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Unhappy Camper (Vol 1, Issue 9)

Dr. Howard Schulman has a lot more guts than me.  While I and the rest of the uber-geek docs do our writing in this rather obscure website called DocEHRTalk, Dr. Schulman takes the story to where it counts—to the public.  Writing in the editorial pages of the Providence Journal this past Tuesday, he gave a very long list of very real problems he has experienced in using EMR. You can, and should, read the article at: http://www.projo.com/opinion/contributors/content/CT_schulman21_09-21-10_4LJTFP1_v7.2756dfd.html  If the policies of this DocEHRTalk website will not allow the direct link, I plead with you to go to the ProJo.com site and type in “EMR” into the search field to find the article yourself.

In my experience, I agree with every single point Dr Schulman makes, and he makes some very dark points--some points that I had never considered. His fifth point scares me most:  That large institutions, whether governmental or hospital chains, may be able to leverage undue power in driving patients and services the way they see fit.  The individual physicians that have to pay, and pay dearly, for the interfaces of their own EMR with that of the larger body will no longer have the ability to tell the patient to go elsewhere for consultative medical, surgical or ancillary care.  That is a rather scary thought when you thing long and carefully about it.

I would disagree with Dr Schulman’s concluding optimism about dictation EMR systems. As currently designed, I don’t believe there is any good mechanism for a physician to dictate their EMR note and fill in all the required structured data fields to chase those meaningful use dollars. At least not with any fluency of operation.

But, in my mind, not enough attention was paid to BOTH sides of the patient privacy concerns.  The concerns over patient privacy are all well and good, but what about the very real concerns we as physicians also have about our liability should a data breach occur? In could be through a dedicated hacker demanding ransom for the breached EMR (as happened in Virginia, see http://voices.washingtonpost.com/securityfix/2009/05/hackers_break_into_... ), or an inside job. Our honest and loyal employees could very well make an innocent mistake, or turn against us at whim, with financially devastating consequences to us through no fault of our own. Should a data breach occur the regulations will indicate that we must notify the police, the State AG, and every single patient whose data has been leaked.  The estimated administrative costs for such a breach has been estimated to be greater than $200 per patient due to costs of notification and providing credit monitoring services. And it won’t be the recently-fired $12 per hour employee who’ll be on the hook; you will. Then there is also the threat of governmental fines, and it has become apparent that attorneys general will not look favorably on data breaches, no matter the source One can just imagine the politically-motivated posturing by the AG’s office in such scenarios, as exemplified in this recent Massachusetts case (see http://www.ihealthbeat.org/articles/2010/9/10/mass-hospital-officials-sa... ).  Then there’s the media circus, God forbid,—local TV investigative reporters knocking at your door or diving into your dumpster. Consider me paranoid?  I invite anyone else to be the first practice in Rhode Island to go through it.

I inquired with some insurance companies last year as to whether they offered a product that would cover medical data breaches.  Doors were slammed, hard, fast, and with a resounding NO. One cannot even buy such insurance, at any price, in today’s market.  The only solution is legislative action that will give some legal protections for our side in the event of an inadvertent or malicious data breach. We really shouldn’t be all that cooperative in HIE efforts such as CurrentCare until we gain those protections.

We need all of us to step back and see just where we’re heading with EMR before this train is driven down our throats. Conventional wisdom says that when someone tells you that they’re from the government and are here to help you—run away fast, and run long.  Just because the government wants us to do something does not compel us to do so—unless it’s to chase those almighty meaningful use dollars.