Today, when I was skimming my tweetstream, I caught a message that stopped me dead in my tracks:
The ability to press one button and send a patient’s entire 600 page medical record to the new doctor belies the wisdom of doing so. #EMR
— John Trainer (@JohnTrainerMD) July 12, 2012
We spend a lot of time on these pages mulling over the best ways to get information from one provider to another, be it via the Direct Project approach, EMR integration across sites or HIEs. And all of this discussion is predicated on the notion that more sharing is largely a Very Good Thing.
And we have good reason to do so. For all of the bitterly skeptical things we can say about EMRs, in the rare cases where they’re humming like a fine ‘Vette they can improve care and avoid patient harm in a long list of ways. They can also serve as a repository for data which can be manipulated, studied, and learned from for both commercial and public health purposes.
But I had never taken a moment to stop and think how ease of sharing patient records might come with downsides of its own. I’m not sure which ones Dr. Trainer had in mind, but my guesses would be:
– HIPAA mistakes become much easier to make and much harder to fix, as data tends to stay where its sent.
– Clicking one button and sending 600 pages of information may be easier for the sending provider, but it may be far more data than needed, which can actually distract from finding the right information.
While security is of course a top priority for the business, making it simple for doctors to send just what’s needed isn’t at the top of the charts for EMR vendors to my knowledge. Maybe it should be.
The CCD and CCRd patient data exchange formats at present seem to have a focus on sending entire clinical data sets.
Things get difficult in the area of data sharing when two provider organizations are seeing the same patient and both want to maintain a consolidated patient record.
Under this scenario, both will be sending the complete record over and over again at some established frequency and both will be getting back a complete consolidated record.
If the EMRs for two trading partners both do not allow backdating, an arrangement could be made to only transfer new data from the last synchronization.
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Of course there is such a thing as too much sharing—–in fact ‘Direct’ should be used so that patients, not doctors, send relevant information to other physicians and health professionals.
The right to segment and control who sees what has long been required for sensitive health information. Strong rights to prevent OTHER doctors from reading sensitive mental health and addiction records have long been the law in all 50 states because so many physicians are not comfortable treating people with these conditions and discriminate against them.
See a short video of “Julie” speaking at the June 2012 International Summit on the Future of Health Privacy about her experiences with ‘providers’ in Partners Healthcare system who read sensitive records of her abuse as a child that were NOT relevant and led to poor treatment at: http://tiny.cc/qmrpnw
When records are NOT controlled by patients, they often refuse treatment and omit information, causing bad outcomes. Patients do not trust all physicians equally, with good reason.
Deborah C. Peel, MD
Founder and Chair, Patient Privacy Rights