High-tech advances? They may prod you to get your medical records, asap

Dumpster-300x251Although enthusiasts still wax on about  how technology will improve lives, patients may want to be wary about purported advances that may end up complicating and even compromising crucial parts of their medical care — including how their medical records are kept and how payers decide if they’re covered.

Let’s start with some kudos for dumpster-diving doctors in Canada who discovered flaws in hospitals’ disposal of supposedly confidential and legally protected patient health records. They went around unidentified facilities collecting from various bins a half ton of paper that doctors, nurses, and hospitals were ready to toss.

After examining the piles of paper, they found most private records had been properly handled. But thousands of documents also were not: They were improperly disposed of, and contained identifying or confidential patient treatment information, the researchers found. Though Canada’s patient privacy laws differ from those in the United States, they agree that patient health records must be guarded, and the researchers found violations of practice, policy, and potentially privacy laws.

Their study, published in the medical journal JAMA, turned upside down what many might think would be conventional wisdom about both technology and best intentions: A key reason why protected materials were improperly handed, they said, could be blamed on the rise of electronic health records (EHRs). This is the very high-tech advance that advocates claimed would make materials easily accessible across hospitals, and, therefore, would cut down on medical personnel printing out and carelessly tossing patient documents. Instead, the fancy systems make it easier for doctors and nurses to print fast copies they want to review — and they handle them with less caution, because they’re not attached to a serious, permanent medical file.

Medical staff, like many green-minded dwellers of the planet, also may be too conscious of and eager to recycle patient records they print, rather than shredding them, as privacy demands might better dictate, the researchers said.

So much for the harms of good intentions, right?

The researchers said that hospital staff, including custodial crews, should get constant reminders and education about the need to protect patient privacy and records. Institutions might want to ensure that, in areas where medical staff will persist in printing confidential materials, documents get shredded and not recycled.

It might be a great idea if the computer systems themselves had new safeguards, such as warnings or protections against printouts of certain kinds of documents. Maybe successful software updates like these could be shared among hospitals to plug problem areas.

Nondisclosure of EHR flaws 

But Politico, the politics and policy focused web site, reported that doctors, nurses, and other medical personnel, as well as hospitals, may be hard-pressed to tell each other and, more important, patients and the public about the many and growing woes of EHRs. That’s because the giant EHR-tech companies, which burgeoned after the Obama Administration sought to improve medical care by providing billions of dollars to boost the systems’ use, have gagged medical staff and hospitals with nondisclosure agreements (NDAs).

The NDAs, Politico says, effectively bar “health care providers from talking about glitches that slow their work and potentially jeopardize patients.” As the news site reported:

Vendors say such restrictions target only breaches of intellectual property and are invoked rarely. But doctors, researchers and members of Congress contend they stifle important discussions, including disclosures that problems exist. In some cases, they say, the software’s faults can have lethal results, misleading doctors and nurses who rely upon it for critical information in life-or-death situations.

Politico details some of the nightmares associated with the NDAs, including researchers’ inability to publish studies on EHR flaws, for example, by illustrating these with screenshots — authors say that hospitals and doctors won’t allow themselves to be identified when they supply such pertinent information, and they are reluctant to participate in works for fear of getting on the wrong side of the giant EHR firms.

While lawmakers have said they will investigate this issue, they and their staff members also have expressed how galling it is for private companies, using big taxpayer funding, to have insisted on and even sneaked in NDAs into government contracts.

In my practice, I see not only the  harms that patients suffer while seeking medical services but also their growing anxiety, anger, and frustration in trying to stay fully informed and to document the safety, quality, and cost of their medical care. Their informed consent should be a paramount concern of medical practitioners, as should be the quality, safety, and security of their medical records.

In my book, “The Life You Save, Nine Steps to Finding the Best Medical Care – and Avoiding the Worst,” I list getting and reading these documents for patients as step one to improve their medical care. Seeing and studying your medical record can provide you with invaluable information and insights about your health and conditions, their sustained care, and how well you and your doctor are communicating and understanding each other about it. You’ll learn a ton about how good your doctor is or isn’t. Doctors and hospitals may throw up obstacles to your getting your own records. Don’t be deterred. And don’t let others compromise the privacy of your health records, electronic or otherwise.

Alas, the NDA has become a bane of medicine, and the sexual abuse and harassment scandals ripping Hollywood and corporate America show the destructive force of secret settlements. Congress should do more than “look into” nondisclosure clauses in big EHR vendor contracts — lawmakers should vaporize them, unless companies, in public hearings, can explain and defend them in the public’s interest, not for their own profit-making.

It’s unacceptable for new technologies to be turned against the human beings they’re supposed to benefit, and this issue looms large in medical advances. Besides electronics in medical records, computing whizzes, for example, also say they want to speed, improve, and streamline the decision-making in medical care. Advocates speak favorably about applications of artificial intelligence and algorithms, complex mathematical computations that reportedly can take the best of human decision-making carried out at blistering speed.

But the Verge, a youth-oriented technology-focused web site, deserves credit for its deep dig on how software and math mumbo-jumbo has created great ned for poor patients seeking public assistance for their chronic health conditions. Private vendors have created for them a medical qualifying and billing system, adopted by some states and other governments, that seems straight out of Hal 9000 and astronaut Dave Bowman in 2001. How do we unplug these beauties, asap?

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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