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After OPM hack, dump idea of centralized electronic medical records

After OPM hack, dump idea of centralized electronic medical records

Send the idea to the death panel.

Electronic medical records were supposed to save doctors’ time and improve results by putting your entire medical history in one place.

Two major problems.

First, it doesn’t work. What takes a physician a couple of minutes to write on your chart now can become a burdensome scroll through computer screens:

Government regulators are backing down from many of their toughest requirements for doctors’ and hospitals’ use of digital medical records, just as Congress is stepping up its oversight of issues with the costly technology.

Under the Affordable Care Act, doctors and hospitals are being pushed to switch from paper to electronic records….

The federal government has spent about $28 billion in incentives to help doctors install and use EHRs, also called EMRs.

But these digitized records remain the bane of many doctor and patient relationships in the Louisville area and across the nation, as physicians stare at computer screens during consultations….

Electronic health records “have made our lives harder” without improving safety, said Jean Ross, co-president of National Nurses United. Last year, the nurse union called on the FDA “to enact much tougher oversight and public protections” on electronic health records use.

Meanwhile, the medical industry is urging HHS to give it even more time and flexibility to improve systems.

“The level of federal involvement and prescriptiveness now is unhealthy,” Wachter said. “It has skewed the marketplace so vendors are spending too much time meeting federal regulations rather than innovating.”

Politico further reports that the idea of electronic records, conceived as an idea under G.W. Bush but implemented by the Obama administration, found a lot of federal money chasing an idea whose technology was not ready:

President Bush’s dream only started to flower when Obama started cutting big checks….

In surveys, doctors describe the EHR as the biggest cause of job burnout—worse than long hours, billing and other nuisances. One frequent complaint is mental strain. In the computer, the doctor’s note goes from being an almost literary narrative of the patient’s condition to a series of checkboxes. Each visit reads much like the last because the computer software provides exhaustive information with the object of satisfying billing needs. The doctors can’t tell one patient from another in the absence of idiosyncratic impressions. The memorable rash or symptom a patient reported is buried in screen after screen of seemingly trivial data. In an ER or ICU, with time of the essence, this can become a critical safety problem.

All is proceeding just as I expected, Destroying healthcare, one form at a time.

Equally important, recent hacks of major health insurance companies reveal our worst fears that the most personal information will be exposed to a foreign government, criminals, or just malicious people out to ruin lives.

Data about more than 120 million people has been compromised in more than 1,100 separate breaches at organizations handling protected health data since 2009, according to Department of Health and Human Services data reviewed by The Washington Post.

“That’s a third of the U.S. population — this really should be a wake-up call,” said Deborah Peel, the executive director of Patient Privacy Rights.

The data may double-count some individuals if they had their information compromised in more than incident, but it still reflects a staggering number of times Americans have been affected by breaches at organizations trusted with sensitive health information. And the data does not yet reflect the hack of Premera, which announced this week that hackers may have accessed information, including medical data, on up to 11 million people.

The OPM hack is particularly troublesome and deep, ABC News reports, as it demonstrates the danger to nation-state hackers from information under federal government control:


ABC US News | World News

The Washington Post article below documents one doctor’s experience with federally mandated electronic health care records.

The story is familiar, as I’ve heard it myself from doctors. Doctors always had to spend time filling out insurance forms, but now it is so much worse. To comply with federal Medicaid and Medicare regulations (plus new Obamacare regs) not only means having the staff to comply (hence, doctors moving to larger practice groups or hospital-affiliated groups), but also more and more time spent trying to comply with electronic medical records requirements….

It’s professional death by a thousand forms.

The massive hack into federal systems announced last week was far deeper and potentially more problematic than publicly acknowledged, with hackers believed to be from China moving through government databases undetected for more than a year, sources briefed on the matter told ABC News.

“If [only] they knew the full extent of it,” one U.S. official said about those affected by the intrusion into the Office of Personnel Management’s information systems.

It all started with an initial intrusion into OPM’s systems more than a year ago, and after gaining that initial access the hackers were able to work their way through four different “segments” of OPM’s systems, according to sources.

While we don’t need to go back to the stone tablet, I have zero confidence in the privacy of any centralized database, a concern I expressed in 2009 even before Obamacare was law, and again in 2011, Don’t worry, your centralized medical records are safe:

Creating a centralized electronic medical record is one of the primary goals of the Obama administration (and Bush before that, although not funded) under the theory that a centralized record will lead to greater efficiencies.

Don’t worry, your centralized medical records will be safe.

Unless, of course, someone working for the government decides to steal it and sell it, as happened in Israel…

Electronic medical records is a questionable idea, centralized electronic medical records is an unquestionably bad idea.

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Comments

Not A Member of Any Organized Political | June 12, 2015 at 2:13 pm

Bravo!

Re: “Electronic medical records is a questionable idea, centralized electronic medical records is an unquestionably bad idea.

It all started with an initial intrusion into OPM’s systems more than a year ago, and after gaining that initial access the hackers were able to work their way through four different “segments” of OPM’s systems, according to sources.
—————————————-
Yes, yes. You are in the hands of top men…TOP men…!!!

They are smarter than you. Trust us.

To which I say…SKKKEEEEEEEEEEEROOOOOOOO you. Hard.

I would imagine that even the lovers of ginormous government do not want a central database detailing the aftermath of their sexual exploits. But, maybe that’s part of being “out and proud”. I don’t know.

Not only spatial diversity, but also independent trials, is a rational approach to mitigating risk and improving processes.

I think the concept of “death panel” is an unsophisticated construct that will be rejected in polite company. Let’s instead call the idea a choice — a bundle of unwanted and inconvenient policies — and plan for its liquidation.

    Sammy Finkelman in reply to n.n. | June 12, 2015 at 3:07 pm

    Restrictions on coverage exist wherever the government pays for medical care and also wants to cut costs.

    Here’s an example of how it could kill someone:

    https://en.wikipedia.org/wiki/Meir_Dagan

    On October 17, 2012, it was reported that Dagan had been suffering from a previously undisclosed illness, and had undergone a successful liver transplant in Belarus ten days before.[19] As criteria for a liver transplant in Israel dictate the patient must be no older than 65, the 67-year-old Dagan had to seek treatment abroad. Israeli Foreign Minister Avigdor Lieberman helped facilitate the operation. On October 27, 2012, Dagan returned to Israel and was immediately hospitalized.[20] He was discharged from Ichilov Hospital and began recuperating.

    Meir Dagan had to get help, or at least got some advice and introductions, from the Israeli Foreign Minister!!

    Do anyone want to call their Congressman if they encounter a severe medical problem?

    Politically connected, or medically sophisticated and highly educated people may find ways around the death panels, especially if they have money.

Anyone believe that all this hacking wasn’t coordinated with the powers that be in our white hut.

    healthguyfsu in reply to LEEJAN. | June 12, 2015 at 3:24 pm

    My tinfoil theory is that an insurance conglomerate is behind it to see if they need to raise premiums based on all of the new patients that they have so little medical information about.

    Paul in reply to LEEJAN. | June 12, 2015 at 4:23 pm

    It’s well known that the “Chicago way” in politics is to find dirt on your opponent and then use it to control him/her. Barry would never have been elected to the Senate in the first place if he hadn’t employed those dirty tactics on his opponent.

LukeHandCool | June 12, 2015 at 2:56 pm

Arrrrrrrrgh!!!!!!!!!!!!!!

Doctors had already devised an encrypted system which could not be hacked nor deciphered.

It was called their handwriting!!

Midwest Rhino | June 12, 2015 at 2:57 pm

Sending our money or data to DC is a big problem. Both get used irresponsibly, or maliciously, often against us.

After Chinagate, and Hillary’s basement servers, somehow the Clintons seem tied to this fiasco. Does anyone remember filegate?

Craig Livingstone, director of the White House’s Office of Personnel Security, improperly requested, and received from the FBI, background reports concerning several hundred individuals without asking permission. … Livingstone resigned from his position. Allegations were made that senior White House figures, including First Lady Hillary Rodham Clinton, may have requested and read the files for political purposes, and that the First Lady had authorized the hiring of the underqualified Livingstone.

https://en.wikipedia.org/wiki/White_House_FBI_files_controversy

But I’m sure Hillary deleted all sensitive information on any political opponents, right? I wonder if Billary gave any million dollar speeches to China front groups around the time access was gained. It sure wouldn’t surprise me.

Sammy Finkelman | June 12, 2015 at 2:59 pm

One problem with EMR is that the precise form of records are dictated by non-physicians, or not by the physician keeping the record, because they are also standardized medical records.

And that creates many problems.

When I started practice, the ‘medical records’ I purchased were 3×5 cards. Reports from consultants told me what I needed to know or responded to my questions without extraneous (already known) BS and gave straightforward recommendations.

I know many physicians (but a tiny percentage) abused the trust of patients and insurance companies, but the overwhelming majority who have always tried to do the right thing have been their victims, too.

Certain aspects of EHR’s are very useful and helpful to me. Most of the documentation part, not so much.

Midwest Rhino | June 12, 2015 at 3:24 pm

Standardized forms might be useful, but not centralized. In time they should be able to just speak the data entry, and the data can be confirmed visually on screen or audibly, automatically scrolling to the right places.

A little more time and the machines will start asking questions and doing diagnosis. But if they are centrally controlled, some Hillary algorithm will mark us for death or diminished treatments. Especially after demerits for “voted tea party”, or the “white privilege”.

Here’s a name : Judy Faulkner

Here’s what you need to know : a top Obama donor whose company is the dominant EMR player in the U.S. health care market.

Electronic medical records are bad for you even if this hacking had never occurred. The main ingredient for a successful doctor visit is recounting your history, your symptoms, and discussing what you are feeling with your doctor. Thanks to EMR, the physician takes all this and puts it into drop down boxes and checklists. He can’t even make eye contact.

It’s bad medicine and it wastes time too. Here’s a journal article- ER docs spend 28% of the time with the patient and 44% of the time with the computer- http://www.ajemjournal.com/article/S0735-6757(13)00405-1/abstract It’s time to allow our doctors to decide what is best, let them run their own offices and keep their own charts.

@Neo – Epic. Every hospital that has converted to that system still shows the scars from the extremely painful transition. Now it’s moving into the Dental market.

Henry Hawkins | June 12, 2015 at 5:03 pm

I was interviewed by the FBI in about 2008 for a security clearance on behalf of a young Navy SEAL who’d been promoted into a spooky SF unit of some kind (he couldn’t identify it for me), after he listed me as a friend and neighbor. They went DEEP into my history and info.

It sounds to me like all that info on me is now in China, correct? Anybody know for sure? I’ve heard that this colateral info on me is in his file as a federal employee. Is that correct?

If so, I for one support our new masters, the Chinese.

他妈的我跑过来。

    LukeHandCool in reply to Henry Hawkins. | June 12, 2015 at 6:10 pm

    Henry,

    Don’t look at me. Listen carefully. Continue to act like you are reading a blog.

    You will find your instructions inside a fortune cookie after dinner tonight.

    Quietly crack the cookie open and when the guest we plant at the table asks you what your fortune says, reply,

    “Haha. Listen to this everybody! It says, ‘You will be asked by an NPR host about your dual American/Israeli citizenship and misplaced loyalty. Haha!”

    It is at this time you will regale the guests with stories you have heard about Israeli agents hacking into American computer networks, stealing information. You will reference the scary “Jewish robby.”

    Should you fail, you will not be preased how we crumble your cookie.

      Henry Hawkins in reply to LukeHandCool. | June 12, 2015 at 6:59 pm

      (roger, check, got it, i’m down, over n out)

      LukeHandCool in reply to LukeHandCool. | June 12, 2015 at 7:26 pm

      And Henry,

      If you disobey these orders, two Wongs will join your table to make it right.

      They will then order the Orange Chicken for you. It is dericious, Henry. Rearry to die for!

        Henry Hawkins in reply to LukeHandCool. | June 12, 2015 at 11:00 pm

        “dericious”? “Rearry”?

        OMG!!! Wacist in the house! WACIST IN THE HOUSE! WUN AWAY! WUN AWAY!

        Vascaino in reply to LukeHandCool. | June 13, 2015 at 10:20 am

        ” If you disobey these orders, two Wongs will join your table to make it right. ”

        If you had written wight instead right, that would have been wacist.
        One has to check on’s privilege at the door before entering.

    @Henry and LHC, I am laughing so hard right now; better than an SNL skit! You two should take this show on the road. 😀

      LukeHandCool in reply to Fuzzy Slippers. | June 13, 2015 at 2:01 pm

      We did, Fuzzy.

      I bailed out after the first night.

      It’s bad enough having to share a motel room with someone who snores like that.

      But to wake up and find he used your toothbrush and your hairbrush is full of hair … that isn’t yours?!

      I couldn’t take it.

      I mean, I could live with him “borrowing” (without asking) my razor …

      … but to shave his legs?!

      I mean, come on!

LukeHandCool | June 12, 2015 at 11:23 pm

Wacist?

It’s Elmer Fudd spelling you wily wascal, you.

https://s-media-cache-ak0.pinimg.com/736x/98/cd/0d/98cd0d8acbb363f87f2c64f6139a00d2.jpg

So . . . Is the idea that we would forget about electronic medical records and go back to paper? If so, we’re going to have an interesting world.

I spent around 22 years in a large teaching hospital, including 8 years as a medical data analyst and 10 years as a senior systems/business analyst. An EMR doesn’t just consist of your primary physician’s clinical impressions. EMR systems include registration, admissions, lab, imaging, physical & occupational therapy, pharmacy, patient supplies, and many other departments. These tie in with electronic billing systems, and that electronic information is used by insurance companies for reimbursement.

In the brave new world of paper records we’ll have to hire an army of people to shuffle all of this paper. We’ll have other armies of people adding up numbers on 10-key machines. Hospitals around the country will have to purchase literally billions of dollars of multi-copy forms. Hospital warehouses around the country will have to stock hundreds of millions of dollars of paper forms. Changes to forms will make old versions of the form obsolete, fit only for the recycle bin. Other armies of people will have to enter information from the paper forms into billing systems. Or maybe the electronic billing systems will have to go, in which case insurance companies will have to hire their own armies of paper pushers.

When your doctor wants to see your creatinine values for the last two years he’s going to have to flip through a lot of paper to find that out. If a lot of your lab work was done at a hospital or another clinic he’ll have to order that paper record to be delivered in time for your visit. Then that paper record will have to be returned and refiled. But not to worry, at least your doctor won’t be looking at a computer screen. He’ll be flipping through a four inch thick paper record.

When you get sick and show up at the emergency room at midnight the ER doc won’t have access to your physician’s paper records. If you’re unconscious the ER doc will have no idea of what medications you take, your medical history, your current problems, or anything else. So that could be be interesting.

After we get rid of electronic medical records we can get rid of electronic bank records, electronic pension records, DMV systems, personnel records, etc., etc, and then we’ll never again have to worry about anything getting hacked. When can we start?

How long is it going to take for our less than diligent representatives in Washington to fix 99% of this problem? If someone wants to get a loan or credit card, they need to show up in person somewhere and show ID. So much for being able to steal someone’s identity all the way from Beijing.

Of course, the credit card companies will scream about this idea — but they aren’t the ones paying the price for all this identity theft crap. We are.

Hi Prof,
It seems that on your latest trip to Israel you left one aspect of the lives of Israelis out of the tour.
All the providers of health care are computerised and no matter where in the country one is, with the swipe of one’s card the provider’s local Dr., has access to one’s history.
With the case of a hospital needing info it’s the case of a phone call by the hospital and getting a fax in return to almost immediately deal with the patient.
Each provider has its site where one can make appointments, request certain tests and find the results of tests.
One’s local Dr., has become adept at typing instead of writing and if necessary issuing printed forms.
Making a request for a consultaion with a specialist or a special test is simplified for the Dr.,as all the info necessary is collated by the m/c and printed out for the patient to take.
All medication is on the computer and the pharmacy can, with the swipe of one’s card, see exactly what they can dispense.
The hospitals have separate sites and with their special card one has access to one’s tests.

    moonstone716 in reply to Vascaino. | June 15, 2015 at 6:40 pm

    So the system is just a dream come true….at least until you turn 65, at which point if you get a major disease you are allowed to die (see Meir Dagan link above)?

    Am I correct in assuming you are younger than 30?

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