Health records need to be online to improve health and save money

I exchange thoughts with healthcare IT people on a daily basis over at Twitter.  So many of them seem perplexed at why we patients look at putting our medical records on the internet with trepidation.

Then along comes this video from Elizabeth Cohen at CNN.  In a matter of minutes, she was able to pull up one of her CNN colleague’s medical records, his kids’ records. She could see which doctors they’ve visited, and what took place during those meetings.

HIPAA is supposed to protect us from others getting our medical records right?

We don’t want potential employers finding out we have to take meds to control blood pressure or cholesterol every day — it’s not their business!

And consider this scenario:  you have no health insurance, or maybe you’ve just been laid off and you’ve lost your insurance.  Now you need new insurance.  Well guess what?  Insurers are looking behind the scenes to find reasons to turn you down. Regardless of how easy it is for others to get your medical records, the Medical Information Bureau makes it easy for insurers anyway.

Here’s my opinion on this issue:  I absolutely believe our health records need to be online, both to improve our health and to save money.  Both are reason enough to do make medical records accessible digitally.

I do not believe patients should be putting their own health information online through Google or Microsoft Health Vault or any of the free applications out there, and I very much object to those large organizations (like the Mayo Clinic) which are getting in bed with these two privacy-sucking behemoths.  Those “free” applications are not free.

I do believe patients can keep track of their own records, digitally, through any of the pay-for-service PHR (personal health record) programs.  You can read about the differences between the free and service fee PHR programs.

Now the government is looking at ways to move all our records online, and they are ready to throw $20 billion into the project.  I support that — with this caveat:  part of that money must make sure that our records can’t get into the wrong hands — including Elizabeth Cohen’s — because while Elizabeth is only showing us the potentials, not everyone has our best interests or good motives for doing so.

By the way, Elizabeth takes time in the video to tell us how to protect our records.  Take a look.  It will serve you well.

Trisha Torrey blogs at Every Patient’s Advocate and is the author of You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Healthcare You Deserve).

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  • Finn

    I have 5 major issues with this premise:
    1. Nothing online is secure; someone else can always get into it. Ask any of the millions of people in this country whose credit and debit card info has been stolen.
    2. Passwords and security questions only make it difficult for others to get into the small part of our online records that hospitals, doctor’s offices, and insurance companies have decided to give us access to. We have no control over who gets into the rest of the records they keep on us.
    3. Insurance records in particular are often wrong. Mine, for instance, says I have cataracts. I don’t; how would that misinformation affect my ability to earn a living if I were a bus driver or an airline pilot?
    4. As long as health insurance is tied to employment, availability of medical or claims records means that people like me, with a history of cancer, or with chronic conditions like diabetes, will never be able to get another job because potential employers won’t hire anyone who may drive up their health insurance costs.
    5. Some diagnoses, like AIDS and other STDs, are even more strictly protected by law because of the fear and prejudicial attitudes they can provoke. This protection goes out the window when such information is put online.

  • jsmith

    I have been a family doc for 22 years. There’s no way I’m putting my family’s records online because I think paper is more private. If you want to put your records online, feel free. But there is no real evidence that it will save money or improve health.
    The feds throwing money at EHRs is more about pork than improving pt care. If you don’t already know this, spend more time at KevinMD.

    • brian

      Same as saying what if one of your employees made a copy of a record and put it out in public, or someone broke into your office. Anything can happen right? Are you comfortable performing online banking? Most of the softwares I implement have bank encrypted protection. There is an alert if an unauthorized user is attempting access, through which servers are monitored 24/7. It’s time for you to wake up as a healthcare professional. Im sure your mercedes is fully loaded, why not your office?

  • IVF-MD

    I respect the right to choose.

    If my patients wish to put their medical record online, fine. I’ll give them a copy of their records for them to post on whichever PHR system they desire.

    If my patients wish me to keep their records privately locked within the confines of my office and safeguard them from the internet, fine. I’ll gladly do that to the best of my ability.

    As for myself and my family, I will absolutely do my best due diligence to keep the information off the internet. I will even try to protect my dogs’ vet records. Anybody who has ever been the victim of INTENTIONAL identity theft or anybody who has ever been the victim of UNINTENTIONAL loss of privacy from bureaucratic errors will laugh heartily at any claim that records are safe online.

  • Donald Tex Bryant

    With the “meaningful use” criteria for EHR’s, one of the requirements is that patients be given copies electronic copies of their health records within 3 days of a request for such. It will be interesting to see how that information is supplied: (1) email, (2) secure portal into EHR, (3) flash drive, (4) other. I haven’t read any discussions by physicians yet on how they plan to achieve this.

  • Mike

    Put nothing online that you would not broadcast to the world.

  • Jackie Fox

    I’m with you all the way on this one. I’m all over the place online like a lot of us are, but I won’t go there with my medical records. I won’t go there with my pharmacy either! They keep offering and I keep saying no, thanks.

    Good post, thank you.

    Jackie Fox
    Author, “From Zero to Mastectomy: What I Learned And You Need to Know About Stage 0 Breast Cancer”

  • pcp

    “I absolutely believe our health records need to be online, both to improve our health and to save money”

    I would very seriously urge the OP to reconsider this statement and ask herself “Why?”. Don’t fall for the hype, but try to be very specific about how it would improve your health, and if it is worth the risks.

    I would never in a million years allow any of my or my family’s personal health information to be anywhere on-line.

  • IVF-MD

    pcp, you and I share the same respect for the truth.

    I would also extend the same courtesy to Ms. Torrey. Perhaps her statement of “I absolutely believe our health records need to be online, both to improve our health and to save money” is the valid truth and not a mere empty false statement from somebody buying into the extensive propaganda.

    But rather than argue either side based on opinion, I, too would like to be open-minded and hear the specific reasons for this assertion of hers.

    How specifically would having her medical records online A ) Improve her health and/or B ) save money?

    Thank you.

  • Finn

    The worst part is that patients are not given a choice. My health insurer and the hospital where 2 of my doctors practice put part of my record online without asking me. These are allegedly “secure portals,” but that assurance of security is meaningless.

  • Margalit Gur-Arie

    I would suggest that “online” is not the biggest problem. Once your records reside in a computer database, whether you can access its contents on the web or not, is secondary to the fact that those who run the servers have full access to your records and can extract them at will. Neither you, nor your doctor can do much about it and most of the time you won’t be aware that your records are sold or “shared”. If your physician, or hospital, has an EMR, chances are that your “de-identified” records are already traveling in cyberspace.
    Yes, HIPAA places some limitations on such practices, but not nearly enough to be meaningful.
    Having your records “online”, just means that in addition to everybody else, you too can gain access to your own records. So, might as well…..

  • elmo

    The idea of having y9our records online is just simply not a smart proposal. Hackers can and will access these records.

    @ jsmith:
    re: “The feds throwing money at EHRs is more about pork than improving pt care. If you don’t already know this, spend more time at KevinMD”

    Here ,here. The simple fact is the feds through the VA have a great medical record system (about the best thing I can say about the VA) that in my experience is much better to much better than anyone of the half dozen private systems I have used. The simple fact is this pork money is based on successful EMR vendor lobbying as opposed to patient care. If one really wanted to solve this problem then build a companion billing program for the VA system and institute it nationwide….end of story. One system and we can access records nationwide. I know that sounds socialistic but this is the same reason we have one nationwide army as opposed to 50 state militias. Instead we have dozens of systems or varying quality (they usually stink) that can’t associate with one another and some pie in the sky idea of a central warehouse. Complete idiocy.

    • pcp

      Isn’t the reason that the VA system works for patient care the fact that it was not designed as a billing system with a lousy patient care module on the side, like almost all commercial EMRs?

  • AA

    As an FYI, I am a person who completely tapered off of psych meds after being on them for 15 years due to experiencing horrific side effects and feeling that non med ways were more effective. Because of biases that many medical professionals have against people with psych med histories (including you need to be on meds for life come heck or high water), when I see a new provider, I don’t share that history.

    The thought that this would be online is terrifying.

    I appreciate the doctors who questioned how having records online improves health. I definitely don’t see it and the fact that my privacy will be invaded adds insult to injury.

  • Ted Rudolph

    Paper medical records – One fire/flood and you have no more records. Ask the people of New Orleans about that.

    Records put online can be hatched. No way around that fact. That’s why we are working on new schemas for data storage. “Bit Torrence” style data management is going to help solve this problem. Your medical record will be split into hundreds of data packages(XML) and storaged across hundreds of computers. Hatching into one computer only gets you 1 piece of a file. You would have to hatch into hundreds of computers and have the “key” to put the files back together.

    The weakest link would be the doctors computer, but at least the records would not be on the computer.

    • IVF-MD

      Thank you. Work hard to make a product worthy of us adopting it. And whether or not you do, please let it me OUR CHOICE of whether we purchase your product or not. Forcing us to do it is unethical, because it’s better that we adopt your product once we judge it worthy for our practice and for our patients, and NOT because some bad law coerces us to do it against our will. Fair enough?

    • Margalit Gur-Arie

      “The weakest link would be the doctors computer…”

      Nope. The weakest link is the owner of all those distributed and federated databases. Locking the house with the robber inside is what comes to my mind right now.
      Insurers don’t hack into computers when they want data; they buy it. Pharmaceutical companies buy it all day long. I am not selling anything, and I know doctors are not either, so where are they buying data from?

  • gjpearce

    The government is giving away $44000. There are free EMR programs like PracticeFusion. Is it greedy to just say I want to go for the money. I am 56 years old. I will retire in a few years anyway.I have a solo ophthalmology practice in a rural area. $44000 is a lot of money to me.

    • Jack

      It’s far more complicated than you think a free software can provide. I know nothing about PracticeFusion. But there are MANY parameters that your EMR needs to satisfy before you can apply for the $44,000. Chances are by the time you pony up the $$ it’ll be close to $44K.

  • Jack

    I suppose the idea is that everyone that NEEDS to access that information can have it at their finger tips. However, this can be achieved if the government would CREATE a NATIONAL EMR software FREE to healthcare providers that will share DATA. The data is store both locally at doctors office and at multiple data sites so information can be accesses by other providers when needed.

    Make it an FEDERAL offense for non-authorized personal to view or collect patient data and large fine $1 million per patient data stolen (or something to that degree).

  • Donald Tex Bryant

    Achieving meaningful use over the 3 or 4 years of qualification for the $44000 is not easy. A lot of processes will have to change at your healthcare site. It will take discipline and cooperation from all of the staff to achieve the mandated requirements and the selected ones. As Jack said earlier, the $44000 will cover the costs of adjustment and integration most likely.

  • IVF-MD

    That $44K did not drop out of the sky. If you take into account the inherent inefficiencies of a tax-collecting and redistribution bureaucracy, perhaps $88K (or more) was originally taken out of the free economy to end up with this $44K. Wouldn’t it have made more sense to skip the middleman? $88K could have done a lot to either bring down the cost of healthcare or otherwise improve the quality of life for doctors, staff and patients.

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