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Electronic Health Records Now In All US Military Hospitals

Soulskill posted more than 2 years ago | from the please-state-the-nature-of-the-medical-emergency dept.

Medicine 86

smitty777 writes "Information Week is reporting on the inclusion of Electronic Health Records (EHRs) in all US military hospitals. This is significant in that it allows the sharing of patient information on a worldwide scale, improving care. This is leading a national trend currently motivated by HIT Meaningful Use legislation, which provides incentives for civilian physicians to adopt EHRs. Not that the adoption is without challenges. The usability of EHRs is also an ongoing concern."

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86 comments

The last months taught you nothing! (2)

errandum (2014454) | more than 2 years ago | (#36490034)

Yes, all cool... Until they are hacked by a random foreign nation that'll have detailed information about all US soldiers.

Re:The last months taught you nothing! (2)

MichaelSmith (789609) | more than 2 years ago | (#36490096)

Random foreign nations have nothing on insiders with an axe to grind. But of course the US military already has a lot of sensitive electronic records. Medical records probably rate fairly low.

Re:The last months taught you nothing! (1)

Dutchmaan (442553) | more than 2 years ago | (#36490202)

Yes, all cool... Until they are hacked by a random foreign nation that'll have detailed information about all US soldiers.

I still don't see why they made the switch from stone tablets to paper. Used to be it took 5 guys to haul away one mans medical records, now 1!!! man can come in an make off with literally hundreds if not thousands of files!!!!

Re:The last months taught you nothing! (1)

MichaelSmith (789609) | more than 2 years ago | (#36490234)

The stone tablets were a big mistake. My money was always on papyrus. You could carry it around with you and if you had enough, you could sail it across the pacific.

Re:The last months taught you nothing! (3, Insightful)

couchslug (175151) | more than 2 years ago | (#36490442)

As a vet, waiting for paper records was a hassle. Gimme instant access, and equally important give my Tricare providers instant access.

I don't give a damn if they stream my colonoscopy video on Redtube or if Slashdot uses my hernia scar for a background.

I want efficient medical care, and must say the military has done well for me for 30 years (active and retired).

It's not about your medical history, per se. (1)

Anonymous Coward | more than 2 years ago | (#36490482)

I don't give a damn if they stream my colonoscopy video on Redtube or if Slashdot uses my hernia scar for a background.

On your medical records there is your SSN, DOB, Name, and Address - everything one needs to open a line of credit in your name and fund their terrorist attack on the US with a bunch of Visa, MC, Amex and Home Depot cards.

Then, the DOJ kicks your door down, slams you to the ground, puts a black bag over your head and cuffs you and then sends you to Syria or Turkey were you will be anally raped with a barbed wire covered cricket bat until you admit to masterminding the 9/11 attacks, the assassinations of JFK, MLK, President Lincoln, and being Osama Bin Landen's homosexual lover.

Then again, if your medical records are leaked, some employer or client sees them and decides that they don't like something in there - regardless of how benign it may be because a lot of people have irrational hang ups about the stupidest shit.

Re:It's not about your medical history, per se. (0)

Anonymous Coward | more than 2 years ago | (#36491080)

There's nothing irrational about it. It's quite simply ammunition and any kind of excuse to deny anything to an employee will suffice. We are in the first phase of a cultural collapse. The aristocracy has succumb to blind ambition and it's only a matter of time before it comes to open warfare.

It sounds silly but then again, who would have thought that NAZI Germany could have happened less than a century ago? The checks and balances have fallen apart. The masses will continue to hide from the problem until they have no other options than to fight. Things could be fixed but they won't. We WON'T tax imports from third world countries. We WON'T protect civil liberties. We WON'T balance our budget. This is a train wreck in progress and keeping your medical history private is just a tiny piece of it all.

Go home citizens. Worry about the important things like your state religion or gay marriage. Leave the other stuff to your aristocracy.

Re:It's not about your medical history, per se. (2)

couchslug (175151) | more than 2 years ago | (#36491270)

"Then, the DOJ kicks your door down, slams you to the ground, puts a black bag over your head and cuffs you and then sends you to Syria or Turkey were you will be anally raped with a barbed wire covered cricket bat until you admit to masterminding the 9/11 attacks, the assassinations of JFK, MLK, President Lincoln, and being Osama Bin Landen's homosexual lover."

No, they don't. My real background is easy to verify with many military witnesses past and current. I'd have to flag everything with "IDENTITY THEFT VICTIM, hold all transactions until verified" and freeze my accounts while redirecting my military retirement pay to another account. Same basic thing I counseled my troops to do when they get divorced.

"Then again, if your medical records are leaked, some employer or client sees them and decides that they don't like something in there - regardless of how benign it may be because a lot of people have irrational hang ups about the stupidest shit."

I'm on disability. I cheerfully bring my records to any employer. I have done so to verify work limitations.

I don't work in career fields with many sensitive people. I don't like the fuckers and they don't like me and that's the way I like it.

If my identity gets swiped I'll have a new hobby of telling the world to double-check anything purportedly done in my name. Shit happens, brace for it.

Privacy is dying and that toothpaste ain't going back in the tube.

Re:It's not about your medical history, per se. (1)

Jah-Wren Ryel (80510) | more than 2 years ago | (#36491872)

If my identity gets swiped I'll have a new hobby of telling the world to double-check anything purportedly done in my name. Shit happens, brace for it.

What you are demonstrating is the natural human tendency to not see past the end of your own nose. You, like most people, are unimportant, by far your biggest risk is getting caught up in some wholesale data theft and then dealing with the relatively minor personal fallout.

But focusing on the privacy of the average Joe in this way obscures the deeper threat. It is what happens when an average joe becomes important that the real risks to society come into play. Take, for example, an up-and-coming politician challenging the status quo - leaking the fact that he's been treated for gonorrhoea a couple of times might be all that's needed to kill his political career.

Privacy is dying and that toothpaste ain't going back in the tube.

That's just what people who don't care say to make themselves feel better about not caring. The world of information has changed, but that doesn't mean privacy died. It just means that we need to establish new social principles that take the place of the old social principles that have been made obsolete by that change.

Re:It's not about your medical history, per se. (0)

Anonymous Coward | more than 2 years ago | (#36493378)

I love your post! Paraphrasing, you said, "you don't matter at all, you near-sighted twit. but joe fuckface becomes a politician, and can be damaged by leaking of embarrassing information about shit he actually did. now, THAT matters.".
 
And I really love your assertion that people have had privacy before the proliferation of electronic records. The U.S. has been using SSN's as a de facto national ID for decades. And you think we can "establish new social principles" to get the assholes who like to use your information for their own gain to somehow stop using it, now that it's even easier to obtain.
 
Lol, "obscures the deeper threat", "establish new social principles". Pompous much?

Re:It's not about your medical history, per se. (0)

Anonymous Coward | more than 2 years ago | (#36494328)

I don't think you could've missed the point any worse than if you had actually tried.

Re:It's not about your medical history, per se. (1)

techno-vampire (666512) | more than 2 years ago | (#36496330)

I'm on disability. I cheerfully bring my records to any employer. I have done so to verify work limitations.

I'm not, but my hearing loss is service connected. (0%, but still better than nothing.) Not only does it mean that my hearing aids and batteries are free, it makes it almost impossible for a potential employer to use it as an excuse not to hire me because I can fill three different quotas for him: people over 60, vets and people with a disability.

Re:It's not about your medical history, per se. (1)

couchslug (175151) | more than 2 years ago | (#36522542)

Note that you can file a Notice of Disagreement later on if any service-connected condition gets worse, or to substantiate a service connection.

Check out the hadit.com forums, and Jim Stricklands material on
http://www.vawatchdog.org/ [vawatchdog.org]

Spread those links around to other vets. I learned enough from them to file my own NOD.

Re:It's not about your medical history, per se. (1)

techno-vampire (666512) | more than 2 years ago | (#36522908)

That 0% is fair because it's derived in an objective and neutral manner. There's a chart of hearing loss where you take the column that matches the loss in the worse ear and the row for the better ear and where they cross is your award. That way, you don't have people in different places getting different awards for the same condition.

Re:The last months taught you nothing! (0)

Anonymous Coward | more than 2 years ago | (#36497498)

As a vet... I don't give a damn if they stream my colonoscopy video on Redtube or if Slashdot uses my hernia scar for a background... military has done well for me for 30 years.

So you want to digitize the medical records of the Advanced Assault Animals you treat?

Re:The last months taught you nothing! (1)

Average_Joe_Sixpack (534373) | more than 2 years ago | (#36490470)

There's no need to go to all the trouble of hacking. I'm sure this EMR is probably interfacing with several clinical systems that have offshore support and data management.

Re:The last months taught you nothing! (1)

MakinBacon (1476701) | more than 2 years ago | (#36495340)

Yes, all cool... Until they are hacked by a random foreign nation that'll have detailed information about all US soldiers.

What are they going to do with the medical records of over a million soldiers? It's not like they can discover some sort of massive "death star ventillation"-style weakness in the entire army using medical records.

Re:The last months taught you nothing! (0)

Anonymous Coward | more than 2 years ago | (#36498078)

Yes, all cool... Until they are hacked by a random foreign nation that'll have detailed information about all US soldiers.

What do you mean hacked.... it has already been hacked as it is run by Lockheed Martin. Good luck with that.

HIPAA and Hackers and Hijinks oh my (1)

waddgodd (34934) | more than 2 years ago | (#36490054)

Let's see, we add this "100% electronic" to a previous article by VA saying that VA and DoD electronic medical records have been combined, and add the two-three years ago VA hack that pulled all the records of a couple hundred thousand vets, and get "yeah, this will turn out well"

All I can say is WOW (0, Interesting)

Anonymous Coward | more than 2 years ago | (#36490146)

All the healthcare records in the military were electronic (with paper copies upon request) as of 2003 when I joined the US Army - this is nothing new - just some dirty liberals trying to take credit for something under Obama they didn't even have a hand in.

Re:All I can say is WOW (2)

PopeRatzo (965947) | more than 2 years ago | (#36490430)

just some dirty liberals trying to take credit for something under Obama

If anyone knows of a liberal in the Obama administration, please let me know because I'd like to make contact with him, since he's (or she's) probably really lonely.

On second thought, if there is a liberal in the Obama administration, you better keep the name quiet, or Fox News and Glenn Beck will start a jihad to get that person sacked for having once called Republicans assholes in 2003.

Re:All I can say is WOW (0)

Anonymous Coward | more than 2 years ago | (#36490914)

there's nothing like that in the article at all. This reads like a press release from CliniComp. They're excited because some of their software was being used in some military hospitals and is now used in all military hospitals. Not really that exciting.

No "dirty liberal" was taking credit for anything.

Re:All I can say is WOW (0)

Anonymous Coward | more than 2 years ago | (#36491400)

That has got to be the fastest the government has ever moved. Bush becomes president in 2001 and through his visionary leadership implements a military-wide EHR in just two years. Amazing. And now some liberal is taking the credit. Figures. Next they'll take credit for Bush creating the Internet.

Electronic patient records (1)

Wowsers (1151731) | more than 2 years ago | (#36490102)

That's nothing. In the UK the National Health Service is scaring people to accepting their details to be on computers instead of paper records. http://www.telegraph.co.uk/health/healthnews/7704050/NHS-scaring-patients-into-accepting-electronic-records-database.html [telegraph.co.uk]

Such scares as:

"Health-care staff treating you may not be aware of your current medications in order to treat you safely and effectively."

"Health-care staff treating you may not be made aware of current conditions and/or diagnoses leading to a delay or missed opportunity for correct treatment."

"Health-care staff may not be aware of any allergies/adverse reactions to medications and may prescribe or administer a drug/treatment with adverse consequences."

Many people have written to keep themselves off the database, but that means nothing as the government does what it pleases, always has, always will.

Re:Electronic patient records (1)

Goose In Orbit (199293) | more than 2 years ago | (#36490128)

Just a thought...

Do you carry your entire health history around with you 24/7? Or can remember every little detail of every drug you've taken, what for, and when?

If so, fair enough - for the rest of us however, somebody (or thing) will have to do the remembering for us...

(I should mention at this point my first job was as a developer on a pathology system used mainly by NHS hospitals)

Re:Electronic patient records (1)

foniksonik (573572) | more than 2 years ago | (#36490738)

I would love to have all my records. Could store them all on a 4 GB keychain drive. Would be better if the health system had a public key to access the data (which would be encrypted). They could share that public key around. I'd have some way to update my private key in case they got hacked.

Re:Electronic patient records (1)

Ihmhi (1206036) | more than 2 years ago | (#36497406)

One of my acquaintance's fathers worked for a NJ town - a rather small one. They had a pilot program going where every ambulance would have a laptop on it, and almost everyone in the city had a thumb drive with their medical info on it in an open format. Never really took off sadly.

Re:Electronic patient records (2)

FraggedSquid (737869) | more than 2 years ago | (#36490240)

Health records have been held in electronic form for YEARS in the UK. Lloyd George envelopes are so 1980's The only difference is that they are held locally (at the surgery or in a data centre) and only accessible to that practice. What you are talking about are the various national shared record initiatives where a sub-set of the record is sent to a central location and can be accessed by other care providers.(e.g A&E staff).

In England if patient dissents from the programme (by having an appropriate Read code added to their record) then when the upload is done all that is sent is a note to the effect that they do not want a record. The NHS IT folk check that the system does this that there is no way any any information from a dissenting patient is sent up. I know I've sat through enough SCR witness testing sessions to last a lifetime. Access at the other end is audited and if necessary an alert is sent to the local Caldicott Guardian (not an end-of-level boss but a senior clinician with responsibility for protecting patient information).

There are a number of national programmes in the UK for centrally sharing part of the record. In England there is the Summary Care Record programme (data sent ranges from nothing to Allergies and time-bounded medication to the previous list plus any items you agree with your GP that can be shared). In Scotland there is the ECS Emergency Care Summary to support out-of-hours care, In Wales and Northern Ireland there is the ECR Emergency Care Record for use in A&E,

Re:Electronic patient records (2)

AuMatar (183847) | more than 2 years ago | (#36490300)

Scares? Those sound like legit concerns to me. The last thing you need is to MRI someone with a metal plate in their head, or to give pennicilin to someone with an allergy. While there needs to be strict criminal liability for providing non-emergency access without permission, sticking with paper records is asinine.

Re:Electronic patient records (4, Insightful)

James Youngman (3732) | more than 2 years ago | (#36490378)

If by "scares" you mean manufactured, misleading hyperbole, you're wrong. There are tens of thousands of adverse drug interactions annually in the UK (and more in the USA). Many of these are avoidable (they're not just drug-drug interactions, adverse drug-condition or drug-{age,procedure} interactions occur too) and key to avoiding this is delivering timely, accurate information to your healthcare providers.

Keeping yourself off the relevant clinical databases is a choice and a compromise of risks; on the one hand the risk that your data will be leaked and on the other hand that your choice to equip your clinicians with less information will cause you to get less effective treatment in the future.

In some senses this is a balancing of benefits to do different people; first, your healthy, vigorous, young self. Second, your elderly, sick, incapacitated self. The latter cares most about the privacy angle but I'm pretty sure the latter cares most about the quality of care. But it would too late for the elderly you to benefit their treatment by reversing the decision made by their younger self.

Re:Electronic patient records (1)

James Youngman (3732) | more than 2 years ago | (#36490390)

Drat, too much haste.

s/do different people/two different people/
s/The latter cares most about the privacy angle/The former cares most about the privacy angle/

Re:Electronic patient records (0)

Anonymous Coward | more than 2 years ago | (#36491180)

The real problem is, that doctors don't WANT to talk to each other. The more they know about what another doctor did, the more they are reliable in any problems that are the result of the other doctor, and can be sued because of it. If they "didn't know", then they can't be held accountable. So in a way, its because of Lawyers that generally people get interaction problems, as most interactions are due to one doctor giving you one drug, and another doctor giving you one that interacts with that. Most EHRs, not only will let you look up drug interactions, they will give you realtime (when you add the drug) if the drug will interact with the patient, based on age, pregnacy, and currently active drugs on the patient, i.e. The caveat to this is that the EHR has to know ALL drugs on the patient, which requires the patient to divulge all drugs they are taking.

Re:Electronic patient records (2)

murdocj (543661) | more than 2 years ago | (#36490428)

If you've ever dealt with a hospital, you'll know that everything NHS cites is true. I've sat with patients and had doctors and nurses come in and ask ME questions about medications, reactions, etc. Or in a few cases I've had to point out that "Doctor so & so was just in here and ordered this 5 minutes ago, are you sure you want to ALSO order that same thing and give the patient a double dose?".

I don't know if the current electronic records system is actually an improvement, but they need to do something to improve the situation. In the meantime, if you ever have to go into a hospital, you better have someone sitting in your room with you, monitoring what's going on.

Re:Electronic patient records (1)

couchslug (175151) | more than 2 years ago | (#36491276)

""Health-care staff treating you may not be aware of your current medications in order to treat you safely and effectively."

"Health-care staff treating you may not be made aware of current conditions and/or diagnoses leading to a delay or missed opportunity for correct treatment."

"Health-care staff may not be aware of any allergies/adverse reactions to medications and may prescribe or administer a drug/treatment with adverse consequences."

Happens with any sort of record. Waiting for doctors offices to swap paper data by FUCKING FAX is no joy either.

TFA does not tell the whole story (2, Interesting)

Anonymous Coward | more than 2 years ago | (#36490112)

The DoD MHS (military health system) already has an EMR in place called AHLTA (previously known as CHCS-2). TFA just talks about a new vendor product (from CliniComp) that's being installed in about 50 hospitals, whereas MHS has more than 100 hospitals all running AHLTA already, along with a few other EMR systems. Bad reporting from InformationWeek, it almost reads like an advertisement.

Re:TFA does not tell the whole story (0)

Anonymous Coward | more than 2 years ago | (#36490220)

AHLTA - what a monstrous bandwidth eating and unreliable POS. Just ask TIMPO what they really think of it.

Re:TFA does not tell the whole story (1)

Locutus (9039) | more than 2 years ago | (#36490952)

I had thought I'd read something about the military hospitals using HL7 and digital records for many years back when Microsoft called Windows Vista. There's some software called Vista that's used in military hospitals or something like that and the military hospitals have been using electronic records for a long time. No surprise TFA was more of a PR stunt since it seems that's what lots of "news" is these days, paid advertising.

LoB

Re:TFA does not tell the whole story (1)

demonlapin (527802) | more than 2 years ago | (#36492284)

The VA uses VistA, not the active-duty military.

Re:TFA does not tell the whole story (0)

Anonymous Coward | more than 2 years ago | (#36494134)

VistA makes the TRS-80 look cutting edge. It's written in M, widely regarded at the worst seriously used language in the world (with the possible exception of APL).

Re:TFA does not tell the whole story (1)

Locutus (9039) | more than 2 years ago | (#36495184)

ah, right. what about CHCS by SAIC and written in Mumps. It's amazing what stuff you find in the cracks when you look around. thx

LoB

What about privacy? (1)

anonieuweling (536832) | more than 2 years ago | (#36490122)

What about privacy? The patient of course has no control over where that record goes...

Re:What about privacy? (1)

Goose In Orbit (199293) | more than 2 years ago | (#36490142)

And they do with paper records?

Re:What about privacy? (0)

Anonymous Coward | more than 2 years ago | (#36490284)

Getting paper records requires human intervention, hopefully that human is aware of privacy issues and will not just handover records on a whim. The Dutch attempt at electronic records was scrapped (for now) because of privacy issues in the (first attempt of a) crappy implementation.

Re:What about privacy? (0)

Anonymous Coward | more than 2 years ago | (#36490672)

There are several Dutch hospitals currently implementing or already up on electronic record systems; my employer is the vendor for them, so the scrapped implementation must have been several years ago.

Re:What about privacy? (1)

rev_sanchez (691443) | more than 2 years ago | (#36490812)

Right now a lot of medical transcription work is sent overseas to take advantage of low cost out sourcing. A few years ago a woman in Pakistan threatened to publish medical records [sfgate.com] from UCSF Medical Center on the internet unless she was paid a bit more.

While it's always possible that external intruders could get by the network security, the EHR's security, and figure out how to access and make sense of the proprietary data in the systems, the biggest threat is from people on the inside.

IAAHITC - I Am A Healthcare IT Consultant

Re:What about privacy? (1)

jhoegl (638955) | more than 2 years ago | (#36490368)

Actually, they do...
HIPAA requires the doctors/Hospital/clinics to have the patients authorization to send medical records to insurance (if requested), and other doctors as long as you signed a release form for that specific doctor.
Oh, and you have to sign a new one every year.
You ever read that stuff you sign at the doctors?

Re:What about privacy? (3, Informative)

sgent (874402) | more than 2 years ago | (#36490970)

In fact they do not have to have that permission. There is a (truck wide) hole in the law that allows disclosure for treatment or business purposes. Both of your examples would fall under this exception.

Re:What about privacy? (1)

Savantissimo (893682) | more than 2 years ago | (#36494144)

Not to mention anybody in any branch of any level of government who asks.

Re:What about privacy? (0)

Anonymous Coward | more than 2 years ago | (#36511078)

Not true. The Department of Defense must conform to HIPAA guidelines and the Privacy Act of 1974 just like every other hospital and clinic in the US. It is a violation of Federal Law to access, view, alter or transport US medical records without a) need to know in the course of treatment of the patient, or b) prior authorization from the patient.

Please get your facts straight before posting illegitimate garbage to a public forum.

Re:What about privacy? (1)

Savantissimo (893682) | more than 2 years ago | (#36516948)

I exaggerated, but only slightly. See http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html [hhs.gov] for the exceptions to the privacy rule. If a nosy tax-feeder can't fit his request into one of these exceptions, then he needs to go back to bureaucrat school.

For instance: "Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; ..."

Re:What about privacy? (1)

Average_Joe_Sixpack (534373) | more than 2 years ago | (#36490540)

What about privacy? The patient of course has no control over where that record goes...

Clinical data lives on multiple systems regardless of a patient's authorization to release the information to payers and other third parties. A hospital may have several clinical information systems located at third party data centers and the folks supporting of those systems may be located anywhere around the world ... same goes for the folks supporting the hardware that is running the software. Theft or misuse of clinical data can occur at multiple points.

military hospital? (1)

Anonymous Coward | more than 2 years ago | (#36490252)

what the fuck, is a military hospital? does it have a military morgue, military pharmacy, military interns, military janitors, military parking lot, and does it have a general cuddy?

Re:military hospital? (3, Funny)

halivar (535827) | more than 2 years ago | (#36490376)

The janitors are civilian contractors. The rest is accurate. What is so strange?

Re:military hospital? (0)

Anonymous Coward | more than 2 years ago | (#36490402)

Why have military hospitals? This would be cheaper by using the regular hospitals. Get a military discount by showing your military ID and then send the bill to Unkle Samm while you get ready to rotate yet again!

Re:military hospital? (4, Interesting)

halivar (535827) | more than 2 years ago | (#36490810)

No, because military doctors make less, and don't need malpractice insurance. Now, speaking as one who has been on Tri-Care: you get what you pay for.

Re:military hospital? (2)

techno-vampire (666512) | more than 2 years ago | (#36496400)

I'm a long-term unemployed 'Nam vet and I get all of my medical care from the VA. Because I have (effectively) no income, there's no copay. That means, I get the nine different pills I take for free, along with the test strips for my blood sugar (I'm Type II) and the insulin I've been on for about a year for free. And, I recently got my cataracts removed at no charge. Not only that, as my hearing loss is service connected, my hearing aids and batteries are free. Yes, when I was working and could afford to pay, there was a copay and I cheerfully paid it because it was still less than I'd pay otherwise, but right now, I'm getting what I don't pay for and I'm thrilled with the quality of care I'm getting because without the VA, I'd probably be dead.

Privacy Vs Saving Lives (3, Interesting)

Anonymous Coward | more than 2 years ago | (#36490286)

I work in Biomedical Science, and see first hand the importance of accurate patient information. Not just for the obvious emergency where its important to know an unconscious person is a diabetic, or for doctors to know allergies etc.
It is also important to know what diseases are prevalant in population, what diseases need management, where resources are needed etc. These are things that are very difficult to do at the moment because of the lack of centralised up-to-date information. A national study needs to be compiled from data from different states, countries, small departments within systems within states...its a nightmare! It could be so much better if we availed of the technology available today.

People are worried about their privacy, but from whom exactly? Who does the common guy on the street fear with their information? Surely it is a good thing your attending doctor has your history? And nobody else is allowed access. And nobody else cares! What about celebrities? Fine, have an opt out. Easy.

People are going to get into a frenzy about privacy, politicians are going to tip-toe around the issue for fear of public outrage over privacy, pathetic journalists are going to stir up peoples fears, and lives are going to be lost. Privacy is fundamental to the system, and needs to be designed in, but the benefits (lives saved) are too great to ignore.

Re:Privacy Vs Saving Lives (1)

Christoph (17845) | more than 2 years ago | (#36495810)

Bravo. There are public health implications to sharing medical data that so clearly outweigh privacy concerns. The difference is a factor of possibly a million lives saved by collecting, sharing, and analyzing medical data versus embarrassing moments and unfair prejudice when data is mishandled (unfair prejudice sucks but it can be and is dealt with by methods other than privacy).

Here's a thought experiment: Imagine an opt-in system that eventually allows a huge meta-analysis of data that discovers the cause (and cure) of autism. Then, a parent's child is newly diagnosed with autism, but the parent (and child) have not opted-in to share THEIR medical data. They are given the option: we will cure your child, but since you are benefiting from the shared data of others, you would be required to also opt-in and share your medical information.

I can't image a significant number of people would say "No thanks. My child being cured of a disabling illness is not as important as keeping our medical information private. We will keep our privacy, and you can keep your cure for this illness."

I will also say "Me, too" on your other point: I do not spend time wishing I knew about other people's foot fungus, back pain, or whatever other medical conditions. No matter how embarrassing or stigmatizing your medical info, unless I know you personally and you come to me for help with your illness, it's just not on my radar.

Re:Privacy Vs Saving Lives (1)

zuperduperman (1206922) | more than 2 years ago | (#36496378)

My main fear about EHRs is mainly the centralized nature of it. Centralized databases are rarely necessary and never good, but seem to be the fantasy of every bureaucracy. I would like my EHR to be electronic, but to carry it on my phone, or in an implanted chip or something. I would like it to be illegal to store even one iota of it in a medical system that spans more than 24 hours. I want to have the power to erase it absolutely and at any time without permission from anybody. When you need to know it you can read it from my phone, and you can store any data you want right back there on the phone. If you have to keep some data for whatever reasons then you keep only the exact parts you need and you anonymize the crap out of it. If you want any more than that then you ask me very nicely for it and I choose to release it to you at my discretion.

What you do NOT do is start compiling a giant centralized database with massive amounts of information about me without my consent just in case some random future researcher wants to plunder it to publish another paper.

Re:Privacy Vs Saving Lives (1)

techno-vampire (666512) | more than 2 years ago | (#36496470)

Centralized databases are rarely necessary and never good, but seem to be the fantasy of every bureaucracy.

Last year I spent five days in the VA hospital in West LA with a blood disorder: ITP. About a week after I got out, I went to a convention on the East Coast. Before going, I made sure I knew where the nearest VA facility was, Just In Case. As it happens, I had no need to visit them but if I had, they would have had access to all of my pertinent medical records simply by calling them up on their computer. Yes, I could have carried a copy of my paper records, but which would you rather depend on in that type of emergency: remembering to carry a file to the doctor or having them instantly available?

Re:Privacy Vs Saving Lives (1)

zuperduperman (1206922) | more than 2 years ago | (#36496836)

Yes, I could have carried a copy of my paper records, but which would you rather depend on in that type of emergency: remembering to carry a file to the doctor or having them instantly available?

That's why I said I would like my EHR to be electronic, but rather than stored centrally, carried on my person, in a way that I'm unlikely to ever forget (phone, implanted chip, etc.).

As a counter point - suppose you did have an emergency and didn't end up at a VA facility but instead at a generic hospital somewhere? If your records were on your phone then they could get them whereas with the VA they might not. I could imagine NFC being a useful technology here - your records are in your phone and you merely need to punch in a PIN to have them made accessible to a health professional - and there could even be an "override" PIN for use in emergencies that accredited workers could look up so that if you're unconcious and can't grant consent they can still get the information.

Re:Privacy Vs Saving Lives (1)

techno-vampire (666512) | more than 2 years ago | (#36497158)

As a counter point - suppose you did have an emergency and didn't end up at a VA facility but instead at a generic hospital somewhere?

Well, I don't have, and can't afford that type of phone, but I guess I could put them on a flash drive if needed. However, in this case, the most likely thing would be that I'd see signs that the ITP were coming back and take either a bus or taxi to the nearest VA because the condition's not one to dump you in a random ER without warning. (Basically, it's caused by a low platelet count, and there are warning signs if you know what to look for.) And, that's part of why I made sure I knew where the nearest VA was, so that I wouldn't have to worry about them having my records.

Re:Privacy Vs Saving Lives (0)

Anonymous Coward | more than 2 years ago | (#36508494)

Almost certainly, the future compensation model for healthcare providers will involve meeting "wellness" objectives for that provider's given population. Instead of the historical model of "fee for service" in which a provider is compensated only when a patient is sick, the provider instead will be financially rewarded based upon other metrics. This approach is seen as one of the major ways healthcare reform will reduce or at least stabilize the cost of healthcare in the US.

Obviously, reporting from electronic patient, encounter and clinical data is required. At any rate, use of EHRs has essentially been mandated by the federal government.

Lastly, the vast, vast majority of healthcare providers are and have been using EHRs for years, but very, very few of them can actually exchange data with one another.

Usability is highly relevant and rarely examined (1)

Anonymous Coward | more than 2 years ago | (#36490354)

While I haven't worked with a full EHR system yet, I have worked with a number of PACS systems (digital X-ray/imaging display). I've used several from different manufacturers, and every single one has had usability problems so severe that I regard the systems as unacceptable (the hospital administrators disagree).

For example in the UK, where the government mandated PACS and other electornic systems by a certain date, there was so much usability concern, that a small pressure group of medical imaging staff eventually formed to try and address the problems. The creation of a pressure group, whose goal is to see the software withdrawn and replaced, is a striking sign of poor usability. Things have improved, and the group has relabelled itself and now has a prominent place in the selection of PACS and other informatics systems.

However, even with more modern software, there are frequently severe problems. Icons where the glyph and description bear no plausible relation to the task performed (e.g. a camera icon, entitle 'snapshot' being used to load a case onto an agenda for a meeting; an icon with a hand and arrows pointing up, down,left, right being used to change the brightness/contrast). Other problems include mouse buttons being assigned in inconsistent or complex ways; e.g. right clicking on colomn header in lists to sort - when every other software uses left button; heavily overloading the mousebuttons, such that a single click is different from a click-and-short hold, which is different to a click-and-long-hold, which is different to a double click, which is different to a click and drag; while simultaneously ignoring system settings about double-click speed, so that clicking on tool 1, then tool 2 in quick succsssion is actually registered as 'click 1, double click 2' which performs a completely different task).

Even at one site, where MDs have been using the new software every day, they still struggle. Even the professors of radiology, whose job is basically to use the system all day, every day to view images, struggle to do relatively basic stuff - even after 3 months. Even I frequently forget or get confused between operations ; heck, I even find myself longing for an SQL prompt, because the GUI search function is so difficult to use (dragging a list of criteria from a box, then attaching boolean operators to the criteria, ordering the criteria and then entering your search paramterers - and just to add insult to injury, your search criteria are cleared after running the search, requiring you to build the whole query again).

Of course, the older systems were worse. I once used one that was "ergonomically" designed and designed in a "flat pictorital" manner. What this meant was no text menus, no hierarchies of tools, no context sensitivity. Just a sea of toolbars and icons. At the bottom of the screen was an ocean of about 280 icons for stuff like (image size:normal; image size: 150%; image size: 200 %; show 1 image on screen; show 2 images horizontally tiled; etc.). Of course, this design philosophy didn't make it as far as the actual dialog boxes, where you had to use PERLesque constructs - like if you wanted to show 'studies for today', you'd have to enter 'date=$today' to get it to do it. Oh, and the performance was just hopeless - but then this system was marketed as using 'cygwin' and 'exceed' technologies for stability. As you might imagine, for an image manipulation and viewing system, the performance was disappointing.

Re:Usability is highly relevant and rarely examine (2)

Average_Joe_Sixpack (534373) | more than 2 years ago | (#36490564)

Management doesn't really get the usability concept. Well they do eventually when the mortality rates rise and the lawsuits start coming in.

Re:Usability is highly relevant and rarely examine (1)

demonlapin (527802) | more than 2 years ago | (#36492306)

I have no idea how expensive it is - I'm guessing that if you have to ask, you can't afford it - but Philips has a system called iSite that is a wonderful PACS. Much better than any other one I've used.

Great, but it doesn't have to be centralised (0)

Anonymous Coward | more than 2 years ago | (#36490396)

Your local GP could hold a copy and you could carry a copy with you on card. One could be updated from the other and if you needed treatment you would always have your health record with you.

The only problem with that is that no government snoop would find it trivial to access all that data in all those medical practices.

However the government are in charge, and they like snooping, and their brothers and sisters in the corporate world also like snooping - so the data is held on a central server. That's more convenient for them, and the notion of their own convenience comes so naturally for them that it didn't even occur to decentralise it.

You can complain all you want. The system wasn't designed for your benefit.

Decentralised systems have their own problems (0)

Anonymous Coward | more than 2 years ago | (#36490712)

The problem with a decentralised system (e.g. a personally held health information card) is how do you ensure that the data at each site is up-to-date?

What if you are outside your home GP's area and need treatment but don't have your card? The card won't be updated, but new diagnoses may be made, or treatments may be changed? The GP may eventually get the message - but what about if you seek further treatment in the meantime? The card and GP's databases will be inconsistent? Which is right? How do you tell?

Data consistency is a big problem with decentralised databases - at least with GPs keeping the records themselves, they know that they have the most complete records, and hopefully most up-to-date. The problem with card is that people may get lulled into thinking that they are always up to date, when, in-fact, they may not be.

Military Hospitals? (0)

ChunderDownunder (709234) | more than 2 years ago | (#36490410)

Great, US Forces can invade and lay waste to your village but at least your wounded will be provided with A1 medical care?

not really revolutionary (0)

Anonymous Coward | more than 2 years ago | (#36490622)

The VA has been using electronic medical records for years, I would assume that they have implemented a similar system. The VA system is fairly straight forward. It is about time.

Anything is an improvement (1)

pcgamez (40751) | more than 2 years ago | (#36490674)

Five years ago I had the opportunity to experience the military hospital system when I broke several bones. The entirety of the treatment program (about a dozen doctor visits plus about thirty physical therapy visits) resulted in only a dozen pages of scribbles (~10 words to each page) from the doctor visits plus the intake paperwork (~4 pages). There were no records of the physical therapy sessions (PS: The VA has refused to cover the injury citing a lack of documentation!)

Compare this to the civilian care I received a few months later for the same injury which had complete descriptions and detailed records of every visit.

So unless there have been radical changes in staff and their practices, all you will end up with is junk in electronic form instead of on paper.

EPIC (1)

modmans2ndcoming (929661) | more than 2 years ago | (#36490834)

Epic's software is very usable. They are currently the market leader and people who have been on Centricty Enterprise are coming to them in droves.

Pure socialized health care (0)

Anonymous Coward | more than 2 years ago | (#36490872)

The military led the nation in racial integration perhaps they will lead us to socialized medicine.

Fixed that for you (1)

argStyopa (232550) | more than 2 years ago | (#36490882)

" This is significant in that it allows the stealing of patient information on a worldwide scale, improving the ease of identity theft and crime"

A couple of minor corrections.

Opinion (1)

RogueWarrior65 (678876) | more than 2 years ago | (#36490936)

IMHO, the reason it's in all military hospitals is because when an order is given, it is obeyed promptly. In the civilian world, it's more like "Yeah, we'll get to it eventually but we're going to need a lot more funding and people and equipment and time off and perks and...."

I work with this software every day... (1)

StandardAI (1988770) | more than 2 years ago | (#36491044)

CHCS and AHLTA are on the slower side. CHCS has an interface similiar to DOS. A big problem with both of them is that they require you to do the same thing over and over for simple tasks. They started rolling out essentris when I worked at labor and delivery, gotta say it was one of the fastest and most user friendly apps but best of all it pools information from one sheet to another which saves time. Also more secure for the fact that it requires you to log in each time you edit a note or add information, which makes it a lot easier to just share the same computer for several patients instead of having to log in and out for each user which can take a while with CHCS and AHLTA.

doctor it was 2005 (1)

wuzzerd (1150445) | more than 2 years ago | (#36491084)

In the private system, I saw my doctor, who never looked in my eyes since she was too busy looking in a laptop. No paper chart at the exam just the laptop with info dating from the start of the new electronic system.

Went to a specialist (on of the most respected in his field). Staring in a laptop he bluffed his way through the $200 exam and told me he could not have performed the surgery in 2005 it had to be 2007. All of this is in the paper chart, which he could understand because he MADE IT HIS WAY. The jokers in charge of this project are on the other side of the continent and even handle the billing for the locals.

Someone is behind on data entry for the histoical charts, but then who can read a Dr's handwriting...

Has the formats battle been solved? (1)

SnapShot (171582) | more than 2 years ago | (#36491092)

Last time I looked into this it seemed like CCR (continuity of care record) was becoming the document standard for these records but the VA already had a system that did not use that document format. Has the industry / government settled on a document standard for (textual) medical records yet?

Re:Has the formats battle been solved? (2)

Bloodwine77 (913355) | more than 2 years ago | (#36492120)

Good question. I work with several EMR vendors and they all side with CCD instead of CCR. Truth be told, there will never be the one true format. My company will have to support CCD, CCR, HL7v2, and lord knows how many proprietary formats for the foreseeable future.

What we do is just store every piece of medical information as discrete, granular data and when pulling from the data storage we assemble it into a self-designed proprietary intermediate format and from there it is sent to a target-specific exporter engine that formats the data as the target (aka EMR or PM software) expects.

In other words, we minimized the impact of the document format by doing all the heavy lifting in our own internal format that contains all the data and codifications itself and each actual format is just a little post-processing engine to arrange it as expected.

UK NHS Computer Records System (0)

Anonymous Coward | more than 2 years ago | (#36491424)

In the UK they tried to force us to have our medical details on a central computer system but a lot of us refused to have our details stored on the national system and we opted out. If you look at the system it is controlled by BT who subcontract most of their work out to India who have different data protection laws than those in the UK. Already medical records have been sold to 3rd parties this has been documented on TV were a TV reporter was offered many thousand of medical records for a small fee - they not only contain your medical records but lots of other personal information about you !! Also the British government have a poor record of keeping your personal information safe and I'm not going to trust some company like BT or any other company within the NHS to keep my personal details secure.

VA is asking for an open source solution (1)

frinkster (149158) | more than 2 years ago | (#36491756)

The VA doesn't seem to want to use this system; in fact, they have an open "Request for Proposal" [va.gov] for the creation of an open source Electronic Health Records system.

Perhaps some people here may be interested in helping. The VA is huge; whatever they standardize on, especially if it is free, is likely to be implemented in many places.

The actual request (with more information linked) is available here [fbo.gov]

Re:VA is asking for an open source solution (0)

Anonymous Coward | more than 2 years ago | (#36491874)

The VA already has a standard solution. Vista-A and VistaCPRS ... it is open source and public domain courtesy of the Freedom of information act.

People whing of security know little (2)

gubers33 (1302099) | more than 2 years ago | (#36492274)

Most of you don't know how EHR's work, by the way you are talking about them. I work for one of the top EHR companies and know that these aren't as insecure as you all think. The data isn't transferred it is all transferred through a hospitals internal network. The only time information is shared between hospitals is if the patient is admitted to a hospital outside of their provider and when this occurs the information is transferred using a high bit encryption (I know what number is, but I signed a NDA). As for the government, I also know that their EHR systems is highly customized and using high security measures then public hospitals. Paper systems were highly insecure as well, I mean you just had to go into a hospital and the records were usually in an unlocked room (witnessed this).

Usability through real-time clinical intelligence. (1)

ashdamle (1419349) | more than 2 years ago | (#36492528)

Contextualized user experiences are one of the key ideas of web2.0 interfaces. This translates into not presented users with irrelevant options. In EHRs, clinicians are provided with screens with 100's of checkboxes. This can be addressed by providing analytics that determine the 20 relevant checkboxes. It was in part to solve this issue we started MEDgle ( http://www.medgle.com/ [medgle.com] ) . At MEDgle, our focus is to enable scalable health by facilitating the distribution of care tasks to the most cost effective individual while ensuring quality of care through real-time clinical intelligence. Feedback, thoughts, etc are very welcome! Cheers Ash disclaimer (I'm the CEO of MEDgle)

old news (1)

swell (195815) | more than 2 years ago | (#36497270)

The VA has had electronic health records for years.

Good for employees (doctors etc who need the info) but there is still no way for veterans to see their own health records online.

For people with government insurance it is a positive trend, but for people dependent on private insurance there are privacy concerns. Who will insure you when your medical conditions are made public? What will it cost?

Information Technology Health Care (0)

Anonymous Coward | more than 2 years ago | (#36498618)

Information Technology has revolutionized various industries.. Information Technology Healthcare [e-igs.com] development in the industry has changed the way and the scope.

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