Healthcare // Electronic Health Records
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7/28/2014
09:06 AM
Mansur Hasib
Mansur Hasib
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When Patients Fear EHR

When patients believe paper medical records are safer and more private than electronic ones, their health can suffer.

Many members of the public mistakenly believe electronic health records (EHRs) are less secure than paper files. Magnified by misinformation and political distortion of facts, an unnecessary fear has taken root in the minds of many consumers -- often with serious consequences.

While states were rolling out their health insurance exchanges last year, a key service provided by the federal hub Healthcare.gov was automatic verification of the application data an applicant entered. Applicants could choose automated or manual verification of their data. The public was unclear about the consequences of their decisions.

[Doctors are warming up to cloud services. Now what? Read Healthcare IT Cloud Safety: 5 Basics.]

If applicants chose automated verification, their applications could be approved within seconds without needing any documentation. If they chose manual verification, their applications would get stuck in a case worker's queue. Workers would then contact the applicant, and require the applicant to bring various documentation to verify date of birth, citizenship, legal status, income, information regarding their family members, and various other things. Their health insurance application approval would be delayed by weeks or months.

Old-fashioned paper medical documents feel safer to some patients than electronic records. (Source: Wikipedia)
Old-fashioned paper medical documents feel safer to some patients than electronic records.
(Source: Wikipedia)

While working at several health fairs throughout the state of Maryland last year, I had the opportunity to talk to people about this issue. Here's what I found out:

  • Consumers thought that by choosing manual verification they would avoid having their information in electronic format.
  • People did not realize the choice would cause a delay in the approval of their application.
  • People had a general fear of computers and electronic information.

I explained to them that their information eventually would be in electronic format, even if they used a paper application form. If they chose automated electronic verification, the system would query the appropriate systems as well as the federal hub, verify the information entered, and provide a decision on the application within seconds. On the other hand, if they chose manual verification, they would need to bring in various documents that would have to be copied, scanned, and retained. It could take them a long time to gather all the necessary documentation; meanwhile, they would continue to be uninsured.

I then explained that paper records are far less secure than electronic records because of the following:

  • When someone views a paper record, no one knows who saw it, for how long they saw it, or when they saw it; we do not even know if they were authorized to view the record.
  • We cannot scramble or encrypt the data.
  • We are unable to retain backup copies in multiple locations to ensure protection in cases of fire or water damage.
  • Multiple physicians or other providers cannot easily see their complete medical records in order to make a life-saving decision for them.
  • Information is often hard to decipher because of variations in handwriting.
  • With electronic records, people have the power to determine how their information can be used and shared. They have the right and ability to view their information as well as correct any inaccuracies in their records. Custodians of their information are obligated by law to adequately protect their information or face severe fines and penalties.

I shared anecdotes of how patients' lives were saved because complete and accurate information was electronically available simultaneously to multiple specialists residing in various states, so they could agree on the least risky and most appropriate medication. This enabled the right decision to be made the first time. A wrong decision would have resulted in the death of the patient.

I then explained that electronic medical records are more secure than paper because:

  • We know exactly who sees their information, when they see it, for how long they saw it, and if they were authorized to see it.
  • Even in cases where an unauthorized access has been made, we have a better chance of catching the perpetrator.
  • We can scramble the information through encryption; we can also obfuscate the information and store it in a shredded file format instead of a complete file format.
  • We can keep the information in various geographically dispersed locations, ensuring availability even in case of disaster.

People felt empowered with the knowledge. It was truly heart-warming for me to watch as smiles spread across people's faces once they recognized the power, the promise, and the higher level of safety of electronic medical records. Once their insurance applications were approved within seconds, many complete strangers got up, shook our hands, and gave us their warmest hugs.

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Mansur Hasib is the only Chief Information Officer (CIO) in the world with 12 years' experience as CIO, a Doctor of Science (DSc) in information assurance, CISSP (cybersecurity), PMP (project management), and CPHIMS (healthcare) certifications, who has written two books ... View Full Bio
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DarrellP725
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DarrellP725,
User Rank: Moderator
8/7/2014 | 9:30:26 AM
Re: Better?

 


"U.S. Homeland Security contractor reports computer breach"

http://news.msn.com/science-technology/us-homeland-security-contractor-reports-computer-breach

"A company that performs background checks for the U.S. Department of Homeland Security said on Wednesday it was the victim of a cyber attack, adding in a statement that 'it has all the markings of a state-sponsored attack.'"

 

DarrellP725
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DarrellP725,
User Rank: Moderator
8/3/2014 | 1:19:58 PM
Re: Better?
"Complaints about electronic medical records increase," by Bill Toland for Pittsburgh Post-Gazette, August 3, 2014

http://www.post-gazette.com/business/2014/08/03/Complaints-about-electronic-medical-records-increase/stories/201407250006#ixzz39LmZEvLE
DarrellP725
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DarrellP725,
User Rank: Moderator
7/31/2014 | 2:40:03 PM
Re: Better?
"Provider Use of EHRs Could Deter Patient Disclosure, Study Finds," iHealthBeat, July 31, 2014.

http://www.ihealthbeat.org/articles/2014/7/31/study-provider-use-of-ehrs-could-deter-patient-disclosure

"Some patients withhold information from their health care provider out of privacy and security concerns related to the use of electronic health records, according to a study published in the Journal of the American Medical Informatics Association, FierceEMR reports (Durben Hirsch, FierceEMR, 7/28)".
DarrellP725
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DarrellP725,
User Rank: Moderator
7/31/2014 | 12:07:54 PM
Re: Better?
Simply saying something is inevitable, doesn't make it so, even with a mandate. Until HIT stakeholders take ownership of the devastating problems with EHRs - by first acknowledging that paper records are increasingly superior - there will never be an urgency to resolve the problems, and EHRs will never reach their potential.

We have all witnessed that just because a now discredited 2005 RAND study promised savings of $77 billion and 100,000 lives a year by adopting EHRs doesn't make it so. And just because President George W. Bush promised that virtually all healthcare providers would have interoperable EHRs by 2014, also doesn't make it so.

In case anyone missed it, a couple of days ago, in addition to the FBI's April 6 warning that EHRs are becoming increasingly more susceptible to hackers, I mentioned that David Blumenthal M.D., the former national coordinator for health information technology says "... from the provider's perspective, there are substantial costs in setting up and using the [EHR] systems. Until now, providers haven't recovered those costs, either in payment or in increased satisfaction, or in any other way." (See: "Why Doctors Still Use Pen and Paper -The healthcare reformer David Blumenthal explains why the medical system can't move into the digital age," by James Fallows, for The Atlantic, March 19, 2014).

http://www.theatlantic.com/magazine/archive/2014/04/the-paper-cure/358639/

A few days ago, I read an InformationWeek article by Alison Diana announcing that the Senate Appropriations Committee is seeking an investigation into whether "taxpayer-supported software is preventing the free exchange of patient records between non-partnering healthcare organizations" (See: "Senate Committee Seeks EHR Interoperability Investigation - Bipartisan Senate Appropriations Committee wants an investigation into poor interoperability, possible 'information blocking' in electronic health records").

http://www.informationweek.com/healthcare/electronic-health-records/senate-committee-seeks-ehr-interoperability-investigation/d/d-id/1297580

Because of strategic misinformation, lack of transparency and wishful thinking in the HIT industry, interoperable EHRs are sounding less and less like a sure thing by 2014, 2016 or even 2020.

Interoperability is the key to EHR success. You'll never get there by attempting to discount the value of paper records. People will simply stop believing you.
DarrellP725
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DarrellP725,
User Rank: Moderator
7/31/2014 | 11:11:33 AM
Re: Better?
D. M. Romano: In spite of the fact that EHRs are more expensive, less secure and more dangerous than paper records? That would be foolish.
D.M. Romano
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D.M. Romano,
User Rank: Moderator
7/31/2014 | 10:56:50 AM
Re: Better?
@Darrell - indeed I have. And while I understand the reluctency of some who prefer "paper transactions," the world we live in nowadays just won't support this strategy for much longer. 
DarrellP725
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DarrellP725,
User Rank: Moderator
7/31/2014 | 10:54:28 AM
Re: Better?
D. M. Romano, you have never experienced identity theft, have you.
pcharles09
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pcharles09,
User Rank: Moderator
7/31/2014 | 9:28:23 AM
Re: How will they know?
@tzubair,

I can understand and appreciate that. At the same time, it does take a lot of education to quell those fears. The problem is that the education is not free & takes a lot of time and hard work.
D.M. Romano
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D.M. Romano,
User Rank: Moderator
7/31/2014 | 8:20:31 AM
Better?
To be honest, I'm baffled at the fact that people think paper records are in some way better. Notice I said better. Are your records safer in a physical state rather than being online? Maybe. Is there more of a chance for an attacker can sabotage, utilize, or even manipulate your records in this fashion? Sure. But personally I'd rather allow the risk of my information being compromised for the sake of expediency (if that were the issue). And I'm saying this while working as a security analyst where I review vulnerability on a daily basis. 
Susan_Nunziata
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Susan_Nunziata,
User Rank: Strategist
7/30/2014 | 9:58:04 PM
Re: Defending the value of EHR versus paper
@DarrellP725: I didn't realize I was arguing. Then again, I'm Italian, and in my family a normal dinner conversation would sound to other ears like a raging argument.

:)

 
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