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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.
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.
Health records have been held in electronic form for YEARS in the UK. Lloyd George envelopes are so 1980's The only difference is that they are held locally (at the surgery or in a data centre) and only accessible to that practice. What you are talking about are the various national shared record initiatives where a sub-set of the record is sent to a central location and can be accessed by other care providers.(e.g A&E staff).
In England if patient dissents from the programme (by having an appropriate Read code added to their record) then when the upload is done all that is sent is a note to the effect that they do not want a record. The NHS IT folk check that the system does this that there is no way any any information from a dissenting patient is sent up. I know I've sat through enough SCR witness testing sessions to last a lifetime. Access at the other end is audited and if necessary an alert is sent to the local Caldicott Guardian (not an end-of-level boss but a senior clinician with responsibility for protecting patient information).
There are a number of national programmes in the UK for centrally sharing part of the record. In England there is the Summary Care Record programme (data sent ranges from nothing to Allergies and time-bounded medication to the previous list plus any items you agree with your GP that can be shared). In Scotland there is the ECS Emergency Care Summary to support out-of-hours care, In Wales and Northern Ireland there is the ECR Emergency Care Record for use in A&E,
You don't need a lab to make mud.
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.
Scares? Those sound like legit concerns to me. The last thing you need is to MRI someone with a metal plate in their head, or to give pennicilin to someone with an allergy. While there needs to be strict criminal liability for providing non-emergency access without permission, sticking with paper records is asinine.
I still have more fans than freaks. WTF is wrong with you people?
The janitors are civilian contractors. The rest is accurate. What is so strange?
If by "scares" you mean manufactured, misleading hyperbole, you're wrong. There are tens of thousands of adverse drug interactions annually in the UK (and more in the USA). Many of these are avoidable (they're not just drug-drug interactions, adverse drug-condition or drug-{age,procedure} interactions occur too) and key to avoiding this is delivering timely, accurate information to your healthcare providers.
Keeping yourself off the relevant clinical databases is a choice and a compromise of risks; on the one hand the risk that your data will be leaked and on the other hand that your choice to equip your clinicians with less information will cause you to get less effective treatment in the future.
In some senses this is a balancing of benefits to do different people; first, your healthy, vigorous, young self. Second, your elderly, sick, incapacitated self. The latter cares most about the privacy angle but I'm pretty sure the latter cares most about the quality of care. But it would too late for the elderly you to benefit their treatment by reversing the decision made by their younger self.
If you've ever dealt with a hospital, you'll know that everything NHS cites is true. I've sat with patients and had doctors and nurses come in and ask ME questions about medications, reactions, etc. Or in a few cases I've had to point out that "Doctor so & so was just in here and ordered this 5 minutes ago, are you sure you want to ALSO order that same thing and give the patient a double dose?".
I don't know if the current electronic records system is actually an improvement, but they need to do something to improve the situation. In the meantime, if you ever have to go into a hospital, you better have someone sitting in your room with you, monitoring what's going on.
If anyone knows of a liberal in the Obama administration, please let me know because I'd like to make contact with him, since he's (or she's) probably really lonely.
On second thought, if there is a liberal in the Obama administration, you better keep the name quiet, or Fox News and Glenn Beck will start a jihad to get that person sacked for having once called Republicans assholes in 2003.
You are welcome on my lawn.
Management doesn't really get the usability concept. Well they do eventually when the mortality rates rise and the lawsuits start coming in.
No, because military doctors make less, and don't need malpractice insurance. Now, speaking as one who has been on Tri-Care: you get what you pay for.
In fact they do not have to have that permission. There is a (truck wide) hole in the law that allows disclosure for treatment or business purposes. Both of your examples would fall under this exception.
"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."
No, they don't. My real background is easy to verify with many military witnesses past and current. I'd have to flag everything with "IDENTITY THEFT VICTIM, hold all transactions until verified" and freeze my accounts while redirecting my military retirement pay to another account. Same basic thing I counseled my troops to do when they get divorced.
"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."
I'm on disability. I cheerfully bring my records to any employer. I have done so to verify work limitations.
I don't work in career fields with many sensitive people. I don't like the fuckers and they don't like me and that's the way I like it.
If my identity gets swiped I'll have a new hobby of telling the world to double-check anything purportedly done in my name. Shit happens, brace for it.
Privacy is dying and that toothpaste ain't going back in the tube.
"This post is an artistic work of fiction and falsehood. Only a fool would take anything posted here as fact."
Good question. I work with several EMR vendors and they all side with CCD instead of CCR. Truth be told, there will never be the one true format. My company will have to support CCD, CCR, HL7v2, and lord knows how many proprietary formats for the foreseeable future.
What we do is just store every piece of medical information as discrete, granular data and when pulling from the data storage we assemble it into a self-designed proprietary intermediate format and from there it is sent to a target-specific exporter engine that formats the data as the target (aka EMR or PM software) expects.
In other words, we minimized the impact of the document format by doing all the heavy lifting in our own internal format that contains all the data and codifications itself and each actual format is just a little post-processing engine to arrange it as expected.
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'm a long-term unemployed 'Nam vet and I get all of my medical care from the VA. Because I have (effectively) no income, there's no copay. That means, I get the nine different pills I take for free, along with the test strips for my blood sugar (I'm Type II) and the insulin I've been on for about a year for free. And, I recently got my cataracts removed at no charge. Not only that, as my hearing loss is service connected, my hearing aids and batteries are free. Yes, when I was working and could afford to pay, there was a copay and I cheerfully paid it because it was still less than I'd pay otherwise, but right now, I'm getting what I don't pay for and I'm thrilled with the quality of care I'm getting because without the VA, I'd probably be dead.
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