Primary Care Providers - Electronic healing Records - The Pros and Cons.
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In this digital age, more and more bulks of data which used to be paper-based, from library catalogs to telephone books, are digitized and stored in a central location for easy access. The idea of Emrs started about 40 years ago.
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The main proponents of Emrs cite the following advantages:
(1) The use of Ehrs supposedly reduces errors in curative records. There is no doubt that handwritten records are field to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of Emrs standardization of patient health records may finally become acheivable.
(2) Paper records can be undoubtedly lost. We have heard how fires, floods and other natural catastrophes destroy bodily records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the bodily records are gone. Emrs also help keep records of health data that patients tend to forget with time, i.e. Inoculations, former illnesses and medications.
(3) Emrs make health care cost-efficient by consolidating all data in one place. Previously, paper-based records are placed in different places and getting entrance to all of them takes a lot of time and money. In a systematic review, Kripalani et al. Evaluated the transportation exchange in the middle of primary care physicians and hospital-based physicians and found necessary deficits in curative data exchange. The report recommended the use of Emrs to rule these issues and facilitate the continuity of care before, during and after hospitalization. Emrs translates into better treatment for patients. Take the example of one asthma center's palpate with Emr: "A major benefit associated with Emr implementation was the growth in the estimate of children who were hospitalized with an asthma exacerbation and received an asthma performance plan upon discharge. Prior to the Emr system, [only] 4% received an asthma performance plan upon discharge. After implementation of the Emr system, 58% received an asthma performance plan upon discharge."
(4) Emrs can save lives. VeriChip, advanced by VeriChip Corporation is the first one of its kind ever popular ,favorite by the Us Fda. It enables rapid identification of at-risk patients and entrance to their curative history, thereby enabling rapid pathology and treatment especially in emergency situations. Superior examples are people with diabetes and/or heart problems who have high risk of collapsing and having attacks. VeriChip is also useful in vehicular accidents and other trauma incidents where the victims aren't capable of answering questions. In cases of large-scale catastrophes, VeriChip facilitates tracking and identification of victims. Agreeing to a coroner in Mississippi, VeriChip helped identify victims during the Hurricane Katrina incident.
Earlier this year, Google health was launched, an online personalized health records service. Google health is based on the principle that since it's the patient's curative record, the patient should control it, rule what should be in it, and who gets entrance to it. One of the features of the service includes records from hospitals and pharmacies that are Google Health-enabled or are registered Google health partners.
The HealthVault is another online health data storage service offered by Microsoft with features similar to Google Health. Keith Toussaint, senior program employer with Microsoft HealthVault recently stated " foremost hospitals like Beth Israel Deaconess curative town are undoubtedly integrating their systems with both us and Google -- because some people like one or the other. It's a Coke or Pepsi thing."
What are the disadvantages of Emrs? Not surprisingly, privacy rights advocacy groups are the main opponent of Emrs. Here is what they have to say:
(1) Emrs threaten our privacy. In this day and age when people's mantra is "I need my privacy", not many people are comfortable about having their whole curative history recorded and digitized for approximately just anyone to see - in other words, incursion into people's privacy. The confidentiality of doctor - patient association is still sacrosanct. Besides, curative data can be used against a someone in some cases - be it for a job application, guarnatee coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more contentious you are in the job market. The planned incorporation of genetic data in Emrs supplementary adds to people's fear of incursion into their private sphere.
(2) Emrs can lead to loss of the human touch in health care. In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. Emr is naturally about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal concept on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.
(3) Emrs are not that efficient. Despite efforts in digitalization and standardization, Emrs are undoubtedly far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's Emr ideas is not compatible with that of a normal practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of Emrs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their Emr implemented in 2006-2007.
(4) Emrs are not safe and secure. Google health and HealthVault are quick in assuring patients of the safety of their online health accounts. entrance to the patient's list is only possible using log ins and password. In addition, HealthVault assures that "all health data transmitted in the middle of HealthVault servers and program providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of safety to safeguard buyer health data from theft, loss, or damage."
However, there are cases wherein passwords and encryptions do not seem to be adequate as data safety tools. Stories of data hacking, stolen identities and blackmail abound. Even high safety databases such as those run by banks and reputation institutions are often compromised. This impression was aggravated by the many well-publicized incidences of data loss or breach. A few examples are listed below:
November 26, 2007, Canada. Hackers accessed curative data on Hiv and hepatitis from a Canadian health division computer. - September 22, 2008, Uk. The National health service (Nhs) reported the loss of 4 Cds in the mail containing data on 17,990 employees. - September 30, 2008, Us. The business Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, along with social safety numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a normal email.
In addition, there is comment over Google health not being a "covered entity under the health guarnatee Portability and accountability Act of 1996 and the regulations promulgated thereunder (Hipaa)" under its terms and conditions and is therefore not field to Hipaa privacy of individually identifiable health information. The HealthVault terms and conditions do not mention Hipaa privacy laws so it is not clear what its status is concerning this issue.
(5) VeriChip is not for humans. It is to be staggering that although many of us are amenable to the use of Rfid chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans, no matter what the Us Fda says. A big opponent of the VeriChip and similar chips of its kind is the buyer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and buyer awareness groups see Rfid tagging (be it on your someone or on the items you buy) as a major threat to privacy and civil liberties. They see the tagging as some kind of "Big Brother" operation. another group, the No VeriChip Inside Movement, likens VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers on the skin of attentiveness camp detainees. Popular Hollywood films on privacy incursions (e.g. The Net, social Enemy No. 1) increased supplementary people's paranoia about personal data.
Where do we go from here? Without doubt, we have the technology to make Emrs standardized and efficient. Google Health, Microsoft HealthVault and similar online personalized health data accounts are enabling patients to take control of their curative records. The main issues that need to be overcome are data security, safety of privacy and gaining the reliance of the patients. It doesn't seem obvious that the use of Rfid and similar tagging chips will become suitable or Popular anytime soon. However, we live in a digital world and we cannot hold back strengthen indefinitely. With improved technology and data safety tools, let us hope the Emr issue will be resolved soon.
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