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Electronic Health Records Now In All US Military Hospitals
smitty777 writes "Information Week is reporting on the inclusion of Electronic Health Records (EHRs) in all US military hospitals. This is significant in that it allows the sharing of patient information on a worldwide scale, improving care. This is leading a national trend currently motivated by HIT Meaningful Use legislation, which provides incentives for civilian physicians to adopt EHRs. Not that the adoption is without challenges. The usability of EHRs is also an ongoing concern."
Yes, all cool... Until they are hacked by a random foreign nation that'll have detailed information about all US soldiers.
Let's see, we add this "100% electronic" to a previous article by VA saying that VA and DoD electronic medical records have been combined, and add the two-three years ago VA hack that pulled all the records of a couple hundred thousand vets, and get "yeah, this will turn out well"
Just because you're paranoid doesn't mean they aren't out to get you
That's nothing. In the UK the National Health Service is scaring people to accepting their details to be on computers instead of paper records. http://www.telegraph.co.uk/health/healthnews/7704050/NHS-scaring-patients-into-accepting-electronic-records-database.html
Such scares as:
"Health-care staff treating you may not be aware of your current medications in order to treat you safely and effectively."
"Health-care staff treating you may not be made aware of current conditions and/or diagnoses leading to a delay or missed opportunity for correct treatment."
"Health-care staff may not be aware of any allergies/adverse reactions to medications and may prescribe or administer a drug/treatment with adverse consequences."
Many people have written to keep themselves off the database, but that means nothing as the government does what it pleases, always has, always will.
Take Nobody's Word For It.
The DoD MHS (military health system) already has an EMR in place called AHLTA (previously known as CHCS-2). TFA just talks about a new vendor product (from CliniComp) that's being installed in about 50 hospitals, whereas MHS has more than 100 hospitals all running AHLTA already, along with a few other EMR systems. Bad reporting from InformationWeek, it almost reads like an advertisement.
What about privacy? The patient of course has no control over where that record goes...
All the healthcare records in the military were electronic (with paper copies upon request) as of 2003 when I joined the US Army - this is nothing new - just some dirty liberals trying to take credit for something under Obama they didn't even have a hand in.
what the fuck, is a military hospital? does it have a military morgue, military pharmacy, military interns, military janitors, military parking lot, and does it have a general cuddy?
I work in Biomedical Science, and see first hand the importance of accurate patient information. Not just for the obvious emergency where its important to know an unconscious person is a diabetic, or for doctors to know allergies etc.
It is also important to know what diseases are prevalant in population, what diseases need management, where resources are needed etc. These are things that are very difficult to do at the moment because of the lack of centralised up-to-date information. A national study needs to be compiled from data from different states, countries, small departments within systems within states...its a nightmare! It could be so much better if we availed of the technology available today.
People are worried about their privacy, but from whom exactly? Who does the common guy on the street fear with their information? Surely it is a good thing your attending doctor has your history? And nobody else is allowed access. And nobody else cares! What about celebrities? Fine, have an opt out. Easy.
People are going to get into a frenzy about privacy, politicians are going to tip-toe around the issue for fear of public outrage over privacy, pathetic journalists are going to stir up peoples fears, and lives are going to be lost. Privacy is fundamental to the system, and needs to be designed in, but the benefits (lives saved) are too great to ignore.
While I haven't worked with a full EHR system yet, I have worked with a number of PACS systems (digital X-ray/imaging display). I've used several from different manufacturers, and every single one has had usability problems so severe that I regard the systems as unacceptable (the hospital administrators disagree).
For example in the UK, where the government mandated PACS and other electornic systems by a certain date, there was so much usability concern, that a small pressure group of medical imaging staff eventually formed to try and address the problems. The creation of a pressure group, whose goal is to see the software withdrawn and replaced, is a striking sign of poor usability. Things have improved, and the group has relabelled itself and now has a prominent place in the selection of PACS and other informatics systems.
However, even with more modern software, there are frequently severe problems. Icons where the glyph and description bear no plausible relation to the task performed (e.g. a camera icon, entitle 'snapshot' being used to load a case onto an agenda for a meeting; an icon with a hand and arrows pointing up, down,left, right being used to change the brightness/contrast). Other problems include mouse buttons being assigned in inconsistent or complex ways; e.g. right clicking on colomn header in lists to sort - when every other software uses left button; heavily overloading the mousebuttons, such that a single click is different from a click-and-short hold, which is different to a click-and-long-hold, which is different to a double click, which is different to a click and drag; while simultaneously ignoring system settings about double-click speed, so that clicking on tool 1, then tool 2 in quick succsssion is actually registered as 'click 1, double click 2' which performs a completely different task).
Even at one site, where MDs have been using the new software every day, they still struggle. Even the professors of radiology, whose job is basically to use the system all day, every day to view images, struggle to do relatively basic stuff - even after 3 months. Even I frequently forget or get confused between operations ; heck, I even find myself longing for an SQL prompt, because the GUI search function is so difficult to use (dragging a list of criteria from a box, then attaching boolean operators to the criteria, ordering the criteria and then entering your search paramterers - and just to add insult to injury, your search criteria are cleared after running the search, requiring you to build the whole query again).
Of course, the older systems were worse. I once used one that was "ergonomically" designed and designed in a "flat pictorital" manner. What this meant was no text menus, no hierarchies of tools, no context sensitivity. Just a sea of toolbars and icons. At the bottom of the screen was an ocean of about 280 icons for stuff like (image size:normal; image size: 150%; image size: 200 %; show 1 image on screen; show 2 images horizontally tiled; etc.). Of course, this design philosophy didn't make it as far as the actual dialog boxes, where you had to use PERLesque constructs - like if you wanted to show 'studies for today', you'd have to enter 'date=$today' to get it to do it. Oh, and the performance was just hopeless - but then this system was marketed as using 'cygwin' and 'exceed' technologies for stability. As you might imagine, for an image manipulation and viewing system, the performance was disappointing.
Your local GP could hold a copy and you could carry a copy with you on card. One could be updated from the other and if you needed treatment you would always have your health record with you.
The only problem with that is that no government snoop would find it trivial to access all that data in all those medical practices.
However the government are in charge, and they like snooping, and their brothers and sisters in the corporate world also like snooping - so the data is held on a central server. That's more convenient for them, and the notion of their own convenience comes so naturally for them that it didn't even occur to decentralise it.
You can complain all you want. The system wasn't designed for your benefit.
Great, US Forces can invade and lay waste to your village but at least your wounded will be provided with A1 medical care?
I don't give a damn if they stream my colonoscopy video on Redtube or if Slashdot uses my hernia scar for a background.
On your medical records there is your SSN, DOB, Name, and Address - everything one needs to open a line of credit in your name and fund their terrorist attack on the US with a bunch of Visa, MC, Amex and Home Depot cards.
Then, the DOJ kicks your door down, slams you to the ground, puts a black bag over your head and cuffs you and then sends you to Syria or Turkey were you will be anally raped with a barbed wire covered cricket bat until you admit to masterminding the 9/11 attacks, the assassinations of JFK, MLK, President Lincoln, and being Osama Bin Landen's homosexual lover.
Then again, if your medical records are leaked, some employer or client sees them and decides that they don't like something in there - regardless of how benign it may be because a lot of people have irrational hang ups about the stupidest shit.
Management doesn't really get the usability concept. Well they do eventually when the mortality rates rise and the lawsuits start coming in.
The VA has been using electronic medical records for years, I would assume that they have implemented a similar system. The VA system is fairly straight forward. It is about time.
Five years ago I had the opportunity to experience the military hospital system when I broke several bones. The entirety of the treatment program (about a dozen doctor visits plus about thirty physical therapy visits) resulted in only a dozen pages of scribbles (~10 words to each page) from the doctor visits plus the intake paperwork (~4 pages). There were no records of the physical therapy sessions (PS: The VA has refused to cover the injury citing a lack of documentation!)
Compare this to the civilian care I received a few months later for the same injury which had complete descriptions and detailed records of every visit.
So unless there have been radical changes in staff and their practices, all you will end up with is junk in electronic form instead of on paper.
The problem with a decentralised system (e.g. a personally held health information card) is how do you ensure that the data at each site is up-to-date?
What if you are outside your home GP's area and need treatment but don't have your card? The card won't be updated, but new diagnoses may be made, or treatments may be changed? The GP may eventually get the message - but what about if you seek further treatment in the meantime? The card and GP's databases will be inconsistent? Which is right? How do you tell?
Data consistency is a big problem with decentralised databases - at least with GPs keeping the records themselves, they know that they have the most complete records, and hopefully most up-to-date. The problem with card is that people may get lulled into thinking that they are always up to date, when, in-fact, they may not be.
Epic's software is very usable. They are currently the market leader and people who have been on Centricty Enterprise are coming to them in droves.
The military led the nation in racial integration perhaps they will lead us to socialized medicine.
" This is significant in that it allows the stealing of patient information on a worldwide scale, improving the ease of identity theft and crime"
A couple of minor corrections.
-Styopa
IMHO, the reason it's in all military hospitals is because when an order is given, it is obeyed promptly. In the civilian world, it's more like "Yeah, we'll get to it eventually but we're going to need a lot more funding and people and equipment and time off and perks and...."
CHCS and AHLTA are on the slower side. CHCS has an interface similiar to DOS. A big problem with both of them is that they require you to do the same thing over and over for simple tasks. They started rolling out essentris when I worked at labor and delivery, gotta say it was one of the fastest and most user friendly apps but best of all it pools information from one sheet to another which saves time. Also more secure for the fact that it requires you to log in each time you edit a note or add information, which makes it a lot easier to just share the same computer for several patients instead of having to log in and out for each user which can take a while with CHCS and AHLTA.
In the private system, I saw my doctor, who never looked in my eyes since she was too busy looking in a laptop. No paper chart at the exam just the laptop with info dating from the start of the new electronic system.
Went to a specialist (on of the most respected in his field). Staring in a laptop he bluffed his way through the $200 exam and told me he could not have performed the surgery in 2005 it had to be 2007. All of this is in the paper chart, which he could understand because he MADE IT HIS WAY. The jokers in charge of this project are on the other side of the continent and even handle the billing for the locals.
Someone is behind on data entry for the histoical charts, but then who can read a Dr's handwriting...
Last time I looked into this it seemed like CCR (continuity of care record) was becoming the document standard for these records but the VA already had a system that did not use that document format. Has the industry / government settled on a document standard for (textual) medical records yet?
Waltz, nymph, for quick jigs vex Bud.
In the UK they tried to force us to have our medical details on a central computer system but a lot of us refused to have our details stored on the national system and we opted out. If you look at the system it is controlled by BT who subcontract most of their work out to India who have different data protection laws than those in the UK. Already medical records have been sold to 3rd parties this has been documented on TV were a TV reporter was offered many thousand of medical records for a small fee - they not only contain your medical records but lots of other personal information about you !! Also the British government have a poor record of keeping your personal information safe and I'm not going to trust some company like BT or any other company within the NHS to keep my personal details secure.
The VA doesn't seem to want to use this system; in fact, they have an open "Request for Proposal" for the creation of an open source Electronic Health Records system.
Perhaps some people here may be interested in helping. The VA is huge; whatever they standardize on, especially if it is free, is likely to be implemented in many places.
The actual request (with more information linked) is available here
Most of you don't know how EHR's work, by the way you are talking about them. I work for one of the top EHR companies and know that these aren't as insecure as you all think. The data isn't transferred it is all transferred through a hospitals internal network. The only time information is shared between hospitals is if the patient is admitted to a hospital outside of their provider and when this occurs the information is transferred using a high bit encryption (I know what number is, but I signed a NDA). As for the government, I also know that their EHR systems is highly customized and using high security measures then public hospitals. Paper systems were highly insecure as well, I mean you just had to go into a hospital and the records were usually in an unlocked room (witnessed this).
Just because you are wrong and I called you out on it doesn't mean I am a Troll.
I have no idea how expensive it is - I'm guessing that if you have to ask, you can't afford it - but Philips has a system called iSite that is a wonderful PACS. Much better than any other one I've used.
Contextualized user experiences are one of the key ideas of web2.0 interfaces. This translates into not presented users with irrelevant options. In EHRs, clinicians are provided with screens with 100's of checkboxes. This can be addressed by providing analytics that determine the 20 relevant checkboxes. It was in part to solve this issue we started MEDgle ( http://www.medgle.com/ ) . At MEDgle, our focus is to enable scalable health by facilitating the distribution of care tasks to the most cost effective individual while ensuring quality of care through real-time clinical intelligence. Feedback, thoughts, etc are very welcome! Cheers Ash disclaimer (I'm the CEO of MEDgle)
The VA has had electronic health records for years.
Good for employees (doctors etc who need the info) but there is still no way for veterans to see their own health records online.
For people with government insurance it is a positive trend, but for people dependent on private insurance there are privacy concerns. Who will insure you when your medical conditions are made public? What will it cost?
...omphaloskepsis often...
Information Technology has revolutionized various industries.. Information Technology Healthcare development in the industry has changed the way and the scope.