[LINK] Electronic medical records: why we should seek a second opinion

Mon Dec 19 15:59:08 AEDT 2011

At 15:30 +1100 19/12/11, David Boxall wrote:
>It seems to me that electronic medical records will most benefit the
>disadvantaged, such as itinerants and the chronically ill. Those of us
>who are more comfortable will quibble about privacy and such, but do the
>risks outweigh the benefits?

Briefly:

-   there's gross over-selling of the benefits of 'more data' being
     accessible by clinicians.  They actually want *less* data.  But they
     want the right data, at the right time, and data that they trust;
     and eRecords schemes may or may not deliver that

-   an eRecords scheme *could* benefit people with chronic or
     complex conditions, particularly those who travel, even over
     relatively short distances
-   it's a pretty fair bet that a bigger proportion of people with
     chronic conditions will (more or less) cheerfully compromise their
     privacy in order to achieve better treatment or service, compared
     with those that don't suffer chronic conditions

-   there are many chronic conditions
-   each needs specific data, and hence specific data structures,
     and there is great diversity among those data structures

-   the PCEHR has been designed as a vanilla-flavoured, for-everyone
     record-layout, because the purpose is to assist bureaucrats,
     auditors, researchers and maybe insurers, secondarily clinicians,
     and, at a distant last, patients
-   the PCEHR contains nothing that targets the categories of patients
     who could gain significant benefits from it

All of this has been said to NEHTA and DoHA over an extended period.

But when bureaucrats have got their hearts set on a bureaucratically- 
oriented scheme that can be sold as being patient-friendly, consumer 
and privacy advocates don't get listened to.

________________________________________________________________________

>From:
><http://www.smh.com.au/opinion/politics/electronic-medical-records-why-we-should-seek-a-second-opinion-20111218-1p0o3.html>
>
>December 19, 2011
>Dr Tanveer Ahmed
>
>There are fears that the US's overreach in Iraq and Afghanistan, in
>combination with its tenuous financial state, may spell the end of its
>global hegemony. But the superpower's downfall is just as likely to be
>caused by the cost of MRI scans as it is by defence spending.
>
>Health remains the greatest non-security challenge Western governments
>face. The task of managing an ageing population, whizbang technologies
>and a demanding public is awesome.
>
>Australia is not quite in the budget quagmire on health, but there is
>every chance its proportion of gross domestic product costs will
>continue to rise above the current 10 per cent. One of the great
>potential contributors to efficiency in what is notoriously the most
>inefficient of sectors is the electronic patient record. By allowing for
>more efficient sharing of information, health records stored as a
>transferable entity in digital form could transform the entire sector.
>Advertisement: Story continues below
>
>The electronics and computing revolutions of the past several decades
>have reshaped much of medicine, giving us advanced imaging techniques,
>microchips for monitoring and regulating heart function, and countless
>new diagnostic tools.
>
>But the information infrastructure of healthcare lags behind. Patient
>records and the data needed for determining effective medical practice
>remain decidedly low-tech.
>
>Every week I have frustrating conversations with colleagues who refuse
>to use email for correspondence about patients, instead directing me to
>send them a fax.
>
>As a junior doctor, I spent countless hours looking for forms, patient
>files and important X-rays. I wasn't alone, as a 2001 study by
>management consultants in Britain confirmed that medical officers there
>spent an hour a day looking for data instead of applying their scarce
>skills.
>
>Just about every other industry - financial services, travel,
>entertainment, communication, you name it - has been radically remade by
>information technology in the past two decades. But not healthcare.
>
>Entrepreneurs have harnessed science and technology to make dramatic
>advances in the practice of medicine but the health information system
>remains archaic and paper-bound. This paradox gets to the heart of why
>healthcare is simultaneously so impressive and so frustrating. The
>opportunity cost of inaccessible and unused data is particularly high
>for the millions of Australians suffering from conditions such as
>diabetes, mental illness and heart disease. This type of chronic disease
>increasingly forms the bulk of sickness and relies on team co-ordination
>to deliver high-quality care.
>
>Such sufferers would benefit enormously from regular, systematic
>analyses of their condition based on automated reviews of their key
>health indicators. It would also save taxpayers billions of dollars.
>
>One of the key concerns from consumers is about the privacy and security
>of the data. This is a particular concern among mental health sufferers
>who worry that sensitive information will become available to other
>health providers or even employers. But we have been willing to accept
>some risk to our privacy in exchange for convenience in the wide use of
>the internet banking, shopping and other services involving personal
>information. If patients could make greater use of the internet to
>improve their interactions with their doctors, they would quickly see
>the benefits and accept the risk, knowing there are appropriate safeguards.
>
>The government's plan to introduce the electronic patient record is on a
>tight schedule with the rollout to begin in July. The push will almost
>certainly need to come from consumers and governments, given such
>investments in technology do not produce a financial return for doctors
>and hospitals.
>
>The main beneficiaries are the patients who will gain new and more
>convenient access to their medical records and the healthcare system at
>large, which will operate more efficiently. The physicians and hospital
>administrators stand to lose their monopoly control over clinical
>information and get paid nothing more for their efforts.
>
>Indeed, many experts believe it will reduce demand for doctors and cut
>hospital admissions, as better information improves prevention and
>discourages the ineffective use of medical services.
>
>But there is a real risk that democratisation may go too far, with plans
>to give greater powers to consumers to alter their own records without
>medical input, which instil understandable fear in both doctors and
>their insurers.
>
>Equivalent attempts have fallen over in Britain due to a combination of
>financial turmoil, a change of government and poor clinician
>involvement. Our government has learnt from these mistakes but the risk
>remains that the issue may not be given due weight by the community. Its
>appearance seems to be limited to the IT sections of newspapers. But it
>could be a transformative event, for it will limit the potential of
>future health expenses to strain our economy, and it will make us healthier.
>
>--
>David Boxall                    |  When a distinguished but elderly
>                                 |  scientist states that something is
>http://david.boxall.id.au       |  possible, he is almost certainly
>                                 |  right. When he states that
>                                 |  something is impossible, he is
>                                 |  very probably wrong.
>                                                   --Arthur C. Clarke
>_______________________________________________
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-- 
Roger Clarke                                 http://www.rogerclarke.com/

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Visiting Professor in the Faculty of Law               University of NSW
Visiting Professor in Computer Science    Australian National University