The pains of a nationalized EHR

There is no accountability. The cool thing about the DoD system is that the users are aculturated to following orders and being “team players” as well as working in a system notorious for punishing gadflies. So, when the collective says “The sytem works great”, the people in the trenches all repeat the mantra on cue, even if it really isn’t.

The great thing about it is that one of the biggest problems with EMR, privacy, is something military personel are conditioned to not expect.

All these “company docs” in institutions going whole hog for EMR without hammering them on the privacy issue are setting the whole profession up for a huge embarassment.

The IT guys just treat it like accounting data and haven’t a clue what is really at stake. Even a lot of docs just think about basic stuff like BP, lab numbers and don’t stop to reflect what is REALLY in there and how the doctor-patient relationship is going to be affected when being victimized by the inevitable massive security breaches becomes a common experience.

You can publish my BP and cholesterol in the local paper, I won’t care. But medical records also includes records of sexual behavior, family conflicts, character flaws, poor self-care, substance use, and moral and social “incidents”.

The IT people treat it like accounting data, but it is different because of the shame associated with our health, our bodies, our behavior, and our emotions. Once the public starts to realize that the medical profession is no longer containing the information entrusted to us on these matters, they will no longer confide in us about them.

Then certain kinds of quality health care will no longer be possible. What is left of “soul healing” in psychiatry will disappear entirely. What is left of the primary care doctors role as confidant and sage counselor will be history. Many diagnostic puzzles will be insoluble because of the lack of frankness.

A lot of “just the numbers doctors” won’t miss it–they are in fact the problem now as they are missing all the rest of it now without a clue. They are also the ones sitting on the “EMR committee” letting this stuff happen.