Cost, disruption not only EHR concerns for docs

In response to Joseph Conn's "AHIC reviews, sends back EHR recommendations":

The American Health Information Community does not recognize that most physicians choose not to use electronic health-records systems because privacy violations are built into these systems and security risks are exponentially greater than in paper systems. Costs and the disruption of changing work patterns are not the only reasons the majority of American doctors don’t use EHRs.

Even though "smart" technology exists that can obtain patients' electronic consents instantly, share only selected data, and then create complete audit trails of every data field or page disclosed, these electronic authorization and consent technologies are not widely used. Authorization or consent technologies can really put consumers back in control of access to their records and stop providers and data banks from deciding who can access and use EHRs.

Today, by far the vast majority of access to and uses of personal health information are secondary uses. Providers and data banks illegally and unethically steal, aggregate and sell patient data for uses patients would never agree to. The vast majority of EHRs have eliminated patients’ opportunities to grant meaningful legal contemporaneous informed consent.

Ask your hospital: Does it sell patient data? Many do. Ask your pharmacy: Are all prescriptions data mined daily and sold? Every single pharmacy in the U.S. is data-mined daily—and there is no way to keep your prescriptions private even if you pay out-of-pocket. Ask all your "providers," not just your doctors, but any of the other 600,000-plus "covered entities" that HIPAA granted the same level of access to your records as your personal physician—do they ever disclose your identifiable or de-identified personal health information without your consent?

It's rather shocking that EHR systems have been designed as if centuries of law and medical ethics never happened, so that access to personal health information is no longer controlled by the patient. The end-users of data are in charge of designing EHRs, so they design what suits them best. AHIC continues to design technology that precludes patients from exercising their traditional legal and ethical rights to privacy—even though it has no legal authority to alter or eliminate Americans' rights to privacy. Only Congress has that authority.

The AHIC recommendations to reward doctors for buying EHR systems that do not ensure the privacy and security of medical records are not only expensive but bad policy.

Why should the government force doctors to buy defective products?

If the federal government is going to pay doctors to buy and use EHR systems, it should first require that EHRs have state-of-the-art privacy and security measures. Good government protects citizens from harm instead of facilitating data theft.

We should be wondering why doctors have to be forced to buy EHRs in the first place. Could it be that EHR technology is not exactly the first thing doctors or patients want? Access to high-quality effective and affordable medical care is what everyone wants, not corporate welfare for the insurance, IT and other health-related industries.

Pay-for-performance schemes raise other serious problems. Instead of trusted national physician medical specialty organizations using science and clinical wisdom to decide what the standards should be for effective medical treatment, industry-driven organizations are setting pay-for-performance standards of medical care. Who do you want to choose the best treatment for you? Your doctors or the insurers and corporations with huge financial stakes in what drugs and products are used and the limitation and denial of care?

Deborah Peel, M.D.
Patient Privacy Rights Foundation
Austin, Texas

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