called VistA (Veterans Health Information Systems and Technology Architecture). Veterans can walk into any facility and have their medical records available.

    And we already paid for it!

    http://www.va.gov/VISTA_MONOGRAPH/ [va.gov]

    • Re: (Score:3, Funny)

      by Tony Hoyle (11698) *

      Unfortunate name :p

      • Re: (Score:2, Insightful)

        by Anonymous Coward

        There also is(was?) a window manufacturer called vista. They used to be the top result in google, but I have trouble finding there site now...

      • Re: (Score:3, Interesting)

        Even more unfortunately, that name was picked in about 1997 or 1998 or so. The prior name of the VHA's electronic medical record system was DHCP (the Decentralized Hospital Computer Program), which was confusing for obvious reasons.

        So, they switched to VistA about 10 years or so ago, and look what Microsoft did.

      • Yeah, the VA has been unlucky in its choice of names for this software.

        Originally this was the Decentralized Hospital Computer Program package, DHCP, back around 1982, before the internets. Then when they began migrating from the old dumb terminal / minicomputer model to an intranet model in the early 1990s they found they had a serious name collision with Dynamic Host Configuration Protocol (a very different kind of DHCP). So in 1996 they changed the package name to Veterans Health Information Systems an

    • by ilo.v (1445373)
      Two problems
      1) It's written in MUMPS (obscure programming language)
      2) It has nothing built into it to generate a bill for the patient, which makes it useless to almost every hospital in the U.S. except the V.A.
      • by lysergic.acid (845423) on Sunday January 18, 2009 @12:07PM (#26506433) Homepage

        1.) who cares what it's written in as long as it's available for popular platforms. and MUMPS is still commonly used in the healthcare industry because it was specifically developed for managing medical databases. it's highly scalable, low maintenance, and much faster than conventional (relational) databases.
        2.) why should a system meant to share medical records across a national medical network generate bills?

        adding non-essential functionality to a medical database and forcing all hospitals to change their billing system would drive up costs and make the system unnecessarily complex. each hospital should be able to choose their own billing system. it's better to have a handful of systems that each perform a single role really well rather than have a single system that tries to serve 20 purposes and does it in a mediocre fashion.

        • Re: (Score:2, Interesting)

          by ilo.v (1445373)

          why should a system meant to share medical records across a national medical network generate bills?

          It shouldn't. The problem is, the fact that the program is open source doesn't help the other 99.9% of US hospitals that need to generate bills to stay alive. Unless the Feds (i.e. taxpayers) pay for the new system, the hospital needs a way to finance the purchase. Integration of the EMR with the billing system is often the only way for most hospitals to justify the expense. (You'll capture every procedu

        • by Xtravar (725372)

          First of all, I applaud your defense of MUMPS.

          Second of all, having the medical system integrated (billing and all) helps keeps costs and errors low. It used to be (and sometimes still is) that a health care organization would have to buy different software for each function and then additionally have to pay for & maintain the interfacing between softwares.

          Billing is pretty much the first thing any health organization will install. It may not be important to you, but they need to have positive cash fl

      • Re: (Score:3, Informative)

        While it is written in M, there is most certainly an integrated billing package (frighteningly enough, in the IB namespace). The VHA most certainly DOES bill 3rd party insurance for recoverable claims.
    • It is not that simple.

      Once you get the medical records electronic at the hospital, you have to make them available to the private practice doctors as well. and Those Doctors have to get the software to make their records electronic, but also have it work with all the hospitals that they work with.

    • by markdavis (642305)

      Unfortunately, from what I can tell, VistA is horribly written, is huge, and in an ancient/obscure language (MUMPS). It also appears to be difficult to implement under only open-source tools and even *requires* the use of proprietary MS-Windows for all the desktop front ends (unless you really think WINE is a solution). Plus, it is only acute-care oriented yet seems to have no centralized patient record.

      EMR is a good goal, but only as it helps a facility reduce paper, prevent mistakes, and provide faster

      • You do raise some good points about VistA. There are some folks in the old guard that cling to M, but I think the vast majority of the the VA's OI&T group have realized that M needs to go away at some point.

        The problem is that the "D" in DHCP really became a joke. Due to some of the quirks of the M language, and the way they were abused back in the late '80s to early '90s, the whole system is really a big hairball at this point. So, the first thing that the VA has to do is to tease all of the separat

  • Scary thing is... they'll get away with almost anything w.r.t. privacy. Average Joe, plumber or not, doesn't seem to care much.

    I wonder why?
    • Re: (Score:2, Insightful)

      Probably because it doesn't affect or concern them personally - or at least they don't perceive that it does. It's usually when it's too late that maybe they discover that it does or it will!
    • by Kindaian (577374)

      May i see the medical records of soon ex-President Bush?

      I bet that when they are in the public, "They" will care about Joe-The-Plumber privacy!

    • I seem to missing your point. As far as I know, privacy will still exist. I know of no proposal to make medical records wide open.

      I happen to work as a sysadmin for a company that works with medical records. Just last Friday I had to attend a 90 minute training session about FOIA and HIPAA and other matters relating electronic filing of medical records. I was left with the impression that they are actually increasing privacy.

      • by ColdWetDog (752185) * on Sunday January 18, 2009 @11:38AM (#26506205) Homepage

        I happen to work as a sysadmin for a company that works with medical records. Just last Friday I had to attend a 90 minute training session about FOIA and HIPAA and other matters relating electronic filing of medical records. I was left with the impression that they are actually increasing privacy.

        There is privacy and then there is limiting the distribution of data. While HIPAA in many ways is a step ahead, the 'loopholes' that give insurance companies, the police, the various bits and pieces of government widespread non negotiable and often non accountable access to pretty darn near everybody has lots of people very concerned. Until and unless Congress really gets clean on 1) ensuring that medical data, including genetic information, is used only by medical personnel for medical reasons and 2) entirely changing the way that health care is paid for in the US this won't happen.

        The strong desire of this society to punish suspected bad people - in this context anyone with an identifiable medical condition that has anything to do with patient lifestyle choices - is going to trump privacy and choice every time. As a physician, it's a very troubling issue. On one hand, I'm sick and tired of the disaster that is the individual paper chart. On the other hand, if you think the problem is bad now, just wait until we've fixed it.

        I'm going back to bed.

    • because they're not stupid.

      if i ever get injured while out of town, i want the hospital that i'm admitted to to have my medical records immediately. they need to know my medical history, my allergies, and what medication(s) i take. medical records are something that most people recognize the need to share with their physicians.

      this isn't the sanctioning of warrantless wiretapping, a national ID card system, the monitoring of travel activity, or the handing over of library records to law enforcement. the pro

  • I find it rather amusing that "Electronic Medical Records, the Story So Far" is a complete non-story.

    • Let's see, every private hospital and clinic in the USA has developed its own normal values for each of its laboratory tests, based on which proprietary instrumentation they bought into, who they buy their standardized reagents from, and how their lab techs are trained to set up the equipment. A CPK result that raises concern in one hospital might well be within normal limits for the hospital two blocks down the street.

      So standardizing all this in a way that would make medical records usable across the co

  • by solder_fox (1453905) on Sunday January 18, 2009 @07:31AM (#26505039)

    Their Health Services are actually very well done conceptually, and they've managed to put the patient in the loop. That's impressive given the degree to which patients are usually out of the loop on their own files. They're also a lot more security-conscious than your average hospital.

    My father called the hospital the other day and gave them his name, and they asked "Is your social security number XXX-XX-XXXX?"

    (Most medical records today aren't things that patients get--MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.))

    Microsoft still have some work to do, but they've put a lot of good talent into the area.

    One thing about electronic records in general--patient accessible ones--is that it should make a difference in accountability. Normally, at many hospitals in the US, if a doctor makes a significant mistake the records disappear. If patients have direct access to their own records, that will become a less common practice.

    • by SupremoMan (912191) on Sunday January 18, 2009 @09:42AM (#26505599)

      My father called the hospital the other day and gave them his name, and they asked "Is your social security number XXX-XX-XXXX?"

      Ummm anyone else see a problem with this?

      • by markdavis (642305) on Sunday January 18, 2009 @10:45AM (#26505881)

        Um, yeah. Social Security numbers are not universal ID numbers. They should be used solely for, get this, Social Security.

        Unfortunately, the medical industry uses SS# on just about everything. In most facilities, they even try to use it as the Medical Record Number! Try to get appropriate care without giving them your SS# and see what happens (I have tried... good luck). And now just about every industry has some excuse as to why they *have* to have access to your SS#. Credit of any kind. Drivers license. Movie rental. Home insurance. You name it.

        Anyway, SS#'s are the #1 way that information about you is tracked, "shared", associated, identified, etc. It is a huge security and privacy problem. There is a reason that when the Social Security Number was invented, it included laws about it was *NOT* to be used for any other purpose but Social Security. You can see just how effective those laws were.

        • There is a reason that when the Social Security Number was invented, it included laws about it was *NOT* to be used for any other purpose but Social Security. You can see just how effective those laws were.

          That is a good lesson for everyone on how governments really work and one that they generally don't teach in civics or American history class. The government will always say that a new program or power will never be abused or used for the wrong purposes and then break that promise as soon as it is convenient and the masses have moved on and forgotten or are not looking. The lesson is that the government cannot be trusted and it is lesson that our founding fathers tried to pass on, but one that has since bee

          • by markdavis (642305)

            I couldn't possibly agree more. This is why I voted Libertarian, even though it is a hopeless cause. The political system is setup for two and only two parties; without runoff voting and abolishment of the electoral college, there will never be any real change.

            Meanwhile, the Federal Government gets more and more and more powerful. Each generation gives up more freedom in the name of safety, not understanding what was already given up.

            The United Federal State of America. Quite depressing. The founding f

      • Apparently, the bank has no problem with lending me a substantial sum in his name.

        But on a more serious note, I think the problem is that our so much of our society relies on a mere secret combination of name and numbers to prove identity. PKI provides a much more secure means of proving one's identity than merely relying on a (presumably) secret combination of numbers known by one's employer, banker, credit card company, and several government agencies as well.

    • by malkavian (9512)

      Ooops, they shouldn't ask that.
      Social Security (Or national insurance number in the UK) is a privileged piece of info. It's a great loophole to acquire someone's number given you know their name and address (phone up hospital, give the name and address, and voila, they give you back the person's Social Security number).
      If you ask for name and date of birth, you can confirm with address. In other words, you're asking for more privileged information than you give back, the combination of all three is suffic

    • by Kindaian (577374)

      If the medical records disappear under the supervision of the stated hospital, then it's the hospital responsibility.

      I don't think that the hospitals will want that liability!

    • My father called the hospital the other day and gave them his name, and they asked "Is your social security number XXX-XX-XXXX?"

      You mean that if you call that hospital and pretend to be person X (known to have have been in there sometime), the hospital will happily give you the SSN that's recorded for person X ? Over the phone, with no further checks or guarantee(s) on the identity of the caller?

      Not that SSN's are well protected anyway, but if the above is true you should definitely take it up with higher management of that hospital (to adjust procedures / staff education etc. hospital-wide), because that's a serious privacy leak.

      • by markdavis (642305)

        >From what I've seen myself, and heard from family members etc. that appears to be the default - to keep patient, and medical data on that patient, in separate places. But why ??? Can anyone from the medical profession enlighten us what's wrong with patients studying their own X-rays, reviewing lists of drugs to be used in the course of a (planned) operation, or re-reading a diagnosis?

        The patient has the absolute RIGHT to see anything they want in the record. But the provider also has an OBLIGATION to e

      • Most medical records today aren't things that patients get

        From what I've seen myself, and heard from family members etc. that appears to be the default - to keep patient, and medical data on that patient, in separate places. But why ??? Can anyone from the medical profession enlighten us what's wrong with patients studying their own X-rays, reviewing lists of drugs to be used in the course of a (planned) operation, or re-reading a diagnosis? And I'm talking totally separate from the issue of how much influence a patient should have on these things. Is medical data only interesting to doctors etc., but not for patients themselves? Are well-informed patients a nuisance, or what? What do medical professionals think of this?

        I'm not in the medical profession, but in the UK at least, everyone has the right to see their own medical records under the Data Protection Act.

        There is much controversy about the upcoming UK digital medical system. Currently projected to cost >£12B, it will electronically record all patient records. Some fear it will be open to abuse, without giving much regard to details like bank records already being digital and "open to abuse".

        Of course, it will be bodged, and indeed open to abuse if cu

    • by amabbi (570009) on Sunday January 18, 2009 @11:19AM (#26506083)

      (Most medical records today aren't things that patients get--MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.))

      IANAD (but I will be one in 5 months or so). If that is Microsoft's position, that is the stupidest fucking thing I have ever heard. Worse than Clippy. Worse than Bob. Look, a patient's medical record is supposed to be an OBJECTIVE documentation of a patient's health status and treatment. How, exactly, is a patient qualified to make an objective assessment of their medical problems, diagnostic workups and treatment regimens?

      One thing about electronic records in general--patient accessible ones--is that it should make a difference in accountability. Normally, at many hospitals in the US, if a doctor makes a significant mistake the records disappear. If patients have direct access to their own records, that will become a less common practice.

      Well, that's just complete BS. I don't know where you get your information, but altering a patient's medical record is illegal and, at the very least, will result in a physician's suspension of privileges from a hospital... and most likely, a revocation of their medical license.

      Btw, your patient record is completely accessible. You just have to make a request to the medical records office. No, it's not available on the web, but it's not as if your MR is a secret like your FBI file.

      • (Most medical records today aren't things that patients get--MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.))

        IANAD (but I will be one in 5 months or so). If that is Microsoft's position, that is the stupidest fucking thing I have ever heard. Worse than Clippy. Worse than Bob. Look, a patient's medical record is supposed to be an OBJECTIVE documentation of a patient's health status and treatment. How, exactly, is a patient qualified to make an objective assessment of their medical problems, diagnostic workups and treatment regimens?

        Who has the most to lose if somebody fucks up a medical record? That's the person who should have the final say about the contents. Authority without responsibility is a major part of what has fucked up our medical system today.

        • by amabbi (570009)

          Who has the most to lose if somebody fucks up a medical record? That's the person who should have the final say about the contents. Authority without responsibility is a major part of what has fucked up our medical system today.

          By that logic, passengers on a flight should be allowed to edit the contents of the flight data recorder.

          Look, I'll re-iterate my point. The electronic medical record is intended to be an objective record of a patient's health assessment. A patient is not qualified to make an objective assessment of their health status. They're able to make subjective reports that are recorded in the medical record. A medical record does not work if it gets to be edited. In fact, many successful lawsuits have hinged on t

          • Who has the most to lose if somebody fucks up a medical record? That's the person who should have the final say about the contents. Authority without responsibility is a major part of what has fucked up our medical system today.

            By that logic, passengers on a flight should be allowed to edit the contents of the flight data recorder.

            Only if you are more interested in making specious arguments.

            Look, I'll re-iterate my point. If a person's medical record gets fucked up, they could end up dying as a result.
            Nothing trumps that. Nothing.

            • by amabbi (570009)

              Only if you are more interested in making specious arguments.

              Look, I'll re-iterate my point. If a person's medical record gets fucked up, they could end up dying as a result. Nothing trumps that. Nothing.

              And exactly how would letting patients haphazardedly edit their medical record going to do a thing to prevent that?

              Do you even know what a medical record is?

              • And exactly how would letting patients haphazardedly edit their medical record going to do a thing to prevent that?

                Gee, I don't see any words to the effect of "haphazrdly edit" anywhere in "MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.)" Perhaps you can point them out?

                • by amabbi (570009)

                  Gee, I don't see any words to the effect of "haphazrdly edit" anywhere in "MS is taking the position that patients should be able to see their own records, and even correct their own medical records. (But with digital signatures to keep track of who is updating the record.)" Perhaps you can point them out?

                  I make the assumption that most patients, without medical training, aren't qualified to make edits to their medical record. I equate that with haphazardly edit.

                  Look, legally, even a patient's physician isn't supposed to "edit" a medical record. It's like a file that you only have append privileges to. Why does it make any bit of sense to allow someone with no medical knowledge whatsoever to make edits?

                  I'm still waiting for an answer. do you even know what a medical record is?

                  • I make the assumption that most patients, without medical training, aren't qualified to make edits to their medical record. I equate that with haphazardly edit.

                    Doctors who can't accept that the patient is in the driver's seat are obsolete.

                    Look, legally, even a patient's physician isn't supposed to "edit" a medical record. It's like a file that you only have append privileges to. Why does it make any bit of sense to allow someone with no medical knowledge whatsoever to make edits?

                    You do understand the concept of audit trails, right? ...digital signatures to keep track of who is updating the record is exactly that.

                    I'm still waiting for an answer. do you even know what a medical record is?

                    It is fundamentally irrelevant whether I can regurgitate a specific definition.
                    What matters is that the record is the property of the patient and the patient bears the ultimate responsibility for its contents.

                    • by amabbi (570009)

                      Doctors who can't accept that the patient is in the driver's seat are obsolete.

                      OK, so as a doctor, if a patient is asking for narcotic pain meds, I should accept that the patient is the driver's seat and acquiesce? If a patient is asking for antibiotics and the doctor is sure that the patient's symptoms are due to a virus, I have to accept what the patient is demanding?

                      You do understand the concept of audit trails, right? ...digital signatures to keep track of who is updating the record is exactly that.

                      So when I'm admitting a patient to the hospital, I have to now second-guess the entries in a patient's medical record to see if the patient mucked around with the records or whether it was genuine?

                      It is fundamentally irrelevant whether I can regurgitate a specific definition. What matters is that the record is the property of the patient and the patient bears the ultimate responsibility for its contents.

                      I'm asking this be

              • by HiThere (15173)

                It seems to me that you are disagreeing about what "editing" is.

                Would you object if each entry that a doctor made has a space attached to it where the patient could place their comments... and neither could alter the entries of the other? Think of it as a database where each record has a text field that is specifically for the use of the patient.

                Would that satisfy both of you?

      • Re: (Score:3, Insightful)

        by GNT (319794)

        I AM A DOCTOR. 11 years medical informatics. 16 in medicine in general, 6 years medical devices.

        And you need an attitude check, if for no other reason than your experience is insufficient to the matter at hand.

        (1) The patient record IS owned by the patient (and the hospital/provider)

        (2) All 50 states mandate access to the record by the patient

        (3)Hospital records are routinely lost and routinely we do not enter crucial data because of liability reasons. A fact-on-the-ground, if you will. Never mind it is

      • The old information is there, I believe, and you know what the patient did. It is, ultimately, the patient's record, and if he sees something that is obviously incorrect he should be able to note that without the added hassle and expense of a doctor's visit for... correcting the record. The audit trail makes it workable.

        The problem isn't always one of qualification--sometimes it's one of a doctor who didn't listen or who jotted something down quickly which--while accurate--was woefully incomplete.

        As to th

      • by Moridin42 (219670)

        Do tell us where you'll be practicing your particular brand of medicine. I'll be sure to avoid that locale like the plague. Just to avoid you. Makes you kinda special doesn't it?

      • Re: (Score:3, Insightful)

        by winwar (114053)

        "Look, a patient's medical record is supposed to be an OBJECTIVE documentation of a patient's health status and treatment."

        You are kidding, right?!? It's a record. Generally a crappy one. That has lots of errors in the best case. Hell, some things aren't even written down any longer for legal reasons.

        "How, exactly, is a patient qualified to make an objective assessment of their medical problems, diagnostic workups and treatment regimens?"

        Some of us know more than most doctors about their specific issues

      • How, exactly, is a patient qualified to make an objective assessment of their medical problems, diagnostic workups and treatment regimens?

        Not only are they NOT qualified, but depending upon how those records are used, they might even be tempted to fudge them or delete items on purpose. For example, they might remove records of treatments for conditions that could effect future health insurance benefits and premiums. There are all sorts of perverse incentives that could come up when patients start altering their own medical records.

    • The use of SSN is problematic.
      Not everyone has one, and some
      folks use fradulant ones. The
      SSA has at least 4.1% internal
      error rate using SSN as an ID.
      And the FTC will soon enforce
      the 'Red Flags' rule, having a
      chilling effect such that most
      health care leaders depricate
      the use of the SSN in med recs.

    • Thanks! I hadn't thought of calling a VA hospital, before.

  • by thrill12 (711899) on Sunday January 18, 2009 @07:52AM (#26505133) Journal
    ...we are already starting with the "EPD" (Electronic Patient Record) this year.
    Every citizen to which it applied got a letter in their home, from the government, asking if they wanted to object. For this they had to reply using the included form and a copy of their ID.

    Until now, approximately 500.000 objections have been sent in.

    Just last week, the government proposed hard actions against those who violate the "EPD", such as high penalties. Insurance companies are not allowed access to the EPD and doing so would give the patient an immediate right to go to a different insurance company.

    Let's be frank - these 500.000 people understand the one and only true thing about EPD : once information is out in the open, you never going to get it back in.

    Just a while ago I got my own medical file from my physician - I am in my 30s - which contained 6 pages of text...
    That's not a huge load of information, and makes it very easy to copy. Once out, anyone knows my complete medical record from my birth onwards. A penalty against misuse would thus not work, it would simply be used to blame any messengers that stand up and find flaws in the security.

    One such flaw was already found last year: most hospitals (yes - publicly accessible hospitals) don't password protect their terminals.
    Argument ? In an emergency, they do not want to put up the physician with all those tough things like entering passwords.

    I respect the ideas of your new president, but I think he should definitely think again when implementing this - information wants to be free.

    Solutions ? Maybe give only the patient the private key to unlock the medical database. It was an argument here, but was quickly thrown away on grounds of "much too difficult" and "what in an emergency" etc. Until that solution is seriously looked upon, or at least until the security of it all is completely looked after, my vote against this would be a big fat "no way".
    • Solutions ? Maybe give only the patient the private key to unlock the medical database.

      Then, if he refuses to give access to his private medical data, he will be denied whatever he is applying for: an insurance, a job, a sports license, etc...
      The best way to ensure your freedom and privacy is to either *not* give you the key (so that no one can force you to release your data) or give you an *alternate* key to an edited version purged of anything you don't want to show.

      • by chooks (71012)

        ... or give you an *alternate* key to an edited version purged of anything you don't want to show.

        I think that is a good idea on the surface. The reality though is that you do not know what parts are OK to leave out. One key piece of medical information can radical change the differential diagnosis and problem solving approach. If you personally redact information, then you run the risk of removing key (pardon the pun) information for diagnosis.

        That being said, however, it is very difficult to get a

    • by Anonymous Coward

      Basically, EMRs are very dangerous in countries that don't have free universal healthcare, like ours, because they promise to make it far easier for insurance companies to identify medical risks (their euphamism for sick patients) so they can be avoided or dumped.

      Obama pledged to lower costs a tiny amount for normal families. Obama has a huge amount of support from the insurance industry on this because they have been pushng EMRs for years as a a way to eliminate the assymetric information held by patients

      • You highlight one of the big problems with healthcare in the US. We buy health INSURANCE, but we're not getting INSURANCE, we're getting some sort of hybrid, bastardized model. As you said, you insure against a risk, known or unknown. In the pure sense, the insurer has put its actuaries to work, looking at the statistics, the populations, so on and so forth, and offers you a price to insure against that risk. You then debate the value of that to you and accept or decline.

        However, we don't have that. We hav

    • by markdavis (642305)
      > once information is out in the open, you never going to get it back in. Actually, it is worse than that. Once information is *collected* you can never be assured it will remain private or used appropriately.
    • by MrMr (219533)
      Every citizen to which it applied got a letter in their home
      Not true. Only the people who had not already opted out of unaddressed paper spam (i.e. the 70% most likely to believe propaganda and advertisements) received this letter.
      In this way the government 'accidentally' failed to provide the option not be be registered to the 5 million citizens who were most likely to object.
    • by winwar (114053)

      I have a better idea. Don't use electronic records. They benefit almost everyone except the patient.

      The paper ones can be transported easily. Anyone can access that information. And anyone who has a truly serious condition should carry documentation of that fact on them.

      Unfortunately, electronic records are coming. And unless there are severe penalties for release (long prison terms/fines that destroy companies) they are going to be as secure as your SSN. For all intents and purposes your records will

  • What privacy? (Score:5, Interesting)

    by Wowsers (1151731) on Sunday January 18, 2009 @08:10AM (#26505203) Journal

    I will tell you about the UK experience of computerised medical records.

    The government wants everyone's medical records on a database, searchable by who knows who for whatever fishing expedition they want (including giving this private data to drug companies and the EU), no justification of their actions is required. The records are not secure, we already know that because the government lost 26 million taxpayers records in one go, and that's supposed to be a secure system.

    So far the scheme has burnt through £16bn (about $24bn), it still mostly does not work, is years behind schedule, and is expected to burn through another £8bn.

    If like me you object to your medical records being computerised and being available to any member of the state for their fishing expeditions, your doctor will tell you to get lost.

    Like it or not, the state will do whatever it takes, and will not care what laws are already in place (like data protection laws) to stop such schemes.

    • Re:What privacy? (Score:5, Interesting)

      by pmarini (989354) on Sunday January 18, 2009 @08:24AM (#26505281) Journal
      and in the meantime, any "insurance" company will also have full access to your your complete medical history, should you apply for a mortgage or the like...
      (not to mention that the broker will "candidly" suggest not to review them before passing them on to insurer... and checks the option box for you)
    • Re:What privacy? (Score:4, Informative)

      by Blue Stone (582566) on Sunday January 18, 2009 @09:16AM (#26505493) Homepage Journal

      >If like me you object to your medical records being computerised and being available to any member of the state for their fishing expeditions, your doctor will tell you to get lost.

      You have not told anyone about "the UK experience of computerised medical records", you've informed them of your own (appaling) experience. Make a formal complaint about your doctor and then change him for one who will respect your right to medical confidentiality (something which electronic records rides a coach and horses through).

      I simply gave my doctor a letter, informing him of my wish to opt out, and he accepted it. There's a form letter on www.nhsconfidentiality.org which I will paste here in it's entirety:

      Dear Doctor,

                                                        Exercising right to opt out

      As you are probably aware, the Government is intending to ask you to transfer
      the electronic medical records of your patients onto a national database called
      the "spine". They intend you to do this without first seeking the consent of
      your patients. It is BMA policy that patients should give their individual
      consent prior to their information being transferred on to the national
      database.

      There are substantial concerns about the privacy and confidentiality of
      information transferred onto the national database, not least because promised
      software security safeguards called "sealed envelopes" will not be in place
      and because the patient's instructions with regard to who may access the
      records can be overridden. I do not believe that such a large database, with so
      many staff users, can be regarded as secure.

      I would be grateful if you would ensure that none of my records held by you are
      entered onto the national system. Would you please also file or scan a copy of
      this letter in my records and also record my dissent by entering the "Read
      code" - '93C3. --- Refused consent for upload to national shared electronic
      record.' into my computer record. I am aware of the implications of this
      request and will notify you should I change my mind.

      This request is itself confidential. Please do not divulge my decision, in an
      identifiable manner, to anyone other than to clinicians who are providing care
      to me and who might otherwise place information about me on the national care
      records service.

      Further information for GPs is available online at www.TheBigOptOut.org/for_GPs

      Yours sincerely,

  • by anorlunda (311253) on Sunday January 18, 2009 @08:23AM (#26505273) Homepage

    In the 1980s, a Scientific American article by David Chaum, and an article from Germany on electronic prescriptions (sorry, no links, it predated the web), educate me about the possibility of electronically secured prescriptions.

    Basically, by creative use of encryption, it is possible to create an electronic prescription that
    (1) lets the pharmacy know that the prescription is authorized, and how it is paid for without revealing the name of the patient or the doctor. (2) similarly allow the insurer, the patient, the doctor and government, access to information they are authorized to have without disclosing anything more.

    The same can be applied in all areas involving privacy and access to electronic records. Encryption can be used to actively limit access to authorized purposes without depending on the lack of human error.

    Isn't is about time that we started using technology in these creative ways to achieve privacy levels as high as technology allows? How about an open source effort to publish papers and algorithmic examples showing how this can be done in an attempt to influence policy?

    • by pmarini (989354)
      you mean pre-dated (the web), do you ? :-)
    • by thogard (43403) on Sunday January 18, 2009 @08:41AM (#26505349) Homepage

      The problems aren't technical so its helpful to follow the money.
      Consider how the payment of an average prescription for a cheap antibiotic in the US. The customer will give the pharmacist the prescription and their "pharmacy card" which will often have a $25 co-pay and they think they are getting a great deal. The pharmacy sends the detail to the medical buying club who may reject it or send back 3 numbers. The 1st number is how much the customer is to pay, the second will be the price to put on the invoice and the 3rd number is how much money gets transfered from the pharmacy to the insurance company or the other way around. The result is the $4 bottle of pills cost the patient $25 yet the price on the invoice says $43 so they think they are getting a good deal and the pharmacy has to send $22 of the money collected back to the insurance company. If you want a good deal, check the prices online and let your pharmacist know you will be paying cash..

      • There have been several times where I have picked up prescriptions that cost less than my $15 co-pay.

        In those cases the pharmacist just says "You are better off skipping the card this time."

        Pocketing over-payments and kick-backs like you describe are probably illegal in most jurisdictions.
        • by thogard (43403)

          It depends... the insurance company will claim that the patient agreed to the copay so its not a kickback. They keep the pharmacy in line by threats to pull business if they don't cooperate. Of course each state has different laws so your state might just have its act together.

      • The very same reason explains why a non-insured chiro visit by my wife costs $45, but an insured chiro visit for the same treatment costs $135, with a $30 co-pay.

        Big hint: the insurance company isn't eating that $90 out of the goodness of its heart.

    • Crypto guys have known how to create secure, customer-verifiable, anonymized transactions for decades.

      I wish that I understood where the cypherpunks went wrong.

    • The issue with e-prescribing in the United States is that, although NCPDP SCRIPT (the standard) is more or less free, there's a horrible system where providers have to pay per transaction to send prescriptions to pharmacies through a cartel of companies. For examples, check out surescripts [surescripts.com] or rxhub [rxhub.net], who run the "Pharmacy Health Information Exchange."

      Like everything else in the past eight years, a monopoly on something has been sold out to one or more companies, then codified into law. Several states have se

    • by martalli (818692)
      In the United States there are constant problems with coverage, preferred medications, and so on. Having prescriptions delievered without the patient's or doctor's information would be incredibly unworkable.
      • by anorlunda (311253)

        I don't buy that; not when the remedy is to expose all patient's information excessively to ease processing of a few trouble cases.

        I believe that the health care industry is much more concerned with making their own jobs easier than they are about patient privacy.

        Sure there can be issues with coverage, preferences and the like, but putting patient privacy at the bottom of the priority list sucks. Each patient should have the right to determine his own priorities regarding efficacy of treatment and payment

    • The name of the medication itself is the problem; if you can hide that from the insurer without introducing enormous fraud problems, then you've done well. There are a lot of things that have only one use. There are a lot more that have only a few. I once had a patient tell me that they used to be allergic to penicillin but "I'm not anymore because they made me not allergic to it." Immediately I knew two things: she had previously had syphilis, which is the only thing they go to the trouble of desensiti
  • Obama (Score:1, Insightful)

    by Anonymous Coward

    I understood Obama's spokespeople to making a big deal about moving to electronic records. Are you telling me that it was actually Bush who made it happen?

    • Re: (Score:2, Insightful)

      by Anonymous Coward

      If Obama does this, then it's a wonderful cost saving measure that will bring health care to everyone.
      If Bush did this, then it's an evil plot by the insurance companies to deny coverage to poor, deserving people.

    • by amabbi (570009)

      I understood Obama's spokespeople to making a big deal about moving to electronic records. Are you telling me that it was actually Bush who made it happen?

      Obama's health care plans includes an emphasis on evidence based medicine, preventive medicine, and improved efficiency and safety.

      In other words, a pretty much verbatim duplication of the CURRENT requirements of JCAHO - the accreditation body that Medicare uses to certify hospitals as compliant and eligible for Medicare funds.

      Change we can believe in, indeed.

    • Check Bush's state of the union address from 4 or 5 years ago. A 12 year plan to move to nationwide EMR records for everyone. Established the office of the national coordinator for healthcare IT which is the administrative arm to make this happen. This launched the National Healthcare Infratructure Network project (currently in its second revision), the Healthcare IT Standards Body (to harmonize competing HIT standards and establish new ones), the Certification Commission for HIT (to certify products for

  • The video I have linked in the post below will give you an idea of how quickly we'll solve this problem...

    http://osrin.net/2008/12/the-rapid-deployment-of-electronic-health-records/ [osrin.net]

  • I can not lay my hand on the part of the Constitution that grants such a power to the Executive. And for good reason. The power to make laws was given to the People's and the States' Representatives in Congress, where the law may be debated and the people's support (or non-support) elicited.

    The power to make law should never lie with just a single man, especially one who does not listen.

  • The reason for the requirement of stringent privacy requirements for health-record keeping is solely due to the sheer number of unregulated, unaccountable organizations dealing with them.

    I am talking, of course, of private health-insurance companies.

    The obvious cost-effective solution is to get rid of them, and implement an universal, single-payer insurer that would cover absolutely everyone (no opting-out) with exactly the same coverage (no more time wasted to figure out if some procedure is covered or n

    • by amabbi (570009)

      The reason for the requirement of stringent privacy requirements for health-record keeping is solely due to the sheer number of unregulated, unaccountable organizations dealing with them.

      I am talking, of course, of private health-insurance companies.

      The obvious cost-effective solution is to get rid of them, and implement an universal, single-payer insurer that would cover absolutely everyone (no opting-out) with exactly the same coverage (no more time wasted to figure out if some procedure is covered or not).

      Since coverage of everyone will be compulsory, there will be no more need to discriminate for pre-existing conditions, thus removing the need for intrusive record snooping in the first place.

      In fact, such a solution is currently in place in **ALL** the industrialized countries, except in the USA.

      There shall be no more pussyfooting around the bush with this issue, the bull's apple need to be bitten by the horns right now.

      In addition to finally covering everyone, the USA will no longer be a turd-world country and a laughingstock in respect to health-care, and in bonus, all the rotten parasites that fester in and around private health-insurance companies will be forced to find an honourable way of paying the bills.

      First off, I just don't understand why people insist that universal health care == single payer. The two are completely separate; you can certainly have the former without requiring the latter.

      There are MANY reasons to argue against single payer health care.... and that is beyond the scope of this /. discussion. I do, however, have to object to your dumbing down of the issue. While one of the main goals of HIPAA was to insure privacy of health care with respect to portability of insurance (the H, I, and

      • by Pig Hogger (10379)

        First off, I just don't understand why people insist that universal health care == single payer. The two are completely separate; you can certainly have the former without requiring the latter.

        That's because only a compulsory single payer is able to avoid discriminating for pre-existing conditions.

        There are MANY reasons to argue against single payer health care.... and that is beyond the scope of this /. discussion. I do, however, have to object to your dumbing down of the issue.

        "Dumbing down", as o

        • by amabbi (570009)

          That's because only a compulsory single payer is able to avoid discriminating for pre-existing conditions.

          That's completely untrue. Say, for instance, I work for LargeMultinationalCorporation. I could have diabetes, high blood pressure and had 3 heart attacks, and I'll still get coverage because I work for LargeMultinationalCorporation. And I did it without the federal government!

          "Dumbing down", as opposed to **OBFUSCATING** in order to maintain the status-quo, so that people keep believing that "the government is **BAAAAD**" so private insurer can continue to gouge the public???

          Please give me one example of the U.S. federal government taking over for a private industry, where the end results were better than if the federal government did not meddle at all.

          Bullshit. What happens is that insurance companies are looking at all possible ways of weaseling out of their contracts in order to increase their profits, and to do this, they have armies of "investigators" who social-engineered their ways into medical records.

          Now you're just making shit up. Do you have any

          • That's completely untrue. Say, for instance, I work for LargeMultinationalCorporation. I could have diabetes, high blood pressure and had 3 heart attacks, and I'll still get coverage because I work for LargeMultinationalCorporation. And I did it without the federal government!

            That's great for employees of LMC, but you're overlooking two things:

            (1) LMC was able to negotiate that kind of blanket coverage with their insurance provider because, well, they're Large. Smaller business don't have that kind of leve

            • by amabbi (570009)

              That's great for employees of LMC, but you're overlooking two things:

              (1) LMC was able to negotiate that kind of blanket coverage with their insurance provider because, well, they're Large. Smaller business don't have that kind of leverage.

              (2) There's absolutely nothing to stop the insurance provider from telling LMC, "Right now you're paying $x million per year for blanket coverage. We can offer you the same coverage for 0.9$x million per year [which will actually cost us 50%, not 90%, of what it does now, although we're not going to mention that] if you accept our suggestions about which types of employees you might want to ease out the door." Nor is there anything to stop LMC's management from thinking this offer is a really good idea.

              If you think there's a way to solve either of these problems without serious government regulation, please feel free to make a suggestion.

              Well, it has been suggested. Read Matt Miller (a liberal political commentator) and his book The Two Percent Solution [amazon.com].

              In response to your points, in Pt 1, my response to that is that issues like this are precisely why Barack Obama's plan to force companies to provide health care to their employees is biased in favor of big business. A company with 100,000 employees can negotiate far better insurance terms and rates than a company with 10,000, or 1,000, or 100. In fact, my "ideal" solution to universal he

          • by Pig Hogger (10379)

            That's completely untrue. Say, for instance, I work for LargeMultinationalCorporation. I could have diabetes, high blood pressure and had 3 heart attacks, and I'll still get coverage because I work for LargeMultinationalCorporation. And I did it without the federal government!

            You'd get covered yes, but the moment you claim, bingo! the "pre-existing condition" card gets played, go to jail, do not collect $200.

            Please give me one example of the U.S. federal government taking over for a private industry,

  • Well there's an interesting debate [arstechnica.com] on EMR, including some physicians.

  • by cunamara (937584) on Sunday January 18, 2009 @11:54AM (#26506323)

    I'm a psychologist and work for a large clinic (93 clinicians, 25 support staff, five clinic locations and a lot of "out in the field" services). My specialty is nursing home services; there are about 15 of us in the nursing home division and we work in about 150 nursing homes. Often a client is referred to me and it turns out they were seen by a colleague in another nursing home. If we had an EMR that I could query remotely, I could find that out and streamline the delivery of services and provide better care. This would be the "added power" part of the discussion and the rosy picture that EMRs present

    The flip side is that computer security is not reliable. Any system connected to the outside world can be hacked remotely one way or another. We have thousands of clients with a lot of sensitive data sitting in our files, currently in locked cabinets behind two locked doors with limited access to maximize security as much as we can. The risk of data exposure is minimal and happens as a result of sloppiness by practitioners (e.g. leaving a file sitting on a desk unwatched). With an EMR, however, the risk of exposure is potentially much higher (e.g., downloading *all* the files instead of swiping or reading just one).

    We have made no provisions for using an EMR in our clinic. We have a computerized billing system which contains insurance information and diagnostic codes- only the information required to send out a bill- but none of our clinical records are in an EMR. AFAIK we are not required to do so.

    • by winwar (114053)

      "With an EMR, however, the risk of exposure is potentially much higher (e.g., downloading *all* the files instead of swiping or reading just one)."

      I prefer the locked cabinent approach. In order for my records to get out, someone has to know where to look. And has to be willing to travel. I have multiple records in multiple states, some of which I couldn't find if I HAD to (legal issues, for instance).

      That is far more secure that cracking one little database....

      • Out of curiosity, do you have revealable tips for making a record (of anything) accessible to you if you want it but utterly immune to discovery if you don't? Apart from moving them (and therefore, potentially, yourself sans funds) to a non-discoverable jurisdiction.
  • After the executive order signed in 2006,

    And from the article...

    President Bush issued an executive order that requires certain federal programs (including Medicare) to develop interoperable HIT systems.

    What the heck is an executive order, and from what does the president derive this mystical power?

    • An executive order is a quasi-law which exists as a symptom of the quasi-monarchical powers which the President has unfortunately been granted by a cooperative Congress and Supreme Court and a complacent people over almost the entire course of American history. It's really just an updated version of "the king's word is law" with a modern gloss. Some blame Lincoln for the Imperial Presidency, some blame FDR, and some blame the Cold War, but honestly the problem goes (at least) back to Jefferson, of all peo

    • by jbengt (874751)

      What the heck is an executive order, and from what does the president derive this mystical power?

      Congress likes to write vague laws, like the EPA shall set maximum exposure limits for such-and-such toxin. Then, it's up to the EPA to research the health effects of such-and-such and set exposure limits, and particaulr rules on how to measure and/or achieve those limits. Then, (or before then) the President may issue an executive order telling the EPA how to do its' job.

  • There are hundreds of various EMR products, which typically cost $30,000 per physician to buy, and $5,000/year/MD for maintenance costs. After paying all that, the EMR products are incompatible with each other, so that records cannot be sent from MD to MD, except to print out the information and scan the pages into the other MD's system. If the digitized information is lost, then the value of the EMR to track information is also lost. A better solution would be to encourage ro require the use of a single
  • then by definition it is an "unfunded mandate", which the Federal courts have clearly established cannot be enforced.
  • All the laws about mandating electronic records need a provision that forbids all entities that handle the data from "exporting" it overseas in any way. Whether that is storage or processing or analysis, do not send my data overseas. Period. The same standard should be retroactively applied to bank records, credit data and the like.
  • The executive order requires interoperable systems for healthcare data, but does not require EMR applications. It says any system the fed buys must be able to share data with other systems, but not that any particular system is purchased for any purpose.

    Also, does not apply to the private sector, although there are obviously many political movements to provide incentives and mandates in this direction.

    The OP is a little misleading. The standards are being developed by HITSP (www.hitsp.org), the money is c

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