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+ - Electronic Health Records Now In All Mil Hospitals-> 7

Submitted by smitty777
smitty777 (1612557) writes "Information Week is reporting on the the inclusion of Electronic Health Records (EHRs) in all US military hospitals. This is significant in that it allows the sharing of patient information on a worldwide scale, improving care. This is leading a national trend, which is currently motivated by HIT Meaningful Use legislation which provides incentives for civilian physicicans to adopt EHRs. Not that the adoption is without challenges. The usability of EHRs is also an ongoing concern."
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Electronic Health Records Now In All Mil Hospitals

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  • This is significant in that it allows the sharing of patient information on a worldwide scale, improving care.

    ...and increasing risks to patients.

    We can pretty sure that the following things will happen

    1) Integration with Homeland Security tracking databases [nytimes.com]
    2) Abuse by insurance companies and healthcare providers to reduce costs / increase profits in ways not envisioned by HIPAA.
    3) Whoiesale data theft for criminal abuse

    • @Jah-Wren Ryel - good points. I completely agree with the risks you've identified. I'm not sure those are unique to the healthcare system, but more byproducts of the increasingly digital age that we live in. I think this is especially true with regards to points #1 and 3 - our over-digitzed lives are becoming easier and easier to track and exploit.

      So, given the inevitability of the EHR in the medical system (and it is inevitable), what can be done about it?

      • So, given the inevitability of the EHR in the medical system (and it is inevitable), what can be done about it?

        Incorporate a design philosophy of compartmentalism. Both at the database level where it would be more appropriate to call it decentralisation so that there is no mechanism to automatically cross-reference data from one database with another and also within each database such that each patient's records are encrypted and the only person with a key is the patient himself.

        EHR's are one use case were DRM can function reliably because they are essentially closed systems - unlike DVD players and PCs, all access

        • Incorporate a design philosophy of compartmentalism. Both at the database level where it would be more appropriate to call it decentralisation so that there is no mechanism to automatically cross-reference data from one database with another and also >

          Hrmmmm...interesting idea, but doesn't that contradict the whole purpose of having an EHR? I mean, if you compartmentalize too much, than you won't have the benefits of information sharing between hospitals and physicians, for example.

          The idea of a client owning their own data is also intriguing, but I'm not sure it would fly. It's too much of a departure from the norm right now. Hospitals own the data, and they like owning the data, and....the biggie...they are the ones paying for the EHR system. So wh

          • Obviously there is a lot more nuance to how things would all come together. But sharing between distinct EHR systems at different hospitals is different from sharing between an EHR system and a DHS database. Ultimately encryption at the patient level makes it infeasible to bulk export from one system to another and that's the key difference from the current wisdom which is to centralise everything and then just manage access control with permissions.

            As for an individual's ownership of the data about themse

            • I'm playing devils' advocate of course, but I think one of the big problems they are trying to solve or will be solving in the near future is data sharing between hospitals. It's not something that we do particularly well (at least here in the states), but it would take care of the problem of duplicate med lists, overlapping treatment, and abuse by patients (that's one aspect of abuse that you didn't really bring up, but it happens a lot now). I'm pretty sure that's the way things will be going, and I'm

              • I think one of the big problems they are trying to solve or will be solving in the near future is data sharing between hospitals.

                Well, that starts to get outside the purview here, but (for example) the idea is that a doctor writing a script would request the patient's list of current prescriptions first, the patient would OK the records transfer (with, say an expiration of the copy of 1 day), the doc would look them over for conflicts with what he's about to prescribe and then update the list with the new medicines. Not particularly different in workflow from the current vision for such things.

                How do they know you are who you say you are and that you haven't monkeyed around with the data somehow?

                They can cryptographically sign the rec

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