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."
Sketchy. (Score:4, Interesting)
I wasn't even aware Google produced a product called Google Health.
I can understand their other technology developments, but this is one area where it's blatantly apparent that they just want to know a scary amount about each of their users...
Re:Sketchy. (Score:5, Insightful)
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Fine and dandy, but not earth shattering nor will it ever amount to much. To be really useful, it needs to input data automa
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Google health uses a subset of CCR. As much as I hate CCR, you can't fault them for their standards use. The only other standard remotely compatible with what they're doing is HL7, but it is more transactional whereas CCR is an actual record.
Not that google health really does anything. At this point its sort of like an appstore for your health records with no apps on it.
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Re:Sketchy. (Score:4, Funny)
Forget MS, an Apple a day keeps the doctor away.
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.
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If they solve the privacy concerns,
They don't appear to be off to a good start, at least not according to this rating of various services where they got nearly the worst rating of the bunch.
http://patientprivacyrights.org/personal-health-records/ [patientprivacyrights.org]
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Well, it can only become adopted by the masses if more people use it and force their doctor to start using it as well. If i go see my doctor and tell him after wards to update my google health profile because I ASK HIM TO, then he has my permission , for a broken arm, to update my status, and that can become more and more useful.
Only by letting people say, it wont work and believing them, will it truly not work.
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Health records should be such that anyone can input data, but to read data should require a special hardware key code. This would be presented whenever health care was purchased. Optionally an implantable ( and erasable/rewriteable key code storage device could be used so that health information could be accessed in case of an accident ).
The ability to start anew with a blank medical record should be everyone's right. Also, it should be your right to roll back one's own medical record to any date and st
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You must be incredibly naive if you think existing EMR companies are going through this much trouble to keep data secure. I worked as a contractor for a leading EMR site, and it was an ASP.NET/MSSQL hack-job littered with SQL injection holes and easy-to-guess backdoors (think admin/admin). I don't hold out much hope that we were the exception to the rule.
Googlectomy (Score:3, Interesting)
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...
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Yeah, that's exactly what he said. Are you high? We know he is, he admitted it.
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"SO you would rather the insurance companies be the only ones with unfettered access to your information?"
Yeah, that's exactly what he said. Are you high? We know he is, he admitted it.
Um, it was a play on Google's 'Buzz' social networking disaster that made everything public and is the antitheses of what we want Electronic Medical Records to be.
And the insurance companies don't have my medical information because I don't have medical insurance anymore. The costs went up 38% - 46% each year for the last three years (I gave up on it before paying that first huge increase).
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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,
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Whether they use computers or not, the doctors still print out hard copies of stuff. At least all the doctors I've been to that use computers do, anyway. I always request a second copy for my own records at home.
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Your QA is called HIPAA and it enforces a whole slew of requirements on to software vendors who supply software that manages medical information.
The interesting issue, however, is that Google sidestepped HIPAA and forces users to voluntarily move their records out side of it. The requirements of HIPAA are very sane and simple - stuff like data should be transferred over S
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You're funny. You think most doctors have been using computers to record medical information.
Health care is the LAST economic sector to move to an electronic data management system. I am in the middle to deploying electronic forms right now for physicians and they are bitching and moaning about it. Doctors are technophobic for the most part. New residents seem to be a lot more progressive in the technological realm, but for most physicians in the industry, they prefer paper records of electronic.
Re:Googlectomy (Score:5, Informative)
One of the many oddities of medicine in the US is the payment model. There are two ways in which physicians can earn money: by doing procedures, or by applying their learning. Now, procedures are fairly straightforward; if you do it, you can bill for it. But how do you get paid to think? You prove how much thinking went into the process by your documentation. On a paper chart, this is straightforward: you see a patient, talk to them, formulate a plan, and scribble out a note. The paper is easy to pull out and read, or copy, or whatever. You can take it with you on a clipboard into the room. Unless you get laptops with carts, you can't do that with EMR.
When you're in a hospital with EMR, you have to remember your username and password (and every password system has a different expiry cycle). In the one hospital in which I work, I have SIX systems with different usernames and passwords - the general EMR system (which has labs and dictations), the radiology system, the pharmacy dispensing system, the OR EMR system, the OR scheduling system, and email. Those who admit patients to two or three hospitals have this problem at each and every one.
In other words, physicians have two jobs - one as a physician, and one as a data-entry clerk. Not surprisingly, we are incredibly averse to spending time and effort on the second of these jobs, and anything that causes that data entry to take more time is costing us money. Not only that - the electronic records are often inferior to the paper ones they replace. In particular, many branches of medicine use drawings or diagrams. It's nice not to have to deal with handwriting, but a heart diagram with coronary blockages marked by location and percentage blocked is superior to a verbal description of those blockages.
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That is why hospitals deploy SSO systems like Sentilian. These systems are especially effective when the application you are setting up in the system support all CCOW features because then you can create a unique application key for the vault group and anyone in that group will just log in with out ever having to register their user name and password.
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And it normally works very well. Just make sure to choose a program that properly implements CCOW or you are screwed.
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Sentilian sign on is invisible to the user as long as the application they are accessing is set up properly and implements CCOW correctly.
As far as paper... it takes up a lot of room, costs a lot of money to store and is very difficult to search
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I didn't think anything could be done worse than Centricity. (Hierarchical DB with COBOL and SNO-BOL? really???)
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Isn't that pretty standard now?
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what are you talking about? Most hospitals use WOWs/COWs.
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We use them for RN charting and med dispensing. physicians can use them if they like but most of them like to sit down and chart on a laptop rather than on a WOW/COW. we also have super thin tablets for them to use to chart on if they wish. most like the ultra portable laptops though because of the keyboards.
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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...
No they are not. I was at HIMSS [himssconference.org] a few weeks ago and I think the latest stat was only 15% or less of providers use full EHRs. That is simply horrible.
nothing in common (Score:2, Informative)
Google health and the stimulus money are 2 very different things. They have no relationship.
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...
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Even if they recognize that, they -still- have to consider HIPAA because there will be lawsuits otherwise. Even if you say 'Okay, upload to Google for me' there's some litigious asshole out there that will say 'Oh, I didn't mean THAT information' and sue them.
So they have to be extra careful with your data, whether you like it or not.
And that's for your benefit, btw.
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You are frightening!
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I”m sorry, but physics disagree.
There is no such thing as data ownership. Because data is not a physical object, like e.g. a chair. The container may be. But the data is not.
If you want control over it, don’t pass it on. Simple as that.
If you pass data on, you split control over it. Now it’s too late, so quit bitchin’.
You can not ever guarantee control over data that is passed on. Even when you threaten with punishment.
The media reproduction industries tried that. And they failed aga
Medical data has owners by law (Score:5, Informative)
There is no such thing as data ownership.
Pity the law doesn't agree with you. Not on medical records [wikipedia.org] at the very least.
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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 a
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So what happens when people have the freedom to buy and take whatever medicine they want? There are externalities -- such as breeding antibiotic-resistant bacteria -- to you taking whatever you want.
Re:They can't get it into their heads... (Score:5, Interesting)
So much of the medical diagnosis could be automated. Everything from image analysis to the various charts they read off.
I am aware that I may be pissing up a rope here. However.
I'm a physician, and I'd be happy to let every drug (except antibiotics) be over-the-counter. Kill yourself, make yourself better, get high - it's really no skin off my back. But good diagnosis is hard, and it's definitely not automatable except in the most trivial of situations. After all, if it were automated, you'd have a great product to sell to physicians who could then hire a vast cadre of nurses to do the patient interviews and generate the diagnoses, which they could then swoop in and bill for.
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After all, if it were automated, you'd have a great product to sell to physicians who could then hire a vast cadre of nurses to do the patient interviews and generate the diagnoses, which they could then swoop in and bill for.
I think a lot of doctors would have an instinctual reaction to a product like that along the lines of, "you can't replace *me* with a machine" and their resistance would make developing a market for it pretty hard. After all, its been widely reported that doctors in the US have been pretty resistant to science-guided treatment and drug regimens, preferring their own personal (anecdotal) experience over guidelines derived from broad-based studies.
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Now, when it comes to evidence-based medicine (EBM), there's a whole separate controversy. The ultimate problem in medicine is that very few studies are actually of good quality. This is partly limited by ethics, and partly limited by the sheer difficulty of enrolling patients. Classic example? There is a simple device called a pulse oximeter that measures the degree to which your hemoglobin is satu
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evidence based medicine does have its place, and i think that we, as physicians should do our best to make sure our practice (using both local and national standards) is evidence based. however, as noted above in the pulse ox comment, sometimes current practice cannot be overcome by EBM. another ex
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And the "ME MY OUR" mentality all works wonders when you are technology centric enough to make it work, and conscious enough to apply it. But what happens when you are unconscious? And even if you aren't unconscious, what happens to the 50% percent of humanity that is statistically dumber than the average Joe?
The sad truth is that we need a system that works, even for the dumb people who can barely scratch their names onto a piece of paper and believe in aliens, creationism, and/or the illuminatti. "You don
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Do you realize that you have everything you want? health providers are legally mandated to give you your health data under HIPAA. Just walk in and tell them you are making a request for a copy of your records as obliged under HIPAA.
Then you can sit back contemplate the stack of random paper and obscure electronic binary formats that they give you and wonder how to read it, and you will realize that the actual problem here is abo
Things like this tend to make people nervious. (Score:2)
Can you waive liability? (Score:3, Informative)
FTA:
California defines gross negligence as either a "want of even scant care" or "an extreme departure from the ordinary standard of conduct." In contrast, ordinary negligence consists of a "failure to exercise the degree of care in a given situation that a reasonable person under similar circumstances would employ to protect others from harm."
The "traditional skepticism" concerning agreements to release liability for future torts is expressed, the court said, in a California statute providing that all contracts with the purpose of exempting anyone from their "own fraud, or willful injury to the person or property of another, or violation of law, whether willful or negligent, are against the policy of the law."
I'd be interested if a lawyer (or other slashdotter) knew of a case where someone was denied remedy in a negligence case because they waived liability.
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Liability waivers are tested all the time in court, sometimes they win, sometimes they lose. Here, it would vary by state, but it sounds like Google agrees to be on the hook for direct damages anywhere, so if they did something (like publicly release HIPAA-protected info), I would think that a doctor who was sued by a plaintiff could turn around and sue G
I trust no one with my health records (Score:4, Interesting)
I'll happily expose my genitals online but not my health records.
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Pics or your full of it...
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:The real problem with centralized records (Score:4, Informative)
It occurs to me I used a bunch of industry specific acronyms in the above post; let me define 'em...
PHR - patient health records
PHI - protected heath information - mostly equivalent to PHR, but sometimes with private doctor-to-doctor discussions (such as a patient's drug seeking habits)
EMR - electronic medical records - "EMR" software as a class basically is the eletronic equivalent of the wall of paper charts in your doctor's office. most PHR exchange will happen between these types of systems, or be printed out, edited, and faxed (sometimes to another EMR).
credentialling / credentials management - tracking of doctor licenses, certifications, etc... this stuff is personal information about the doctors (ssn, etc) that's flying around between their office, the govt, and insurance companies.
NPI / NPIDB - National Practitioner Data Bank - government database of the public parts of a doctor's credentials; that's trying to unify and replace all the others that are out there (UPIN, Medicaid, Medicare, DEA). It's in use, but the information frequently is years out of date, even with the best intent of all involved.
Re:The real problem with centralized records (Score:5, Informative)
The thing is that a decentralised system isn't a bad thing at all. PKI was designed, from the start, to be usable as a non-centralised system (non-pyramid). Realistically speaking, using the same example as the one you offered, where a doctor needs to validate medical records provided by the patient to be truthful, you only need to verify the other doctor's credentials and a signed file.
Now we get back to the old "How do I trust another doctor's certificates?", well, we use a centralised service. Each doctor needs to enroll [nist.gov] (Google cache [google.com] of the same document) to get his certificates, and they are delivered by a central authority, possibly governmental (or whatever authority governs doctors in your country). It's not a very hard thing to do, and can be implemented for roughly a couple million dollars -- the whole system.
How many doctors are there in the US? A laughable amount if you compare how many certificates are issued for the DoD. Heck, you could even implement it to be fully PIV-C compatible, and get cross-certification from the US government, and would allow doctors' credentials to be easily validated during a crisis.
Heck, nobody even needs to own the PKI solution in the US. The government can do it for you, if you are a valid organisation, an excellent project provides certificate management [idmanagement.gov] for you. Outside the US it gets a bit more difficult, as interoperability is not quite as great as in the US, however PIV is starting to have quite a lot of traction in Europe as well (I can't remember off the top of my head if it's PIV-I or PIV-C that is being implemented with the UK police forces). A pretty good read [nist.gov] (Google cache [google.com] as it doesn't seem to be loading from here) about how data is provided on a PIV smartcard.
That being said, maybe the health care professionals ought to have raised their voice at the same time the engineers and scientists did [nist.gov] (Google cache [google.com])?
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I agree with you: decentralized is fine; and decentralized + PKI would be even nicer security wise. And as a patient, I'd trust it over a central system for all the reasons mentioned elsewhere in this discussion.
My main point was that while PKI is optional for decentralized PHR, in order to develop a centralized PHR system like Google Health, you pretty much *have* to have PKI before the doctors will use your system. The lack of trust is a design flaw which, somehow, I don't think any of the centralized phr
risk (Score:2)
do you want a google for preexisting conditions? (Score:2)
do you want a google for preexisting conditions?
Where you can a google search a way from being TOLD NO HEALTH CARE FOR YOU!
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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.
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Before you complain about number 2:
There are certain guidelines that, if followed, are supposed to improve mortality. The problem is some patients are just lost to followup, therefore miss out on the procedures that may potentially save their lives (such as colonoscopies).
If the database is not drilled for these procedures, I can see a lawsuit happen from the family members of someone who got lost to followup and then died of metastatic cancer (due to a missed colonoscopy) or sudden death (due to not getti
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BTW, as a developer of an EMR (or as it's currently called, EHR - Electronic Health Record. Gotta keep up with the buzzword bingo) and friends with a number of doctors using our EMR, competitors' EMRs, and plain paper, the number one problem with using electronic records to get more money is that the insurance companies are on to us.
One doctor started getting regularly audited by Medicare because their E&M code "bell curve" shifted upwards - they were doing more level 4 and 5's than before, all because
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I believe 2014 is the target date to decrease physician reimbursement by 5% for not using EMR software
You should NOT be billing defensively! You need to have competent chart-audits regularly and bill for what you actually perform. You need to keep meticulous notes to v
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More costs than you would think! (Score:3, Interesting)
There still are large amounts of paper necessary for day to day operations and getting Doctors and clinics to effectively use secure online services has been nothing short of a nightmare. It costs more to do day to day operations and many say they would find going back to simple reliable terminal based systems more efficient and cost effective! The costs of supporting, securing and system training for PC based software is over the top and is a tremendous burden on any essential service.
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...
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Really, all rudeness aside, I would love to see this list of companies willing to risk liability for accidental disclosure. And on what planet do you think Google can indemnify themselves from criminal liability?
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What you actually think Google is the only data warehouse on this planet? There are plenty of HIPAA compliant medical transcription services that already handle patient records. You didn't realize hospital outsource transcription services? Not to mention, the insurance companies have a electronic clearing house too.
So how does the lack of me providing a list of competitors indemnify Google?
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All those points are well and good, but none of those "license agreements" really hold up if people sue, especially en masse.
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Sure. I'll help the lazy troll...
Kaiser Permanente is working with Veteran Affairs and DoD for their EHR exchange and below is a small portion of a list of EHR software producers and service providers:
Allscripts
Waiting Room Solutions
EaseMD Solutions
McKesson
Pure Safety
Smooth Practice Solutions
IOS Health Systems
Eclipsys
Antek Healthware
SpectraSoft
HealthPac Computer Systems
EMR Experts
Intivia
Marshfield Clinic
Bay View Soft
ProtoMED Medical Management
Clinix Medical Mana
they missed hippa? (Score:2)
Violation of HIPAA? (Score:1)
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.
HITECH law changes make Google a Covered Entity (Score:1)
And therefore covered by HIPAA.
Google Health = PHR NOT EMR (Score:2)
It should be pointed out that Google Health is not an Electronic Medical Record, it is an online Personal Health Record, with patient entered data. It may be handy in some cases, such as if you travel a lot and want a common place to keep your allergies and medications, and some basic information may be able to interface with existing EMR systems on a read only basis, but it is in no way equivalent to an Electronic Medical Record.
Not surprising... (Score:2)
I have no idea why the summary says "surprisingly few" are using this. People don't want it, even the people who don't normally realize how much data they're giving away don't want this. It's not easy for the medical profession to use and it doesn't really provide anything of great value to the patients either. First, try getting your medical records from a doctor or dentist some time-- every doctor I've ever talked to about it (I move a lot) always gives me a hard time when I request copies of everythin