Medical Professionals Aren't Leaping For E-Medicine 98
theodp writes "Despite all the stimulus money being directed toward developing electronic medical records, surprisingly few doctors, hospitals and insurers are using Google Health and other sites like it. One reason, Newsweek suggests, may be that Web-based personal-health records like the ones being compiled on Google Health don't appear to be covered under HIPAA, which requires that health care providers and health plans protect patient confidentiality. 'We don't connect that information to other aspects of Google,' explains Dr. Roni Zeiger, product manager for Google Health. Still, the federal government is in the process of drafting privacy recommendations that would apply to Google Health, as well as the makers of consumer apps that perform tasks like monitoring blood pressure."
Re:Sketchy. (Score:5, Insightful)
They can't get it into their heads... (Score:5, Insightful)
That it is OUR health data... and not theirs. If *I* want to post my health info to google, I should be able to. I should be able to obtain my own data relatively easily and painlessly (aside from whatever the doctor did to me, I mean!) and I shouldn't have to go through the whole battery of duplicate tests everytime I go to a different doctor.
I don't exactly want just anybody to be able to get to MY data either... But I trust google with it a lot more than I trust my insurance company!
No matter how this all pans out... I just want to have access to all of it myself, not locked up in some doctor's storage shed, or some insurance company's tape archive..
It's MY data... give it to ME, and let ME decide what to do with it. If I leave it out in the open, and the insurance company decides to charge me more because of something *I* allowed them to read, or if *I* lose info, and have to duplicate a bunch of tests.. at least it will be *MY* fault...
Re:Googlectomy (Score:4, Insightful)
SO you would rather the insurance companies be the only ones with unfettered access to your information?
I think the REAL reason Dr.s aren't too keen on the E-records is lawyers and liability. Every person who sees that data is another risk of a malpractice suit in their eyes.
And let's get over this E-Records" thing already... Face it.. you doctor is already using computers, and storing your information on them... The real issue is data portability. Info from Dr. A should be accessible to Dr. B when needed, and we should ALWAYS have access to our own data...
The real problem with centralized records (Score:5, Insightful)
I work for a company that produces various types of medical records management software (credentials management, PHI document exchange, EMR); and I've spent a lot of time talking to a number of doctors, both tech-saavy and not so much. That disclaimed...
Let me tell you what the key problem is with electronic medical records: they are legally the property of the patient, but no doctor can (or will) trust the important details of such records unless they come from another doctor, and have a verifiable history leading back to that doctor. Not that they don't believe the part that lists a patient's allergies, but when the medical record says the patient has a debilitating disease which *requires* they be given morphine and lots of it, the doctor has to be able to verify the patient didn't just fake a record for a quick drug fix.
This leads to an interesting state electronically: if data records are to be centralized, a public key system must be set up, tied to each doctor, allowing them to both contribute & authenticate records, and allowing the patient to do the same (but the patient contributions will have to remain "untrusted" medically). You can have centralization without a public key system, but then you're just trusting the gatekeeper to never mess up, get hacked, or paid off. And even if you'd set up such a system which you know (as a programmer/cryptographer) can be made to work... you have to get the doctors to trust it as well; as given how seriously most of them take the responsibility to safeguard their patient's records, that's a hard sell even to a tech-saavy doctor.
Which is why the only major movement we've had in adoption of electronic records has been a decentralized one... doctors are converting their offices to use electronic systems internally, exchange information electronically; but always records are transmitted in a p2p fashion (whether by email, fax, courier, etc); allowing the receiving doctor to trust the veracity of the information (at least as far as they trust the originating doctor); without requiring them to trust the patient.
Google Health is merely one of the most prominent "my PHR online" projects out there, but the problem they are faced with solving is not merely legal or luddite based, but a issue of cryptographic trust in it's truest sense.
And that's not to mention that centralization of medical records creates a much more attractive point of failure for all kinds of things (such identity theft, if merely for the purposes of using some else's insurance),
and even if a public key system is implemented, the doctor (and staff) are handing off part of their trust to a central database... and given the mess of outdated information the NPI registry contains, they are loath to believe in such a system.
disclaimer: my company has a number of ongoing projects in this field, but my assessment here is pretty well unbiased architecture and adoption-wise as far as I know, we have a number of pokers in the fire fitting most of the above scenarios.
Re:Sketchy. (Score:3, Insightful)
Fine and dandy, but not earth shattering nor will it ever amount to much. To be really useful, it needs to input data automatically from all providers, pharmacists, hospitals, etc. That has a number of significant privacy and organizational issues that I don't think even the Great Google can overcome.
Re:They can't get it into their heads... (Score:3, Insightful)
You are frightening!
Re:Googlectomy (Score:3, Insightful)
SO you would rather the insurance companies be the only ones with unfettered access to your information?
I think the REAL reason Dr.s aren't too keen on the E-records is lawyers and liability. Every person who sees that data is another risk of a malpractice suit in their eyes.
And let's get over this E-Records" thing already... Face it.. you doctor is already using computers, and storing your information on them... The real issue is data portability. Info from Dr. A should be accessible to Dr. B when needed, and we should ALWAYS have access to our own data...
My doctors, and my kids' doctors, certainly are NOT using sophisticated computer storage. In fact, the last time I was in the pediatrician's office, the Dr. was complaining that she couldn't read the other Dr.'s handwriting, so she called him at home and asked him what he had written. They take all their notes by hand and refer to the hand written notes rather than anything computerized. I'm sure that the office secretaries have to compile some sort of computer-based reports for the insurance companies, but the Dr.'s are using handwritten notes.
Oddly enough, I'm glad that the Dr.'s I see are using hand written notes and direct conversations. I've done enough software development in my time that I'm not comfortable with applications written in the "standard method" for the "market-leading OS" to keep track of vital health information for my family.
If we could have some sort of quality assurance for the applications, OS, and hardware that are keeping track of these records, then I'd be more comfortable.
EMR is much more than record keeping. (Score:4, Insightful)
I am a physician.
The only way doctors are going to go to EMR systems is when they improve the bottom line.
The people that create many EMR systems understand that, and build the systems in a way so that physicians can increase the billing rate above what they can do with paper systems.
I currently do my patients records on paper. I bill much lower than I could, because I'm scared about penalties associated with being caught over-billing.
My office is going EMR within the next year. I am positive that the amount I will bill for just about everything will increase, and I will (hopefully) offset the cost of going electronic at that point.
Is EMR going to reduce the cost of health care? Almost certainly not. It will likely allow physicians to drill down into their database of patients to see:
1. which ones haven't been seen in a while and bring them in.
2. which ones are eligible for a procedure but haven't had it yet.
Will this decrease patient morbidity (illness) and mortality (death)? Probably, but that can only be determined by (likely retrospective) studies.
Why should I care about Google? (Score:3, Insightful)
If Google isn't getting their money's worth from all that campaigning with Obama, why should I care?
There are other corporations that understand HIPAA, the value of privacy, and willing to enter an agreement that makes them risk liability and criminal penalties for accidental disclosure.
I can't understand the irrational willingness to give all data to Google. Of course, this is Slashdot so a lot of comments are from people predisposed to like and trust Google. This is despite comments from Google executives that say otherwise. I guess Google's position would be that if you have something embarrassingly wrong with you then don't go to the doctor...
Re:They can't get it into their heads... (Score:3, Insightful)
And what planet have you been living in?
If you want a prescription, can you just get one yourself?
Do you know why you aren't allowed to? Because you're not responsible. You need to expertise of a doctor to diagnose and prescribe things for you. You can't be responsible with prescriptions. And you certainly can't be trusted with your own health data.
Of course that's what the medical associations tell us... to maintain their strangle hold monopoly over health care.
That's the real reason they are against any of this. So much of the medical diagnosis could be automated. Everything from image analysis to the various charts they read off.
Like laptops in schools (Score:1, Insightful)
E medicine is like laptops in schools. It seems like a good idea but adds nothing to the interaction of doctor and patient. But it is great innovation for the government bureaucracy busy bodies and other do-gooders who feel the need to insert themselves between my doctor and my colonoscopy.
Re:Sketchy. (Score:4, Insightful)
In fact, Google should focus on coordinating and aggregating transactions, it could revolutionize the industry. Coordination of benefits between insurers would reduce paperwork and speed up payment. Services that don't generate claims (paid out of pocket, provided by a non-profit, etc.) wouldn't be missing like they often are in insurers' systems today. Fraud and abuse would be much easier to spot.
The challenge has been organizing and correlating the data. Google may be the perfect company to solve that problem.