Best you stay anonymous with that kind of nutty and overwrought fretting.

What is released to insurance companies is only released with the patients permission and is limited in scope–not the entire record and not all the records of your practice.

As for your being annoyed . . . well be annoyed, be very very annoyed. From your comments I am convinced that on this issue, my ethics and understanding of my obligation is superior to yours–not as good with the prissy-assed comments though.

Don’t get your pants in such a bunch. I care as much as I always have about confidentiality and keep my practice as compliant as the next guy. Why you think my “attitude” troubling is beyond me; I am sure you don’t know me, but your presumption of ethical superiority is both annoying and unjustified. I don’t get on my high horse about privacy as a primary reason for not adopting an EMR because there are so many other more obvious and compelling reasons than that to not convert to EMR right now. The ethical reasons are a very distant reason to object, so distant that they are not relevant to my consideration at this time. Sorry that doesn’t mesh with your thinking, but that is the way of the world.

And just because someone chooses to differ from your thinking does not make them your ethical or moral inferior. Kindly get over your silly self.

There is no unbreachable security as concerns medical records, unless you choose not to keep records at all. Offices with paper records have to be cleaned, have to have workmen in, and charts pass from doctors–your “covenanted” ones too–to their employees (not so covenanted) and back.
There might not be the data mine-ability in paper recordkeeping, but patients long ago surrendered absolute information security once they turned their payment over to third parties. Patient names, social security numbers, dates of birth, dates of service, ICD codes and CPT codes have long been fed to third parties, with patients’ express permission. It is not my duty to police what those third parties do with that information. If they breach that confidentiality by selling to other parties, they face the consequences. Is that so difficult to understand? Or are you so out of touch with the way medical practice has operated for the past forty years that you don’t understand this to be the case?

I took the Hippocratic oath. I think an oath is something serious and breaking mine would trouble me. I think medicine is moral enterprise which shoud only be practiced by those who take oaths and duties seriously. There are too many opportunoties for a conflict between the doctors self-interest and the patients interest for it to be otherwise. Your attittude troubles me greatly.

Your are right about HIPAA, but HIPAA is not the origen of or definitive of the physician’s ethical obligation, which is at least 2500 years old, is a central defining feature of allopathic medicine, and preceeds and supercedes the relevant law.

Look at what we have in reality? We have overpriced sytems that look more like Windows 3.1 – Programmers, have you ever heard of MAC or have you seen Vista? Have you ever been to Yahoo.com? Have you thought about “ease of navigation”? I doubt it.
The system my health care system has presented me is a prime example of a clunker. The core was programmed 20 years ago, and you see it and feel it. History and tradition are a good thing, but not in software. It is so old fashioned, you see the Windows 3.1 still peeking through the creaks. It is crystal clear that it is a patchwork of not very well integrated components. It is embarrassing. Amount of work that has gone into investigating consumer needs and making it easier to use: Minimal. Price: Maximal.

And, talking about money. The clumsy Centricity that I am using has a completely separate billing component. The billing component knows nothing about what goes on in the EMR. This is the biggest stupidity I have ever seen. Billing should be done fully by the software based on the documentation. And should you fail to immediately understand this, you do not belong here in this discussion. We document what we do and we bill according towhat we do. Billing is 100% dependent on what we do, straightforward. So simple, a caveman could do it. And the famous software package Centricity of the famous American company GE should be able to do it too. It should be designed to do it in the first place. It should not even be separate from the documentation part, it should be a completely integrated part of documentation.

With all due respect, Scott is not a physician and has never used an EMR in daily life. I just finished implementing an EMR in my practice. As a hospital employed physician I did not have to buy the system, I just received the hardware and software and started using it.I am a computer enthusiast. And I was very, very disappointed by the EMR (Centricity from GE). It slows me down, it drains my productivity, it makes simple tasks complicated, every little thing takes clicks and click and clicks and more clicks and then some more clicks. It does not provide good access to data, it does not give me the same quick overview of a patient that I had in my paper chart. upon opening my paper chart I had the “summary”, a kind of history of the patient with some personalizing remarks and notes and reminders – all on the left side. one glance and I remembered the patient and knew what was going on. My EMR does not allow that, it only gives me the stupid ICD 9 codes, uncoded comments, notes and remarks are “forbidden”. When I protested about the lack in functionality I heard the sadistic comment “We try to keep the system standardized”. Hey, that works in big corporations, not in private practice. Another one is “We have to do this for patient safety” of “it is a HIPPA requirement”. Patient safety is such a fabulously chic buzzword at the moment. But it is a very bad excuse for a clumsy, klutzy system that makes you confirm and confirm and confirm again the most simple steps!
I drive a Volvo for security and it drives as well or better as any other car. Security happens behind the scene. My Volvo does not force me to stop every 100 feet to look around and it does not limit my speed to 25 mph in the name of safety, my car does not force me to stop before making a right turn and confirm that I really plan to make a right turn and so on.
Everybody out there, please understand. The sole idea of software is efficiency and ease of use.
The idea is the Three Click Visit. First click to confirm the history entered by the patient or the nurse, second confirming the template that the system chooses for you and third confirming the prescriptions that will be faxed to the pharmacy, the education leaflet printed for the patient and the automatic letter being faxed to the PCP.That would be a system everybody runs to adopt. Please do not try to find contorted far fetched theoretical reasons for “lack of adoption”.
IT IS THE EASE OF USE AND THE COST.
Repeat after me: EASE OF USE AND COST, EASE OF USE AND COST, EASE OF USE AND COST
And that, my dear concerned observers, is the reason that physicians are slow in adopting EMRs! EMRs on the market today are complicated, user unfriendly, inflexible and expensive. What a winning combination! We can’t wait to buy one of those systems. Did I mention that they drain productivity, but we get paid less instead of more? Physicians are just a tougher clientele. We are not employees in a big corporation where you can simply slap a computer on each desk and say: put up with it or leave. We actually (still) have the freedom to choose (still). We would love to have EMRs, but we are not going to put up with crappy ones. So, make some good ones, and keep the price down. Is that so hard to understand? If Yahoo was as difficult and clumsy to sue as my EMR, it would already have vanished from the net.
Can someone please design a systems with a surface like Vista or Mac OS, a system that is built after careful user studies and user analysis, after studying what physicians do all the time, systems that physicians can adapt and mold exactly to the way they want.
And then make those systems cheaper. Forget the abusive purchase prices and the high maintenance costs. Doctors are not rich anymore!