My extreme concern about data protection and privacy have made me wonder how effective the drive to electronic medical records (EMRs) will be, particularly in the behavioral health arena. My clearest recollections from the first day of my psychology internship at a community mental health center are all of the instructions related to protecting patient privacy. As a mental health software vendor, I have continued to have this strong drive to protect the data of any patient. Finally, HIPAA and HITECH have caught up with the concerns of those of us trained to put patient privacy protection ahead of most other concerns.
The rush to EMRs that can share information with one another (interoperability) has as its goal diminished costs and increased quality of health care. The need to keep that information secure and private is usually dealt with almost as a side issue. I have often heard statements like these: “Why, of course the data will be protected. Why are you so worried about keeping data private? Sharing it with other providers is much more important than privacy. Some compromises will need to be made . . . ”
The American Medical Association, in their discussion of patient confidentiality, briefly indicate their concerns about EMRs.
Electronic health information systems allow increased access and tranmission [sic] to health data. Physicians in integrated delivery systems or networks now have access to the confidential information of all the patients within their system or network. Confidential information also is disseminated through clinical repositories and shared databases. Sharing this information allows patients to be treated more efficiently and safely. The challenge for physicians is to utilize this technology, while honoring and respecting patient confidentiality.
Sharing confidential information among treating professionals is only one aspect of this issue. Now we must consider to the issue of sharing the electronic data with the patient.
According to John Fully on nextgov, patients want access to the information stored in the electronic records about them maintained by their physicians. 93% of patients have rarely or never asked their physicians for electronic copies of their data, but 70% say it is very important to them that doctors and hospitals provide those electronic records. 60% of patients and over half of physicians say sharing information from EMRs with patients will be a crucial measure of how successful health care reform and provision of stimulus dollars has been.
One potential method for sharing those electronic records is the Personal Health Record (PHR). After all, having an electronic copy of the physician’s record but having no way to store or to access it will not be a very beneficial state. As a result, provider organizations, payers, and even Medicare have begun to connect EMRs, claim histories, and PHRs as an effective way of tracking your health.
Even so, patients are hesitant.
. . . while the products use some of the same technology that banks use to secure financial data, some patients remain wary of putting health information online. Only about 4% of the online population uses Internet-based PHRs, according to Elizabeth W. Boehm, a principal analyst at Forrester Research Inc. in Cambridge, Mass. Many people don’t see the need, Ms. Boehm says, while others are nervous about putting confidential health information online.
That figure is telling. It is not that only 4% of patients use a PHR . . . only 4% of the online pupulation uses one . . . only 4% of the people who use the Internet all the time utilize an online PHR.
I have registered for the PHR used by my insurer. The Privacy policy says all the right things. I have entered some information into it, but I am still hesitant to put everything there. The conventional wisdom is that these programs are secure. I’ll give you an example of why I am slow to completely adopt.
About 18 months ago, I noticed that one of my mother’s physician claims was rejected by her Medicare supplemental plan. When I looked at the EOB more carefully, I noticed that it had been filed on my insurance plan rather than on my mother’s Medicare supplement plan. Since we both have the same insurer, I telephoned, explained what had obviously happened and was assured that it would be corrected. When I checked my PHR today prior to writing this blog, I found that claim still sitting in my record.
I have never been a patient of the physician who filed the claim, so I know he did not file the claim with my insurance information. I am thirty years younger than my mother and my first name does not come close to hers. But the same last name and address resulted in this confusion that has not yet been corrected. I cannot help but wonder what other two bits of information might result in the confusion of something important in my file and that of some stranger. Since this payer automatically adds claim information to the PHR, their system now sees me as the patient of a cardiologist . . . something I have not yet become. I wonder what other data confusions I have in store.
What is your take on PHRs? How do you see them affecting the behavioral health community? Please enter your comments below.
