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Subject: Electronic medical records in stimulus package rss

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Isaac Citrom
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Actually I believe the correct terminology would be more like digitized medical records.

So, President Obama has included $20 billion for digitizing the entire medical records system of the US. I know for a fact it will take 5-10 years to accomplish. This is my very stock and trade.

Firstly, from 10,000 feet I think it's a great idea. You have some kind of a device like a bank card sized card or a USB key. You carry all of your records with you. It makes you much more medically mobile as well as critical in emergency situations. Hopefully, "they" won't have to ask you the same questions 6 times per intervention anymore; perhaps only 3 times.

Apart from the jobs in the information technology industry that it will necessarily create, I think it will also create a lot of medium-low level paying administrative jobs because of the nature of digitizing information. On the other hand, a lot of current jobs will become redundant. That is usually the case with any automated business process. So, I'm thinking that there will be a net gain in jobs overall even in the long term.

The reason is that all that information that is currently recorded on paper has to be entered into systems, i.e. digitized. The state of today's technology is still that the most convenient way to record information is with pencil and paper. Doctors will continue to scribble things down on pads. But then, they will hand over those hand-written records to new office staff whose job it will be to type it into the various software systems. I'm guessing that generally that will be women.

Theoretically, there should have to be less information capture overall. One of the points of such automations is that information needs to be captured only once. So, goes the theory. The effectiveness of this retooling will depend on how the business process of the medical profession takes to the change.

Having said that, typing is hardly the only way to capture data. Writing by hand is still the preferred method because electronic capture is not quite there yet. For example, the electronic writing pad is still too bulky. It's less convenient for sure. As software and hardware technology improves, the primary sources of information, such as doctors and nurses will be able to write things down and it will be automatically digitized as they write.

That's for diagnostic information. For administrative information it should be a lot more efficient more quickly. Any administrative information about a citizen need be captured only once. After that any device that can identify you can instantly connect you to your information. For example, Radio-frequency Identification (RFID) technology will pick up your ID from the card you are carrying wirelessly. An administrative agent could have your information on the screen before you even sit down. That's a gimmiky example but it shows how different things can be.

Of course, the big issue is data security. Nobody wants their medical information to escape. Right now, it's generally pretty safe on paper and behind a physician. The doctor has to talk or you need physical access to the paper file. That is, it's a lot hard to hack a filing cabinet, if you take my meaning.

Nonetheless, the World will move forward. Data security is an issue to deal with not an obstacle to progress.

But, even though I think this is a good thing, a smart move, I don't see how it will create jobs in the short term (24 months). I agree with various pundits that it was a political mistake to put elements of the Democratic agenda in with the stimulus package. I wonder what $800 billion of pure job creation endeavours would have done.
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Matthew Kloth
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My wife has worked for medical records (just got layed off), and I'm always surprised at how low-tech everything always is.

I'm so used to online databases, instantaneous communication, and information being only a few seconds away.

It's always a brick to the head when I go to places like the DMV.
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Isaac Citrom
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chiddler wrote:
Other countries have done it. It'll happen.


Which?
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Isaac Citrom
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chiddler wrote:
Britain's NHS is past midway through the process, aiming to be complete in 2010 - that's 60 million records, they started in 2005.

60% of Doctors here in New Zealand use them - admittedly not yet nationwide, but well on the way - its 4% in the US.


Sweden and the Netherlands have almost complete digitisation of medical records.


That's my point. Nobody has yet. Various countries have implemented various initiatives to encourage digitization. The Netherlands is very high with 92% of physicians using some digital record keeping.

In any case, getting health professionals to record data digitally is one thing, making the data portable (usable by everyone.anyone) is a whole other ballgame.

So, no, no country has done it yet, and I think it will be a while yet before that happens. From what I gather, many people each have their own idea of what to do and how to do it. This is normal and part and parcel of information technology as it is now. Engineers took a very long time to "decide" about a common usage. These necessary standards in the health industry are still emerging.

Part of what Obama needs to do is to provide leadership and direction on a national level. Simply pumping money into the matter will create a lot of good stuff but naturally become a vast sea of competing products and initiatives. It could be a long while then until things sort themselves out. The UN's OpenMRS initiative is an example of trying to come up with a single platform that anyone can tie into and build upon.

I really like Brad's comments about voice-to-data digitization. The more natural data capture is, the better things will go, I think.
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Well, in my Doctor's office, everything is done electronically and we are in a very rural location. The doctor and nurses carry around laptops and they enter everything via the laptop, so everything is digitized there.

And it is easier for them because it has been tweaked enough so usually they just have to use a stylus to click information so handwriting is really unnecessary. Therefore, some of the work has already been done. The issue will be is coming up with standards so that all information is encoded in the same way by all offices. That will mean Government jobs will be created to come up with those standards and maintain and oversee those standards.
 
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Ken
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isaacc wrote:
Hopefully, "they" won't have to ask you the same questions 6 times per intervention anymore; perhaps only 3 times.


As nice as this would be, I wouldn't bet on it. Asking the same questions over and over is also part of some diagnostic techniques, according to some nurses/doctors I know.

Quote:
Doctors will continue to scribble things down on pads.


You don't think the current crop of tablets/slates is up to the task? I've been using Tablet PCs for about 5 years in my work and they do a great job. Mine would be too heavy for this application, but there are many that are much lighter (3-5 pounds).

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Of course, the big issue is data security. Nobody wants their medical information to escape. Right now, it's generally pretty safe on paper and behind a physician. The doctor has to talk or you need physical access to the paper file. That is, it's a lot hard to hack a filing cabinet, if you take my meaning.


Yep. HIPAA in the US started the ball rolling, but with a horribly vague set of guidelines. I'd expect a trade organization, accrediting body, or combination of them to get together and define something more useful. Like the Payment Card Industry - Data Security Standards do for the credit/debit card industry.

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But, even though I think this is a good thing, a smart move, I don't see how it will create jobs in the short term (24 months).


Well, you mentioned a big one yourself - there's a small mountain (actually, probably a very, very large mountain) of medical records that currently only exist on paper. So one of the first things I can see it doing is getting people working to digitize that data and verify that it came through accurately.

Then there's installing the infrastructure in the hospitals to make this all work. There's a boatload of cables to be pulled, conduits to be added, holes to be drilled, switches to be installed, and wireless access points to place (digital records just scream for better wireless at hospitals). That's also a lot of gear and material to buy. You've got computers to buy, configure, and test, software to select and implement, training to do...

There's a whole lot of activity - a good amount of it at decent wages - that needs to go on. That said, I don't know that it's "front-loaded" enough for my particular tastes to be in the stimulus package, so I'm inclined to agree with the criticism that this is the wrong time. Particularly since I'm not sure that the health care privacy standards are defined with sufficient clarity that my records aren't going to end up exposed. I think it will create jobs - probably starting in about 6 months, but that it won't "hit its stride" until month 12.
 
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Ken
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WhiteKong wrote:
It will not be a net job gain. It will be a huge net job loss. When telephone switchboards were digitized, about 200,000 switchboard operators lost their jobs aver about a four year period.


And were promptly replaced by people making and installing phones, switching systems, cable plant, etc. The jobs lost in one industry were replaced in another industry. Plus, individual productivity increased for everyone with a phone, since you could now dial directly instead of waiting for the operator to pick up. Oh, and the PBXs and switching systems created a pretty large export market for the US for a good while.

Would you like to try again? 'Cuz job losses in one market are usually offset by gains in others if the economy is working properly.
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Isaac Citrom
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As a sidnote, yes, I see wireless being installed at hospitals. I thought wireless signals were taboo and would interfere with medical equipment. That's why we have to shut off our cell phones. Suddenly, if it's for doctors, wireless is OK. I'm sure there'll be some technical reason why their wireless signal is OK.

What I have seen is that some people make an effort to use a tablet PC and they're happy with it. Most find 3-5 pounds still too heavy. For example, I'm one of them. I used to have a palm PC. I thought I would be so totally organuzed digitally. What I found was that it was too inconvenient compared with pencil and paper. I found that when I needed to note something it was too much of a bother to turn on the device and then find the right application. Grabbing a notepad and a pencil was near instantaneous.

That is to say, I have seen that technology catches on when it makes things easier. When it becomes more of a chore, people tend to not use it. We need to be careful. Mandating things means bureaucracy. For example, if you force a doctor to use a tablet PC and he finds it inconvenient he will end up just writing less notes. Then you get into a mode where you start having to mandate just what he's supposed to be writing down in order to enforce the system's business rules. When you get into that level of micromanagement, things break down and there is rebellion instead of adoption.

A good example is the poster above's example of his doctor's office. He describes a situation where the health professionals simply use a simple stylus to make selections. That implies a lot of systems analysis in order to analyze the entire medical profession in hyperdetail. You end up getting pick lists of choices, for example. Although they are useful, it is extremely hard to analyze to that level of detail. What happens is that the options given frequently are not flexible enough to describe the varying situations of real life. People enter the closest answer insetad of the real answer, because the real one is not in the list.

Bureaucrats (technocrats actually) end up actually defining what is and isn't. Freeform text is the best way to capture such important information because it is flexible enough to accept the real world as it is. But, it's harder to digitize freeform text into data. It's not enough to capture a picture of the scribblings. That's OK as a matter of storage. But, that's not usuable data. The scribblings have to be analyzed by intelligent software and turned into atomic data.

That's trickier to do, requiring more sophisticated hardware (i.e. heavier) and more involved software (i.e. more involved applications). I know it sounds anti-technology but do not underestimate the value to people of the simplicity and usefulness of a blank sheet of paper and a five cent pencil.

I'm looking forward to when we can really have electronic paper. Using very thin display technology, for example, I'll be very happy to see dedicated text capturing devices that are nothing more than a very thin display, like a clipboard, and a stylus. There's a reason, for example, why electronic books are catching on with such inertia and why designers try so hard to replicate the simple usage of a book.

We have learned in IT that trying to force people to adapt to technology leads to bad results. The trick is to adapt technology to how people like to work. Moreover, writing is tried and true. Technology will work best that can make that easier, not technology that forces people to do things in a less efficient manner because the technology is problematic.

Thinking aloud, I'm wondering if it would not be a better idea to digitize medical records 10 years from now instead.
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Ken
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isaacc wrote:
As a sidnote, yes, I see wireless being installed at hospitals. I thought wireless signals were taboo and would interfere with medical equipment. That's why we have to shut off our cell phones. Suddenly, if it's for doctors, wireless is OK. I'm sure there'll be some technical reason why their wireless signal is OK.


It's a question of spectrum. The 2.4 and 5 GHz spectrum are public access in N. America/Europe, so any device in a hospital could be subject to external interference in those ranges. Cell phones operate within different spectra and medical devices may or may not have been certified to avoid interference.

Having deployed wireless systems in hospitals, medical devices that are potentially sensitive and/or could interfere with wireless signals are screened off using Farraday cages or paints that contain metallic particles.

Quote:
Grabbing a notepad and a pencil was near instantaneous.


Current tablet systems really do get to just about this level if they're configured right. 3-5 pounds is heavier, but for the convenience and features provided that can be a weight worth bearing. For example, say you're a doctor or nurse recording a new medication in the patient's records. What if that tablet/slate let you quickly access their current prescription records, add the new medication, and alert you to contra indications? Or interactions with other medical conditions that would steer you from one medication to another? I agree that if you just do "write on here instead of here," it's never gonna be worth doing.

I'm snipping the rest just because it's easier to reply to it in general.

When I visit my doctor's office, much of the paperwork they fill out is already stock forms with check-boxes or fill-in blanks. For example, if they're ordering lab tests, it's just about never that they hand-write the lab order - they fill out a stock form. Those are very, very easy to turn into electronic forms that link to databases. Where the EMR systems need to be really smart is in being able to handle the "other" categories that can't rapidly adapt to stock forms. So taking notes on a diagnostic session needs both the "stock" information like blood pressure, temperature, weight, etc. and the notes that are more free form ("experiencing frequent headaches, often following visits to some RSP thing on a BGG thing"). There's work to be done turning those types of notes into something that's "more useful" than text in a memo field.

You're 100% right that the systems are going to require some significant design work to get those items right, more than a bit of integration work, testing, and maintenance to make them worthwhile. The reason the government investment is worthwhile is that the initial investment to do these things is daunting to the medical profession because there's not a good ROI model that shows it ultimately pays off, so few want to be first.

The first versions of the PC didn't transform the way we work, after all. They were around for years. I'd argue that what changed the way we work was actually the introduction of spreadsheet software that drove the change. Technology without a good application is a toy. When the applications are there, then its a tool.
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Isaac Citrom
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perfalbion wrote:
WhiteKong wrote:
It will not be a net job gain. It will be a huge net job loss. When telephone switchboards were digitized, about 200,000 switchboard operators lost their jobs aver about a four year period.


And were promptly replaced by people making and installing phones, switching systems, cable plant, etc. The jobs lost in one industry were replaced in another industry. Plus, individual productivity increased for everyone with a phone, since you could now dial directly instead of waiting for the operator to pick up. Oh, and the PBXs and switching systems created a pretty large export market for the US for a good while.

Would you like to try again? 'Cuz job losses in one market are usually offset by gains in others if the economy is working properly.


And it has to be that way, doesn't it. If technology keeps reducing the total necessary work force and the population keeps increasing, wouldn't that lead to disaster.

Also, with the example given of the many telephone operators that wer let go, regulation had everything to do with that. While there was a monopoly, business lines and long distance was expensive but it also supported the residential accounts and all those services run by humans. Competition led to lower prices but "Bell" had to let go a lot of people because of it.

It's the usual Walmart meme. Yes, we can get 55 gallon drums of pickles for $1.49, but that also means workers make minimum wage and there are less workers hired. Perhaps many people are too young to remember. When I was 18 I worked in a hardware type department store. Each department of about 3 aisles had five people working at any one time. It seems quaint now in that if you have a question you go hunting for someone 8 aisles away or wait in line to have your question answered.

Lastly, those higher monopoly prices also supported infrastructure spending. Before, Bell would have spent the money to wire unprofitable rural areas. Now, we depend on government to make "infrastructure investments".

Then the point was to outsource our work to developing countries and imported workers who are prepared to work at a huge discount. But then, their economies grow instead of ours, and demand more resources such as gas. We pay higher prices for gas and pay environmental premiums so that China can turn on a new coal-fired plant every week.

There's no free ride. I think it would be a lot more evident if taxes were raised to the point sufficient enough to cover these expenditures. Instead we are paying for it with debt. Up until now, 33 cents of every tax dollar is used to service previous debt. I'm afraid for my sons for when 75 cents of their tax dollars will be used to service debt or when the shit finally hits the fan.
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Ken
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There's certainly a debate to be had over whether or not we've reached a point in developed countries where we cannot replace jobs with jobs of similar quality when market disruptions occur. I'm not convinced that's the case, but it is theoretically an issue. If you shift high-paying manufacturing out of country for cost reductions and the only replacement is a "You want fries with this?" job and that's the only type of new job created, then it's potentially a problem. I don't think that's the case, and as the undeveloped economies develop, their wage base will increase and suddenly it might not be so cost effective for businesses to ship jobs out of country.

I think it's ultimately going to be a balancing act where the scales tip one way, then back the other way and our policies need to smart enough to handle the swings. In the US, look at what happened with the steel industry or the automotive industries. US Steel is again a growing business, and foreign car manufacturers have significant manufacturing in-country.

I'll further agree that there's no free ride and debt-laden spending will eventually drag the economy down. It's one of the reasons I'd consider the G. W. Bush administration a disaster. In eight years, we managed to double the national debt (again) and go from projected structural budget surpluses to structural deficits.

That said, now isn't the time to fix that. If a government can have an impact on the economy, it's by running a deficit when the economy is down. Cutting government services, reducing expenditures, etc. is fine, but if you're already shedding jobs and income gov't. cut backs will only exacerbate the problem. I wouldn't mind seeing a balanced budget focus that looked over a 5-10 year horizon so that government had flexibility to put some capital into a bad economy, but had to be ready to pay it down when times were good. When one goes to buy a car or house, doing so on a strictly cash basis is only an option for a small number of people and credit's likely to be required. Balancing that credit over the life of one's budget is what's important to keep the debt load manageable. I see no reason that government spending shouldn't operate on the same principle.

I do think that the US is spending way beyond it's means right now. But cutting back at this very moment may be a fix for a long term problem that only causes more damage in the short term than is acceptable. If a patient shows up with pnemonia and a heart condition that requires surgery, it had better be one hell of a heart condition for you to operate if the pnemonia might kill them on the table.
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Isaac Citrom
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Ken, perhaps. I've so lost all confidence in anyone's economic fortune telling that your opinion is as good as any other. Each argument seems to make sense. But, when it comes down to it the proof is missing from the pudding. Again and again things go differently from what economists say and there seems to be an endless series of "oops, didn't see that coming."

A cornerstone of science is predictability. Economics is starting to seem more to me like psychology. Or, perhaps it is like the weather and we just don't know enough about climate to make hard predictions.

Perhaps we're not supposed to. Perhaps that's the nature of huge systems. But, we seem to be making decisions like we know what we're talking about.

As a lay person I listen to one economic pundit and say, hey that makes perfect sense. Then his colleague says the opposite thing and I find myself again saying, hey that makes perfect sense. And so it goes with the third and fourth guys. Whether your Christian, Jewish, Muslim, Hindu, atheist, whatever, logically they cannot all be right. In fact, only one of them is going to Heaven and the rest are going to Hell, if you take my meaning.

I have no hopes of financial security for my children except if they become independently wealthy (~$5 million) and can isolate themselves from economic turmoil. That is, I don't believe anymore that one can do the "right things" and if you do, things will be OK.
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Ken
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isaacc wrote:
Ken, perhaps. I've so lost all confidence in anyone's economic fortune telling that your opinion is as good as any other. Each argument seems to make sense. But, when it comes down to it the proof is missing from the pudding. Again and again things go differently from what economists say and there seems to be an endless series of "oops, didn't see that coming."


I don't expect any government or even any industry to have sufficient foresight to predict the actual events that it needs to be prepared for. I don't expect my President, Congressman, Senator, City Councilman, State Assemblyman, etc. to be able to say "in five years, we need to be worried about this."

But prior to Reagan, we ran a relatively low national debt. Certainly it was serviceable, and arguably it was unavoidable - even government is going to issue bonds or other debt instruments to fund major projects. At the end of the Clinton administration (with a Republican congress - I don't ignore their impact), we had gone from structural deficits to surpluses. We're now back to structural deficits.

I expect my government to fix that. To run deficits that make sense (like in a down economy) and be even or run surpluses when that makes sense. We'll never be completely out of debt - spending $2 trillion to update infrastructure over 10 years, for example, is too much for the budget to bear as direct spending. But there's a reasonable debt load we can carry, service, and have a healthy economy. It's just not 5 times the annual budget or approximately 85% of GDP.

But that means we have to actually vote for people who get that. Sadly, we don't seem to have figured that out.
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Some people will be glad to hear that the funding for computerizing health records has almost entirely been stripped out by the Senate compromise.

It seems to me that if we're going to stimulate the economy with government spending, we might as well spend it on stuff that everyone agrees is a good idea. Like building schools, improving the efficiency of health care, insulating buildings, buying fuel-efficient cars for the government, etc. But clearly this means I don't think like a Republican.

The best news today is that the compromise also cuts way back on the corporate tax giveaway to firms that made profits in the past and are losing lots of money now. That made no sense.

Still to be decided on the Senate floor whether they will reinsert the tax credit for flipping houses.
 
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isaacc wrote:
That's my point. Nobody has yet. Various countries have implemented various initiatives to encourage digitization. The Netherlands is very high with 92% of physicians using some digital record keeping.


As a sidenote, the NL government is currently implementing 100% electronic and interchangeable medical records. With this system information can be exchanged between hospitals, GP's, pharmacies etc. with a few clicks. Most information is already digitized so the implementation of a common system is not that great a step. The project is not uncontroversial; most concerns are about privacy. Is it really necessary for a pharmacist to know my entire medical history every time I have to pick up some antibiotics or whatever? Who will have access to my records? Why can't I have unrestricted access to my own records or control over who gets to see them?
 
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Ken
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I don't know what the laws are in the Netherlands, but I can tell you what I know about the control of medical records in the US.

Venga2 wrote:
Is it really necessary for a pharmacist to know my entire medical history every time I have to pick up some antibiotics or whatever?


No, and the systems that are involved would be required to properly protect patient privacy. It's even possible that "access" to the records will mean a computer analyzes medications and conditions and alerts the pharmacist to potential dangers without giving him access to the cause. He'd then have to refer the problem back to the doctor.

Note that the law in the US doesn't require this, but it does require patient privacy be protected. That implies access to only necessary information.

Quote:
Who will have access to my records?


Anyone you specifically authorize. There is talk of allowing anonymous access to electronic records for research purposes so that a larger database of treatment efficacy or drug effectiveness and side effects could be studied across larger populations.

Quote:
Why can't I have unrestricted access to my own records or control over who gets to see them?


In the US, you do. 100% under your control. The HIPAA act requires this and custodians of records are responsible for complying with this restriction. As records become digital, I'd expect exceptions to be added to handle emergency situations so that the ER/Trauma Center you get taken to can ask for and receive your records if you're incapacitated, but under normal circumstances, releasing records is a cause for civil and potentially criminal action.

The Netherlands law may be different, but I wouldn't expect too many differences if they exercised care in crafting the law.
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Ken,

Thanks for expanding on those questions. They were somewhat rhetorical, but it interesting to expand on the issues nonetheless.

I also do not think that there are huge differences in privacy law between the states and NL. However, there is a difference between the law and the actual practical implications. As the plan (which is not a just plan, but a project in full swing) stands I will not be able to log in online to my own records and see who checked them etc. That actually requires the filling out of forms, requests etc. And then you may get a printout if you are lucky enough that the hospital has some time for you.

Quote:
and the systems that are involved would be required to properly protect patient privacy


Of course, but I am doubtful about how this will be implemented in practice, as the exchange of information uses the internet. And we all now that it never happened that massive amounts of sensitive data was acquired by hackers or because some idiot left a USB stick in a taxi.

And we are talking about sensitive data here.
 
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Quote:
But then, they will hand over those hand-written records to new office staff whose job it will be to type it into the various software systems. I'm guessing that generally that will be women.

And why would you guess it would be women? Sexist much?



Brad, not that it's really important to this thread but if you were to check most offices you'd find more women than men in the lower level positions. And your lower level office positions would be the ones doing transcriptions and things of that nature. It's not sexist... it's just fact.
 
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Ken
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Venga2 wrote:
As the plan (which is not a just plan, but a project in full swing) stands I will not be able to log in online to my own records and see who checked them etc.


That may actually be more secure, if you think about it. Ensuring that the person accessing your records is actually you isn't necessarily trivial. It'd be better if they gave you some notification of access (like e-mail or mailing), but this could be a reasonable measure to protect you.

If it doesn't show, I happen to work in networking space.

Quote:
Of course, but I am doubtful about how this will be implemented in practice, as the exchange of information uses the internet. And we all now that it never happened that massive amounts of sensitive data was acquired by hackers or because some idiot left a USB stick in a taxi.


Exchange of information and unauthorized access are slightly different things I won't go into. But it's fair to say there are various encryption and validation methods that can be used. And if you don't permit public access to the systems so that it's server-to-server traffic only, that exchange can actually be made pretty damned strong.

Understand that most data exposures come from sites where a member of the public can log in to the site and access information or from systems that are storing data they shouldn't have been storing in the first place (and thus weren't protected properly).

Quote:
And we are talking about sensitive data here.


Yep. I've designed networks for hospitals and helped them craft standards. It's never a guarantee, but you can make the protection pretty damned strong.

It's also arguable that it's not more sensitive than credit information, and that flows over the Internet with amazing regularity with (all things considered) very few breaches of commerce sites.
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David desJardins
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perfalbion wrote:
It's also arguable that it's not more sensitive than credit information


I think health information is a lot more sensitive than credit information. And the problems of access are much greater because there are many more people who need access to (some part of) my health information than who need access to my credit information. I think electronic records are necessary but I think you are dramatically oversimplifying how difficult it is to do a good job of giving consumers adequate protections and access to their own information. And there are a whole lot of people in the medical establishment who look down on consumers and want to paternalistically "protect" them from real control of their own information.
 
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Ken
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DaviddesJ wrote:
I think health information is a lot more sensitive than credit information.


Depends on the risks you're concerned with. Access to your health records might provide me private information I shouldn't have, and even information that could damage you if publicly released. Credit information is more directly damaging on a financial basis for most people. That's why I said "it's arguable." Individual sensitivities will vary.

Quote:
I think electronic records are necessary but I think you are dramatically oversimplifying how difficult it is to do a good job of giving consumers adequate protections and access to their own information. And there are a whole lot of people in the medical establishment who look down on consumers and want to paternalistically "protect" them from real control of their own information.


Some would consider me an expert in the field, and I don't believe I've ever said it would be easy. Just that it would be possible if properly designed.

Immediate access to your own records is one of the stickier wickets in getting that design right. Verifying the identity of the person attempting to access the records isn't necessarily trivial, and a simple user ID/password may be insufficient protection. That said, there are more than a few ways to address those concerns, and some very innovative two-factor systems that could address the problem without too significant a cost.
 
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David desJardins
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perfalbion wrote:
Immediate access to your own records is one of the stickier wickets in getting that design right.


Allowing me to correct errors in my own records is even harder.
 
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Ken
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DaviddesJ wrote:
perfalbion wrote:
Immediate access to your own records is one of the stickier wickets in getting that design right.


Allowing me to correct errors in my own records is even harder.


In your medical records? Or your credit records?

You can detect errors in either, but both are records you'll have to work with others to remedy. Medical records are harder because they're usually regulated by state bodies.
 
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David desJardins
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perfalbion wrote:
In your medical records? Or your credit records?

You can detect errors in either, but both are records you'll have to work with others to remedy. Medical records are harder because they're usually regulated by state bodies.


I meant correcting errors in my medical records. The records are supposed to be for my benefit, the idea that some "state body" has any role in "regulating" my ability to correct mistakes is a perfect illustration of the problem.
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I know that we're told that HIPAA is supposed to provide us with greater protection of the privacy of our medical records, but in actuality, it gives others greater access to your private medical records, especially the government and you less control of who sees those records. Earlier laws were actually better at protecting privacy of those records.
 
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