As more doctors and health care providers move toward electronic medical records and ultimately become part of a health information exchange network, who will have access to these records?
Will the front office staff have access? Your insurance provider? The government? Google?
“The biggest problem is loss of privacy,” said Dr. Hadley Callaway, keynote speaker at the Bryan School’s Electronic Medical Records (EMR) Implementation Conference in EUC’s Cone Ballroom. A past president of the North Carolina Medical Society, the surgeon is a faculty member at UNC-Chapel Hill. He is also a board member of the NC Health Information Exchange, which was incorporated in April.
The tension over privacy concerns vs. better health care was just one of the many topics discussed during the conference titled “Demystifying EMR Implementation.”
It was hosted by the Bryan School’s McDowell Research Center for Global IT Management, the nation’s first center to explore the worldwide applications of information technology. The center chose the topic because of the pressing interest in the subject of electronic medical records. As Dr. Prashant Palvia, director of the center, said in introducing Callaway, “It’s very timely.” Palvia had noted that while there are financial incentives for EMR adoption, there are obstacles and challenges.
About 105 attended. Ten vendors displayed their systems at booths and tables.
Edward Robinson, MD, noted that many doctors like to use “free text” – in other words, they want to type in what they observed. That allows for nuances, for opinions, full explanation, etc. But that is “the death knell” of a data base. With scans or free text, “the use of it as a data base is lost,” he said. Robinson is medical director of the Guilford County Department of Public Health and a faculty member at the UNC-CH School of Medicine. He will also be an adjunct professor at UNCG’s Department of Public Health Education, from which he received a master’s in May.
Eugenie Komives, MD, vice president and senior medical director at Blue Cross/Blue Shield of North Carolina, and Rick Moore, the National Committee of Quality Assurance’s chief information officer, also spoke on the topic of critical issues in EMR implementation.
Vendor presentations and a session on best practices in EMR implementation rounded out the conference.
A question that arises is, Whose records are they? Will they be yours?
It’s helpful to know the acronyms.
Your PHR (personal health record) can apparently be shared and controlled by you. However, Electronic Medical Records (EMR) will be for use by medical staff within one health care entity, such as one hospital. Electronic Healthcare Records (EHR) can be shared by multiple health care providers, using HIE. Healthcare Information Exchange (HIE) will be the standardized, interoperable exchange of healthcare records that providers can share.
As this standardized exchange moves forward in coming years, Callaway envisions certain scenarios arising. For example, some patients will want to go in and make corrections – or what they believe are corrections. Lawyers will be able to easily review the records patients pass to them, and more lawsuits may ensue. The “art” of medicine will go away, as doctors stick closely to protocols – knowing every move may be scrutinized. Records will be less candid, with fewer doctors’ opinions and judgments. The ease with which patients could move to another practice for elective procedures or second opinions will ramp up the use of advertising and marketing. He presented these scenarios as part of his keynote remarks, “Unexpected Consequences of Health Info Exchange on Medical Practice.”
Health information exchange holds many promises: more accurate records, better communication and coordination among providers, better and less expensive health care. But, as he noted with a slide showing the proverbial elephant in the room, there is a tradeoff. “We won’t have the level of privacy we have now.”
Additional information can be found at http://www.nchica.org/GetInvolved/CACH /The%20Future%20of%20Healthcare%20Information%20Exchange%20in%20North%20Carolina%20HA.pdf. This web page is the source of the information and acronym definitions in paragraph 12.
More information can be found at http://www.nchica.org/default.htm.