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Accurate data collection for medical records is a great accomlishment, but Im curious why anyone would want the fed guv involved in it?
I became uninsurable for health insurance in my state because of an entry to my medical record by my family physician: "I recommended psychiatric counseling because of his strong feelings about vitamins."
From this one entry, no health insurance company in my "state" would insure me.
I was trying to get a folic acid prescription for my pregnant wife (you needed a prescription in 1974).
The medical profession refused to prescribe this B vitamin for anyone at that time, because it might mask the symptoms of an anemia.
I sure am glad my medical records are easily moved from Dr. to Dr.~~best thing that's happened in healthcare in years. Not everyone likes being restrained to one Dr. because he controls your records. Getting your record to in front of another Dr. when you become sick hundreds of miles from home can save lives and has probably saved mine.
If that's what you think EHR is all about, you have another think coming. That's how they were "sold", but that's not how it works. There are several platforms for EHR. They don't talk to each other. Some platform called "Epic" (the implications are hilarious, as in epic fail) is probably the most popular, but there are many others. Even with the same platforms, most get customized to the office, and there are HIPPA regulations and the like that prevent a lot of direct sharing.
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Originally Posted by HeyJude514
LOL. You certainly are all "gun hoe" about right wing conspiracy theories, even if your posts are rarely rooted in reality. Thanks for the laugh.
Electronic medical records is a good thing. As someone who used to audit medical records, I can tell you that there were many instances of paper being lost or misfiled, and when you wanted to transfer from one doc to another it could be a nightmare getting all your records. Welcome to the 21st century.
I agree with all but the transfer issue. Unless your new provider is using the same platform, there is not electronic transfer possible. Easier to read, yes. Harder to lose, yes.
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Originally Posted by Three Wolves In Snow
Do you people even read? Please explain why these agencies:
Federal Trade Commission, The Federal Communications Commission, The Department of Labor, The National Science Foundation, The Food and Drug Administration, The Department of Justice, The Department of Education...
Need to know your private MEDICAL information?
What makes you think they have access to these records?
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Originally Posted by middle-aged mom
Back when....my employer changed healthcare insurers every damn year. This almost always meant switching medical and dental practices to avoid paying out of network fees. It was necessary to physically go in and request a hard copy of records. Some practices charged a fee for this service.
Back then it was common to submit a hard copy claim and wait and wait and wait for payment. MDs, hospitals and patients waited for the paper to be processed assuming it was not lost, somewhere. Errors and omissions were common and the wait for correction meant further delays in payment.
Creating a system for coding major disease diagnosis goes back to the 1700's in Australia, of all places. An international list of causes of death, based on codes, was adopted in the 1920's.
Medical practices, hospitals and insurers began trending towards electronic record keeping and claims processing more than 20 years ago. Medicare and the Stimulus helped to defray the cost of converting to a standardized Electronic Medical Record ( EMR). Hard pressed to imagine anyone who would think maintaining and processing hard copy records ensured greater privacy or was more efficient than EMR.
Prior to the ACA a majority of states allowed insurers to discriminate against those with pre-existing conditions. Most states had a defined look back period that varied state to state. One state, Indiana, had no defined limit of look back. A 25 year old Cancer diagnosis could disqualify someone from future insurance. The ACA eliminated discrimination on the basis of prior or current health situations.
One would not know how widespread the flu was if there were no metrics. One would not know that say, Vermont was harder hit than other areas of the US. One would not be inclined to pursue why Vermont got hit harder than NH. Maybe fewer people in Vermont got flu shots or vice versa.
It would be impossible for states to monitor drug prescriptions or cooperate across states. Why are the MDs in Palm Beach writing 752% more scripts for Oxy than in say Boca?
See above re: sharing. I don't even know if it's possible to share when the same platform, e.g. Epic (Fail) is being used. We just switched to EHR in July, so I don't know if billing/insurance has been improved. We still have the same number of people working in admin. We still have our hard copy records too, as they have information in them from before this past July.
EHR has nothing to do with pre-existing conditions. If anything, it would make them easier to find, though!
You assume no records of say, flu, were being kept before EHR. This is incorrect. Reportable diseases have been reportable for decades. The report still has to be made to the state agency. The EHR doesn't automatically report a case of flu to the state.
As far as monitoring prescription use/abuse, EHR is useless for this too. Privacy restrictions still apply.
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Originally Posted by Frank DeForrest
Accurate data collection for medical records is a great accomlishment, but Im curious why anyone would want the fed guv involved in it?
Well, it's no more accurate than previously. Garbage In, Garbage Out.
Electronoc mediacal records sound good, however, there are serious issues.
Medical records traditionally have been written down and then transcribed either into a database or other paper forms. The trend today is direct electronic entry by the doc during the patient visit.
Any time data is transcribed there is danger of error and the error could be a serious as opposed to, oophorectomy date for a male patient.
Then there is Hippa and patient confidentiality. So the patient name is obscured by programmed codes. Downstream you might have the wrong patient. Especially if you are un conscious in another state and you are alone in need of emergency care. Hope the database didn;t get corrupted or the data exception report didn't bring up a false positive..in other words the associated retrieval and storage programs have been validated.
Add to that the complex and interpetive medical coding systems like medra, whoart, etc. All heirarchical coding systems which can classify meds, histories, conditions or advers events in new and novel ways which require a rationale to be correctly compared. Chest pain might be coded cardio by the typical autocoding system or inattentive coder of it could be code to track to muscoskeltal, meaning you tore a muscle throwing the football around with your kids. So which is when you arrive unconscious at an out of state hospital.
We have the nuclear explosion of the obamacare database that demonstrates the disasterous potential of government run programming despite the millions of overestimate cost.
We are going in the direction of on-line medical records though the 21st century is apparently not futuristic enoguh to have lives hanging by a thread conpounded by colossal government inefficiency.
Keep the feds out of our healthcare and tread gently into the future.
Train routed incorrectly due to data entry misplacing a decimal and meeting a low bridge.
And then huiman error aside from e-data
Sis goes to doc, says she smells geraniums.....could be a tumor or sinusitis, Later visit her records reflect she had an allergy to geraniums...Oops!
Mom goes to doc asks her how her new med is doing....Oops! wrong chart
Cardio guy says enlarged heart, other docs in his 'group' said to agree.... NIH says the echo was read wrong, no cardio issues, be free, go forth and multiply......Oops!
Pharmacist gives ziac instead of zestril as prescribed...big real big OOOOOOPS!!!!!!!
Rehab center gets wrong info from hospital admission and treats with nmeds for SOB shortness of breath..what ??? turns out the guy in the next bed admitted at the same time as mom reported those symptoms. Oops!
Huh, read the BP incorrectly and repeatedly, kid doesn;t have an adrenal tumor.....Oops! discovery from my due diligence not he hospitals.
kid might have an allergic reaction to Floxin the Er doc says, we'll give her another antibiotic.. heres a script for Cipro...Whoa, Oops!, hold On!! Cipro is also a quinalone. Huh? let me check. OOOPs! sorry about that. Your welcome.
So let's add e-data to that mix before it is ready, or the goverment imposes itself in the mix and see the death rate explode.
All of that stuff can happen in hand-written records, too.
Having interacted with the actual databases involved in EMR, I can tell you right now that EMR is the mother of all wishful thinking boondoggles simply by virtue of the cronyism with Judy Faulkner and her EMR baby - Epic. I've dealt with three systems (epic and two others) that represent roughly 80% of the EMR racket, and there's so much money being wasted down these EMR sinkholes it's absurd.
Besides Faulkner being a massive DNC donor and on Obama's immediate friends list, Epic is the glaring, shiny illustration of a form of corporate waste that is not only ubiquitous, but is only rivaled by the larger version used by the Federal government on a daily basis to waste vast sums of money for the enrichment of someone politically connected - proprietary contracts.
Before we discuss how it works, understand a couple things not too many people (and almost no executives) know - there are two main kinds of databases architectures: transactional and analytical. They have very different architecture and considerations, but also have very different utility. Here's a fun fact from someone with two decades working with both in 6 different industries including medicine, a bunch of global certs that say I know my way around them really, really well, and tasked daily with getting them to play nice with each other - any company that promises their one database does both well is lying, because one database cannot be constructed and optimized to do both well at the same time. It's impossible.
The next thing to recall is the promise of EMR - how it will save on future costs by streamlining decisions, alerts, diagnosis, and finding patterns within health care data that guides innovation to where it will make the best impact. That's how every politician, Democrat or Republican, has sold the EMR revolution to us. OK< back to EMR and Epic....
Yeah, Epic sucks as a transactional system, and the analytics are worse than awful. Why? Because it's proprietary. That's why. So if your Epic install isn't functioning well (and it won't be, since no out of the box install of an ERP or other large scale database ever does), you have to have Epic's people "fix it" or you risk the most feared thing in a corporate executive's life - violating your license agreement with a software vendor, which could result in...**gasp**...loss of tech support. So let us say the transactional piece fails miserably, as it did in Texas with an ebola case. Well, only Epic can fix that particular bug, and that will require months, more likely a couple years, to iron out...because you cannot dare risk losing tech support...oh hell no. And once more, a database is great at transactions, great at analytics, or bad at both, pick one of the three. Typically, the purchased ERP behemoth is super duper normalized transactional and comes with horrendous analytics. (for more on that, please see: "why everyone who ever bought Lawson or PeopleSoft for HR overspent by at least 3x what they originally thought, and went 3-4 years minimum past deadline")
Now, let's say the $70-80 million your hospital system paid for your Epic (or other EMR) install came with craptastic analytics (which they all do) and you'd like to hire some libertarian minded business intelligence/data warehousing/analytics pro to build you a better analytic system. Here's come Volobjectitarian and others of similar talent to do just that. Hey Epic, I need the hooks to your DB so I can drop all you data to my DW staging area to begin doing my DW/BI thing. What, I am not allowed to do that? Why not? Oh that's right, it violates the software license and we have to buy, contract and never modify your packaged anayltics that know nothing about our hospital, our staff, our doctors and most importantly, our patients.
And there's why it ends up as a big fat boondoggle. Proprietary contracts do not allow the data to be put to the one use the politician sells you on, which is all that data being "informationally" useful in a data warehouse analytic system. You must wait for the vendor to develop what you need, but only after you pay them 5-10x what it would have cost in-house IT to do, and in 4-5x the amount the time.
I've had the "nope, your hook to our DB violates the terms of the license" discussion with three different EMR vendors, and in every case, my management has told me too bad, we have to let them provide a solution. In one case, a simple dump of basic patient data kept in a total of four tables required maybe 3 dozen meetings and 9 months. I wrote the hooks, staging area and ETL routines in 2 days, offered to give them to the vendor's people, was rebuffed and waited for 9 months to see data in four tables. That's EMR in the real world. I can build a tailored DW solution for almost any industry in under 24 months. Top to bottom, every stage, every layer, even the user output tools. BUt myself and anyone like me are not allowed to do so because it messes with people like Faulkner's bottom line, who uses the threat of the license violation and executive group think to make sure nobody ever looks behind that curtain. Note - very often, this is where preferred "independent consultants" like Accenture, Deloite, Hackett, etc come in, who have prearranged pay-to-play with your behemoth vendor, so they appear as if they get the job done that your FTEs cannot, but it's another boondoggle as well.
On top of that, executives who say they want analytics really don't. Here's why - analytics can and often do tell them things about their own company they'd rather never saw the light of day. The manager who has padded 5% to bonuses every quarter for a decade, the supply chain that takes 30 days to fulfillment of which 15 days are totally wasted on workflow inefficiency, and yes, doctors and nurses being unable to efficiently navigate a byzantine transactional database system and the added complexity routinely causing real world life and death consequences. Etc etc. Every company wants DW/BI until they find out what DW/BI can tell them, then they don't want it as much. Great set of articles on this topic at the Data Warehouse Institute, the whole "but what if nobody wants BI to their job?" phenomenon.
So what happens is these big honking unicorn solutions that are supposed to save the world with data become nothing but really expensive spreadsheets nobody is ever going to look at housed on giant multi $million machines, tended to by a small army of consultants and yes men.
That's the EMR dream in practice. Feel free to be skeptical of just one person's view, and by all means, go ask any DW/BI pro in any industry who isn't employed by one of the behemoths, but is instead a full time employee trying to help their own company be more profitable with the purchases from said behemoths. Ask 100 of them, bet 95 or more tell you the exact same tale I just did. You'll begin to understand why EMR is a very costly joke being played on the entire country.
I sure am glad my medical records are easily moved from Dr. to Dr.~~best thing that's happened in healthcare in years. Not everyone likes being restrained to one Dr. because he controls your records. Getting your record to in front of another Dr. when you become sick hundreds of miles from home can save lives and has probably saved mine.
Did you miss this part of the OP?
...........Federal Trade Commission, The Federal Communications Commission, The Department of Labor, The National Science Foundation, The Food and Drug Administration, The Department of Justice, The Department of Education...
If that's what you think EHR is all about, you have another think coming. That's how they were "sold", but that's not how it works. There are several platforms for EHR. They don't talk to each other. Some platform called "Epic" (the implications are hilarious, as in epic fail) is probably the most popular, but there are many others. Even with the same platforms, most get customized to the office, and there are HIPPA regulations and the like that prevent a lot of direct sharing.
And where HIPAA doesn't stop you, the Privacy Act, software vendor licenses, and the company's own various levels of management will.
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Originally Posted by Katiana
See above re: sharing. I don't even know if it's possible to share when the same platform, e.g. Epic (Fail) is being used. We just switched to EHR in July, so I don't know if billing/insurance has been improved. We still have the same number of people working in admin. We still have our hard copy records too, as they have information in them from before this past July.
EHR has nothing to do with pre-existing conditions. If anything, it would make them easier to find, though!
You assume no records of say, flu, were being kept before EHR. This is incorrect. Reportable diseases have been reportable for decades. The report still has to be made to the state agency. The EHR doesn't automatically report a case of flu to the state.
As far as monitoring prescription use/abuse, EHR is useless for this too. Privacy restrictions still apply.
Well, it's no more accurate than previously. Garbage In, Garbage Out.
EHR records, if a doctor/hospital were so inclined to do so, would be cheaper and easier to deal with using low wage medical records transcriptionists and a few people good with Excel. Honest to G-d, given how absurd the licensing, cost and bureaucracy of EHR systems currently is. You're better simply paying a few stay-at-home moms $15 an hour to dump all your paper records into Excel, and storing on hard media. At least with Excel you could do some analytics, maybe. Epic is a pile of crap, and it's the best EHR system out there.
If only it stopped at that.. you really don't believe it won't go further ?
At that point it becomes conspiracy theories, and I just find that laughable, but it is hard to convince people of that when they are in fear of everything.
Accurate data collection for medical records is a great accomlishment, but Im curious why anyone would want the fed guv involved in it?
Oh they collect a ton of data. Nobody ever gets to do anything useful with all that data, but yes indeed, it gets collected.
All involving the government would do is add a couple zeros to the cost of the waste, fraud and abuse already perpetrated by Epic and its various competition.
Computer medical records are fact no matter what if you want to be treated. New System I believe is called Pecos. But you either are in it or no benefits from insurance to Medicare will be approved. Doctors are all joining to charge so even with cash its now your doctors record method.
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