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Dana Blankenhorn
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Will the EMR movement become a political divide

By | August 22, 2008, 6:44am PDT

Summary: Countries that are much further along in adopting EMR technology are now seeing pushback, mainly over the issue of centralized storage.

EMR database image from Google Images via HealthlineFor most of the year the move toward Electronic Medical Records has been one of the few medical reform ideas with broad bipartisan support.

(Google Images is credited with this picture on a HealthLine story about EMR vendor Practice Fusion.)

John McCain likes it. Barack Obama loves it. It is said to be a top voter priority.

But when I broach the subject at ZDNet opposition is easy to find. Some worry about mistakes. Others are concerned over costs. Still others see a government power grab.

Blue Cross Blue Shield of California recently gave $1.5 million to study EMRs, and another $1 million to study a chief aim of EMRs, the elimination of mistakes in hospitals.

But the head of that group is also scheduled to speak at next week’s Democratic National Convention in Denver.

Is the issue about to become politicized?

Craig Stoltz of HealthCentral thinks Obama’s embrace of EMRs may be much tighter than McCain’s. Countries that are much further along in adopting the technology are now seeing pushback, mainly over the issue of centralized storage.

The need for security, privacy, and control over the dissemination of records under HIPAA has slowed their adoption here. Countries without HIPAA are much further along.

Opposition expressed here to the plans of Google Health and Microsoft HealthVault to enable the storing of records, under the control of patients, is along the same lines.

Some readers don’t buy the argument that patients, and not the sites, will have full control of the resulting records. There is rampant distrust of both big business and big government.

The question is, could this turn into a prairie fire? Are proponents of EMRs underestimating the opposition, as the Clinton Administration did a generation ago?

Can this technology trend be reversed?

Poll

Do you have serious objections to the mass adoption of Electronic Medical Records?

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Topics

John McCain, Opposition, EMR, Hipaa, Government, Regulatory Compliance, Regulations, E-health, Vertical Industries, Healthcare, Human Resources, Policies And Procedures, Enterprise Software, Software, Dana Blankenhorn

Disclosure

Dana Blankenhorn

Dana Blankenhorn has been a journalist, writer and part-time futurist for over 30 years. At the present moment I run only a personal blog in addition to my ZDNet open source blog. DanaBlankenhorn.Com has the subtitle The War Against Oil. In the past I have used it to write about political history, e-commerce, personal matters, some ideas related to open source, and The World of Always On, which is the idea of using sensors, motes and RFID to turn WiFi links into platforms for applications which live in the air. My IRA account at Schwab holds a few tech shares, most notably some Intel and Applied Materials, but there are no open source companies in it. I don’t even own any CBS stock.

Biography

Dana Blankenhorn

Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994.
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EMR/EHR and PHR
stevenli 25th Aug 2008
VistA is indeed the grand daddy of EMR programs and probably the most robust of them still to date. Ironically, MUMPS is the programming that many 'current' programs are based, eg: EPIC which is deployed by the likes of Kaiser Permanente. The Veteran's Affairs (VA), embarked in a revolutionary re-engineering process of VistA (CPRS-R) back in 2003, but the funding was quashed by the Ex-Dell executive advising the VA due to budget and reorganization issues in IT in the VA. The DoD system works for them since they need a field system that's simple, yet robust...not the EHR for the masses.

The key to mass deployment and adaptation to an efficient medical system national that will be revolutionary will be two-fold--utilizing both the PHR and EHR simultaneously.

1. EMR:
The health industry is a cottage industry--built from the individual private practices and local hospitals. Decisions on deployment of the EHR is based at this basic level. Whether it be VistA, EPIC, Allscripts, or GE, they all work well and are geared to 'share' data based on common nomenclature and data fields.

The local IT will be tasked to secure this information. No sharing of information is reinforced with along the HIPPA guidelines.

2. PHR:

This is where the patient control is key and comes into control. The patient will be able to port his/her data from system to system via the PHR. Some industries are pushing online 'cloud' repository that is convenient and patient controlled. Google and Microsoft (pilot study ongoing with Kaiser), are the main players in this arena. Another very low tech way is to use the ubiquitous USB keyfob encrypted and stored data a la MedicAlert style to allow the patient to update data.

The real benefit occurs when #1 meets up with #2. The physician provides data from the EHR A and gives it to the patient to upload in the PHR. Ideally this is seamless with minimal human interaction, thus the online 'cloud' benefit of #2 communicating when the patient authorizes the physician to upload the data (ROI via HIPPA). Then patient goes to provider 2 and allows the download of the PHR to provider 2's EHR B with a similair ROI process.

Voila. Seemless patient data transfer between two independent EHR environments via existing technology that will remain under the patient's control on who/what/when data is released.

The KEY stumbling blocks remain to be that the 'trust' factor on where the PHR resides. Most patients are comfortable with the EHR at the local level. It's the 'big brother' concept of having PHR data in the cloud that will be the limiting factor.

Medicare reform is starting to push the EHR adaptation with the carrot (albeit 2% is not much). Soon the stick will start (-2% on medicare reimbursements). This is not fast enough and should be accelerated by the government for fast local adaptation of a EHR. The benefits of medical error reduction is in itself reason to push this through Congress.

Steven
View in thread
0 Votes
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FYI: Its now EHR, not EMR...
Been_Done_Before 22nd Aug 2008
the change is to include dental, pyschological and other healthcare services.

Electronic Health Records.

We are in the middle of deployment strategy planning. The cost of deploying equipment and personell to get this up and running is staggering. Then take into account that you have to retrain all your staff and adjust patient flow before you go live. Its an expensive endeveur that many companies just cannot affort right now.

Many of the countries that have EHR also have national healthcare systems. Our VA is now on EHR, its easier for the government to "pay" for it than businesses, which is why i believe adoption in the U.S.A is running at a much slower pace.
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Did not get the memo
DanaBlankenhorn 22nd Aug 2008
Sorry, the buzzword police did not send me the memo yet changing the acronym.
0 Votes
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RE: Will the EMR movement become a political divide
jfp 22nd Aug 2008
My Wife went to a Dr office the other day that was on a fully electronic system. The nurse walked out of the room and left the laptop not locked with not only my wife's but other patients medical records up on the screen and accessible.

Practices like that are why EMR in this country are a bad idea, its not the system its the users of the system that will make it insecure and a liability.
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Simply put...
dragon@... 22nd Aug 2008
It WILL be HACKED.

There will be no real control by us over OUR data. The goverment will insist that it has the legal right to know.

Like your SSN# is by law, not to be used like it is.
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Practical reality
Rick_R 22nd Aug 2008
Practical reality is that privacy concerns gradually die. The first generation complains. The next generation is brought up with the idea of convenience. The same idea is presented over and over and gradually accepted. After 9/11 in the U.S. Bush & co. created a "shadow government" to operate side by side with the AUTHORIZED government. Why don't we hear anything about THAT government anymore? Now we have the FBI being able to issue warrantless secret information request letters under "national security". The same will happen to opposition to EMR.
0 Votes
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Maybe the reason you do not hear about this
GuidingLight 22nd Aug 2008
"shadow government" is that it never existed?
0 Votes
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Some suspicion is healthy.
Anton Philidor 22nd Aug 2008
Though "shadow government" is excessive, the Bush administration did set a number of policies which evade the (loose) monitoring and regulating regime in the laws.

This debate will be considered like Jefferson's argument that as Commander-in-Chief he needed to respond to emergencies more quickly than Congress could pass a resolution or like Nixon's argument that the government is his personal property. A cousin of the "unitary presidency" argument.

My expectation is that after the next successful terrorist attack on US soil, the Bush efforts to obtain information will be considered excessively fastidious.

Emergencies are the best way to expand government power.
0 Votes
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Definitely
John L. Ries Updated - 25th Aug 2008
Jefferson's position on war declarations was rather ironic, given his advocacy of limited government and strict interpretation of the Constition, but pragmatism is often prompted by reality, and I think his actions against the Barbary States without waiting for a declaration of war were proper. He should have still asked Congress for a declaration as soon as possible thereafter.

I'm still waiting for an explanation as to why a declaration of war hasn't been necessary since 1941. The absolutist rendering of the Commander in Chief clause has never struck me as very convincing. We certainly could have declared war on North Korea, North Vietnam, Iraq, and the Taliban regime in Afghanistan after hostilities began, if necessary (we could easily have declared war first in the last two cases), and IMHO, should have, if we were going to put troops in harm's way.
0 Votes
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According to those who believe in such things...
John L. Ries 25th Aug 2008
...the "shadow government" has been around since at least the 1970s (at least, that's what the Christic Institute was saying in the 1980s). In many ways, ideas about it resemble the conspiracy theories of the John Birch Society, despite the political differences between the two sets of advocates.

If it exists, it certainly wasn't formed by the current President.
0 Votes
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RE: Will the EMR movement become a political divide
GregStarr 22nd Aug 2008
Well if EMR's become an issue the chances are about %50 that anything happens. Of course, any candidate that's thinking straight and watch the accessibility of medical care diminish while there is a realization by the general public that these inequities may be even difficult for republicans to stomach.

To offer the EMR as a panacea is a scarey thought since there is so much variations in what hospitals need. All it takes is a glance up stream of the EMR itself can be simply a path to even more problems.

There are the twitching MBA administrator juggling the manpower situation with every little fluctuation in cost. There is no tendency to look at fundamentals.

There is a whole infrastructure of support serves that are unaccountable. There is the primary physician who has to pay for this. Evidenced based medicine ha-ha-ha-ha. Re bottled swamp water form the 70's. I didn't work then and people were accually studing it(including myself) then.

Greg Starr
0 Votes
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RE: Will the EMR movement become a political divide
GregStarr 22nd Aug 2008
"M" or "H", "M" is where the money is. To go back to the government being concerned about health we have to go back to Kennedy. I've said it once and I will say it again VistA works, I've seen happy employees and patient using the system with a reduction in employees through attrition and a reduction in costs. Sure the government is providing the VA with a revenue stream but the stream is diminishing. The program is bases on a powerful, all but extinct, language called MUMPS.

The quality that made it a decisive success is ability to adapt according to user need. My wife has made her own forms on the system with IT support. I've done medical system analyzes before they take a great attention to details and a intimate knowledge of "buisness rule."

With a system where the users can create their own information pathways the fields the file structure, there reports become self evident and the system works. The IT people with sensitivity to "buisness rules," can then add value by adding the proper filters, validation and references. This approach is less expensive and it works better.

Let's talk about the DoD debacle with 3 Billion dollars of tax payers money and produced a system that sorely underperformed the VistA experience. How many companies are willing to invest 3 billion dollars in a system that we could even learning anything from.

Mumps is not necessarily the answer even through it seems to tolerate a lot of traffic with big files and with a fast response time. It is that given a fundamentally operating program can grow in the direction of the individual hospitals needs. So if any money is going to be spent, I hope that the developer and the amount have not already been settled upon, and allocated by a midnight session of congress to avert a disaster.
The shame of it is that this whole venture could be done privately without the politics because although the EMR is viewed as a cost saving measure, there is very significant evidence(not particularly complicated either) that such a record system would be efficiency and efficacy positive thus producing more profit.

Finally fire all the blue ribbon consultants and middle level managers. They haven't the slightest idea of what an EMR needs to do.
0 Votes
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RE: Will the EMR movement become a political divide
GregStarr 22nd Aug 2008
Simply asked, why would a hacker want to crack an encrypted file that contain a social security number. If the government uses the information in aggregate great for them but they would need permission. No one said that the information was the property of the government any way. The identifying information in the government is so encapsulated that the FBI didn't know what the CIA knew about a certain person or organization. There are much easier ways to get SSN information.

By the way, we have a system where an insurance company can share your medical care information with their subsidiarys unless you "opt out" yearly. I turns out that an insurace company has scads of subsidiaries and they legally own that information that mean no protection by the privacy act. That's really something to think about.
Greg Starr
0 Votes
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RE: Will the EMR movement become a political divide
smithscott98 24th Aug 2008
I read your article on electronic medical records and would like to recommend that you and your readers test drive our unique solution. MyMedicalRecords.com (MMR), a Patient Health Record, put a priority on two issues that are difficult to find together in most PHR programs and EMR systems. First is ease-of-use???all your healthcare providers need is a fax machine to put all your records into your account: each is turned into a PDF image using a proprietary process, which you then file. Second is privacy and security: we have such a bulletproof system that no hackers-for-hire have ever been able to penetrate it. You can share the account with up to 10 members of your family and each one would have secondary passwords to be sure privacy is protected. We also provide a special file that can be accessed by emergency personnel, which can have your critical information, like blood type and drug allergies. MMR is also by far the most feature-rich PHR on the market and is an Integrated Service Provider on Google Health???we have everything from a drug interaction database that red flags contraindications to calendar reminders for doctor appointments and prescription refills. If anyone wants to try this out for 30 days, just use the code TRYMMR.
Scott Smith
MyMedicalRecords.com
Smith.scott98@gmail.com
0 Votes
+ -
EMR/EHR and PHR
stevenli 25th Aug 2008
VistA is indeed the grand daddy of EMR programs and probably the most robust of them still to date. Ironically, MUMPS is the programming that many 'current' programs are based, eg: EPIC which is deployed by the likes of Kaiser Permanente. The Veteran's Affairs (VA), embarked in a revolutionary re-engineering process of VistA (CPRS-R) back in 2003, but the funding was quashed by the Ex-Dell executive advising the VA due to budget and reorganization issues in IT in the VA. The DoD system works for them since they need a field system that's simple, yet robust...not the EHR for the masses.

The key to mass deployment and adaptation to an efficient medical system national that will be revolutionary will be two-fold--utilizing both the PHR and EHR simultaneously.

1. EMR:
The health industry is a cottage industry--built from the individual private practices and local hospitals. Decisions on deployment of the EHR is based at this basic level. Whether it be VistA, EPIC, Allscripts, or GE, they all work well and are geared to 'share' data based on common nomenclature and data fields.

The local IT will be tasked to secure this information. No sharing of information is reinforced with along the HIPPA guidelines.

2. PHR:

This is where the patient control is key and comes into control. The patient will be able to port his/her data from system to system via the PHR. Some industries are pushing online 'cloud' repository that is convenient and patient controlled. Google and Microsoft (pilot study ongoing with Kaiser), are the main players in this arena. Another very low tech way is to use the ubiquitous USB keyfob encrypted and stored data a la MedicAlert style to allow the patient to update data.

The real benefit occurs when #1 meets up with #2. The physician provides data from the EHR A and gives it to the patient to upload in the PHR. Ideally this is seamless with minimal human interaction, thus the online 'cloud' benefit of #2 communicating when the patient authorizes the physician to upload the data (ROI via HIPPA). Then patient goes to provider 2 and allows the download of the PHR to provider 2's EHR B with a similair ROI process.

Voila. Seemless patient data transfer between two independent EHR environments via existing technology that will remain under the patient's control on who/what/when data is released.

The KEY stumbling blocks remain to be that the 'trust' factor on where the PHR resides. Most patients are comfortable with the EHR at the local level. It's the 'big brother' concept of having PHR data in the cloud that will be the limiting factor.

Medicare reform is starting to push the EHR adaptation with the carrot (albeit 2% is not much). Soon the stick will start (-2% on medicare reimbursements). This is not fast enough and should be accelerated by the government for fast local adaptation of a EHR. The benefits of medical error reduction is in itself reason to push this through Congress.

Steven

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