The Inevitable Future of Electronic Medical Records

Recently by Cynthia J. Koelker, MD: Essential Medical Skills To Acquire

For the past year now I've been using an Electronic Health Record (EHR) and believe the writing is on the wall. These computerized medical records are not about improving health care; they are about control of both the physician and patient.

Beginning in 2013, doctors who don't prescribe electronically will be penalized financially. Although this mandate is Medicare-driven, Medicare collects statistics for patients of all ages and insurance groups, not just those receiving Medicare benefits. What Medicare requires eventually effects us all.

So what do I foresee? A primary goal of the EHR is the universal availability of your medical records. If you're in Florida and visit an Urgent Care center while on vacation, "ideally" your records from your Ohio family physician will be readily accessible. With your health records on computer, theoretically the information can be transferred nearly instantaneously. The problem is, there are hundreds of different EHR systems, and they do not communicate with each other, and your doctor may not be able or willing to provide this information in the middle of the night. The easiest solution to this problem is the adoption of a single system used nationwide by all providers.

If only one system is to be used, it will likely be government-controlled. For timely exchange of information, your records will need to be hosted on the Internet (which many already are). This makes it simple for governing agencies to collect data on both patients and physicians. If America ever goes to a single-payer system, you can guarantee data collection will skyrocket.

You will also need a number, a card perhaps, similar to an insurance or Medicare card. But my patients commonly forget to bring these along. What if you show up in the ER without identification? Why, the simplest answer is to have your EHR-access information available in or on your body. Pets are commonly "chipped" with tiny RFID implants, in case they are lost. What about your Granny with Alzheimer's, or young children, or mental patients prone to wander? They too can be chipped – and so can we all.

If you think this is crazy, consider that Medicare is already collecting data on your body mass index, your tobacco use, your vital signs, diagnoses, and medications. Insurance companies and pharmacies track which drugs I prescribe and whether my patients are compliant with refills. In Ohio, every controlled drug that is prescribed is reported to a database. Last year it was voluntary for me to check my patients. This year I am mandated to check this database on all patients using any controlled drug or tramadol in an on-going basis. Whereas this mandate is to find the few who are abusing medication, it subjects all of us to governmental monitoring. Additionally, this mandate will require dozens, perhaps hundreds, of hours of my time to detect a problem, wasting both time and money. The benefit to society is unproven, but it's the law. Your name, too, may be in a government database. A few Vicodin after a dental extraction may land you there.

My only patient to refuse the EHR to date is a former citizen of the USSR. What does that say? Does she know something we don't?

At least for now, you can refuse an EHR record – at least at my office. Other doctors may not be so accommodating. If they have transferred all their records to computer, they may have no means of maintaining a paper record. And if your doctor is an employee, he or she has little if any say-so in the matter.

The EHR amounts to a little-recognized infringement of your personal freedom. Perhaps this article will engender a rebellion against computerized medical records. I'm actually hoping so. My paper records were better organized, easier to access, and definitely more secure.

Cynthia J. Koelker, MD is author of 101 Ways to Save Money on Health Care: Tips to Help You Spend Smart and Stay Healthy and Armageddon Medicine, How To Be Your Own Doctor in 2012 and Beyond, available at her web site, along with hundreds of free articles, Armageddon Medicine.