[Med-privacy] EMRs

[peter marshall]

AARP Bulletin Online March 8, 2008


Electronic medical records can improve care and reduce errors.
Doctors and hospitals are making the switch.
One big hurdle: guaranteeing privacy.

By Patricia Barry


You're seeing a new medical specialist for the first time, but there's=20=

no paperwork to fill out. Instead, this physician has everything about=20=

you at her fingertips=97your medical history, your primary doctor=92s=20
notes, the results of your lab tests, the medications you're taking. In=20=

seconds it's all on her computer screen.

Or maybe a doctor is writing you a prescription for a newly diagnosed=20
condition. But first he looks at the computerized records to be sure=20
this drug works safely with other meds you're taking, and to see if=20
it=92s covered by your insurance. Then, with a push of a button, he =
sends=20
the typed script to the pharmacy. You needn't worry that the doctor's=20
handwritten scrawl will mislead the pharmacist into giving you the=20
wrong drug.

This is the future, but for some patients it has already arrived, as=20
more doctors and hospitals get "wired" by moving to electronic record=20
keeping and paperless prescribing.

Health information technology (HIT)=97the bland umbrella term for this=20=

revolution in health care=97promises vast benefits that go way beyond=20
convenience. "By computerizing health records, we can avoid dangerous=20
medical mistakes, reduce costs and improve care," President Bush said=20
in 2004 when announcing a plan to get most Americans connected to=20
electronic records by 2014.

Getting there means overcoming many obstacles, even though the medical=20=

community=97from doctors and nurses to hospitals and insurers=97recognizes=
=20
HIT's benefits. "HIT has huge potential, and in the next several years=20=

it will become much more universal than it is now," says Don Goldmann,=20=

M.D., a professor at Harvard Medical School and vice president of the=20
nonprofit Institute for Healthcare Improvement in Cambridge, Mass. "But=20=

we shouldn't underestimate the complexity and cost."

Above all, HIT raises big questions about patients' privacy rights and=20=

sensitive information getting into the wrong hands. That issue, still=20
far from being resolved, has for now stalled Congress' efforts to speed=20=

up the process of implementing electronic records nationwide. As many=20
as 98,000 Americans die each year as a result of medical errors,=20
according to the National Academy of Sciences' Institute of Medicine.=20
Another 1.5 million people are harmed by errors in medications.

Even simple technology can help reduce errors=97typing instead of=20
handwriting a prescription, for example. More than 3,000 drugs have=20
names that look or sound like others, according to the U.S.=20
Pharmacopeia, the official standards-setting authority for medications.

But errors can be made by keystroke as well as by scrawl. And that's=20
why experts say a full "e-prescribing" system, especially when combined=20=

with e-records, offers greater safeguards. If a doctor accidentally=20
types the wrong drug name when the patient's diagnosis is already in=20
the system, it can trigger an alert that the drug doesn't fit the=20
patient, says Allen Vaida, executive vice president of the Institute=20
for Safe Medication Practices, a nonprofit in Huntingdon Valley, Pa.=20
"The software can give alerts for drug interactions and allergies and=20
dosing. So if you happen to key in 200 mg when it should be 20, it says=20=

this dose is out of the range, so check it."

Providing instant checks and feedback for prescribing doctors=97and even=20=

giving them quick access to the latest medical research=97is a major=20
advance in improving the quality of care, says Steven Waldren, M.D.,=20
director of the Center for HIT at the American Academy of Family=20
Physicians. "It's like jet pilots. They know how to fly the plane, but=20=

every single time they get into a jet they have a checklist," he says.=20=

HIT "can provide the same functionality, so that the right thing is=20
done on the right patient at the right time=97every time."

In hospitals, another new safeguard is a bar code embedded in the=20
patient's ID wristband that can access the medical record. To ensure=20
correct treatment, nurses use a device like a supermarket scanner to=20
check the bar code repeatedly.

Linda Mays, 59, a Board of Elections clerk in Delaware, Ohio, noticed=20
this when she had surgery at her local hospital, Grady Memorial. "They=20=

scanned it when I left for the operating room, when I was in the=20
holding room and just before I fell asleep," she says. "It made me feel=20=

safe." Storing a patient's record in one file that several providers=20
can access in seconds can prevent unnecessary tests and lots of wasted=20=

time, doctors say.

Rebecca Fogel, M.D., a family physician now in Brooklyn, N.Y., had her=20=

first experience with e-records at a community clinic in Providence,=20
R.I. "In a word," she says, "it was fabulous."

Making sense of a patient's paper chart=97a binder maybe two or three=20
inches thick=97and trying to decipher previous notes on faded pages has=20=

"reduced me to tears of frustration" on occasion, she says. "At best=20
it's maddening, but at worst it's dangerous."

Searching an electronic record on her laptop is easy and reliable. "You=20=

keep clicking, and different screens pop up=97the patient's meds list,=20=

problem list, allergies, test results, past surgeries," she says. "It's=20=

all there."

Another plus: If a patient calls at night or on the weekend, the doctor=20=

can access the medical record on a home computer instead of relying on=20=

memory. And the system can instantly generate reminders of when=20
patients are due for tests, checkups or shots. "It just enhances what=20
you can do for the patient," Fogel says.

But some systems are more reliable than others, and converting to=20
electronic records can be complicated and expensive. A basic system for=20=

doctors' offices can cost $20,000 to $80,000. Still, the number of U.S.=20=

doctors in small practices using e-records is growing, reaching about=20
28 percent in 2007. Recent bills in Congress would offer doctors=20
grants, loans and other incentives to go digital.

The legislation also sets the stage for achieving=20
"interoperability"=97the buzzword for enabling different digital systems=20=

to share records seamlessly.

But the big challenge is privacy, a concern of patients, doctors and=20
policymakers alike. People need to feel confident that their medical=20
records remain private, or they won't want them in an electronic=20
system, says Deborah Peel, M.D., a psychiatrist from Austin, Texas, and=20=

founder of the Patient Privacy Rights nonprofit group.

"We don't have to get rid of privacy to have health IT=97in fact, we can=20=

have far more exquisite privacy protection with technology than we can=20=

with paper," she says. "But in this world that's the Wild West, where=20
anyone with a database feels free to use and sell your records, we need=20=

a safe place to keep records that we control." That place could be a=20
national health bank "with state-of-the-art Fort Knox security," she=20
says.

New legislation, Peel says, is needed especially to protect personal=20
health records (PHRs), into which patients can import their own medical=20=

records. "A PHR is not an official health record, so no laws cover=20
them," she says. "That makes them a perfect setup for data mining."=20
Patients should have a legal right to control all their medical=20
information, Peel argues, with penalties for those who breach it.

But that=92s a political sticking point in Washington. Some people, like=20=

Peel, want privacy rules enacted first. Others want to let the market=20
resolve the issue. Still others, in the face of congressional gridlock,=20=

favor legislation that would set up an independent body to develop=20
regulations outside Congress.

"That's the most pragmatic approach," says John Rother, AARP policy=20
director. "We need to both protect privacy and advance HIT as fast as=20
we can."

=09
Where It's Working

Boston's Brigham and Women's Hospital, with an advanced electronic=20
records system since 1993, reported an 88 percent drop in serious=20
medication errors in the first two years alone.

The Veterans Affairs health program's fully integrated, unified system=20=

gives VA doctors instant access to the records of more than 5.5 million=20=

patients anywhere in the country.


Copyright 1995=962008, AARP.=20=