| Also driving the move toward EHR is the fact that broad implementation of such systems will allow quick access to large amounts of data for researchers to use in determining effectiveness. This may become part of the federal government’s comparative effectiveness research agenda, now being revived for the first time since the mid-1990s, when Congress forbid the Agency for Health Care Policy and Research (AHCPR), and later its successor agency, the Agency for Healthcare Research and Quality, from developing condition-based guidelines. This followed an outcry from surgeon groups upset that the AHCPR guidelines on acute low back pain had denounced excessive and inappropriate early use of surgical procedures, in guidelines that also identified spinal manipulation as one of only two doctor-delivered procedures for low back pain supported by the scientific literature.
The Question of Confidentiality
A significant area of concern about the shift to EHR relates to the creation of a single cradle-to-grave record containing an individual’s complete lifetime health record. For example, if someone was treated for drug dependency, or depression, or incest-related rape at a young age, should this information be readily accessible by every doctor (or staff member) involved in their care for an unrelated condition at age 50? And should it be available to potential employers, insurers, voters (if the patient runs for office), or to anyone using the World Wide Web if a rogue medical staff member decides to upload a digital document?
The answer, according to Joe Brisson of HIT Associates, is that no document (even those at the CIA) can ever be considered perfectly secure, but that anyone accessing or forwarding such a document without permission would be subject to very harsh penalties. The security settings in certified interoperable EHR systems can precisely identify all who have accessed a particular document. As Brisson puts it, for a doctor spreading such confidential information without permission, “it would be the last time you ever practice.” Both Brisson and Steven Kraus, DC, of Future Health Software, also note that a patient’s records are not all stored at one location. Interoperable EHR systems work by swiftly gathering requested information from multiple sources, not by keeping them all in one database.
Significantly, Dr. Kraus emphasizes that “the patient is in control of what gets shared.” Patients must approve the sharing of records, and can decide what is to be included in any data transmission between offices. Patients will have personalized health records (PHR), composed of all their available health data. If the patient does not approve the sharing of certain data, it cannot legally be shared.
Kraus also reports, based on conversations with staffers at the Department of Health and Human Services and the Office of the Coordinator for Health Information Technology, that these agencies are acutely aware of possible fears of “Big Brother,” and that the idea of creating a massive, centralized database “is not even on the table right now, because it is widely understood that there is no way the American public would accept it at this time.” For now, the data will remain decentralized. It will be up to future citizens and governments to ensure that it remains so.
Daniel Redwood, DC, is Editor-in-Chief of Health Insights Today. |
