Health Records 2.0

Wednesday, January 07, 2009

Dr. Farzad Mostashari, assistant commissioner of the NYC Health Department's Primary Care Information Project Bureau, talks about New York City's push toward electronic health records. And Dr. David Blumenthal, Harvard Medical School professor, director of the Institute for Health Policy at Massachusetts General Hospital, and former senior health policy adviser to the Obama campaign, talks about what to expect on a national scale.


David Blumenthal and Farzad Mostashari

Comments [23]

Amy from Manhattan

In the mid- to late 1990s, 1 of the articles I wrote an abstract for was a study that found having doctors dictate their notes & transcriptionists write them up improved accuracy significantly & reduced the no. of mistakes. Since that time, my impression is that this practice has been implemented unevenly. I hope this aspect will be integrated into any plan for keeping electronic records.

But another issue is whether patients understand & carry out their part of the treatment they need. I recently copyedited an article on osteoporosis that found a high percentage of patients take <80% of their medication (the minimum required for significant effectiveness). Patient education is also necessary to make sure people understand the need to follow their drug/exercise/etc. regimen & the consequences if they don't. On a national scale, this could save billions of dollars in the costs of caring for more severe disease that could have been prevented.

Jan. 07 2009 12:26 PM
(Mr.) Lynn Lander from Northern NJ

It is very clear from the discussion that there are two distinct issues which need to be dealt with separately:
1. the merits of electronic medical records
2. security and privacy.

If we can agree that e-records are potentially a major step forward in health care, we can forge ahead with development of systems that assure security and privacy.

Jan. 07 2009 12:15 PM
cmb from Harlem

I used to manage an outpatient practice at one of the largest harvard-affiliated hospitals in Boston and was there when we transitioned our physicians over to the electronic medical records system. Hospital-wide, efficiancy among physcians, nurses, and administrative staff increased and medical errors decreased. I personally wouldn't trust a physician that didn't use electronic methods of record keeping. The only problem is that now that I have moved to NYC, my electronic records are there in Boston and I still have to go through the hassle of having them tranfered in paper form to my new doctor. Having a system that allowed my records to be accessible wherever I am in the US, would allow my doctors to have a better idea of my full medical record, without the wait and hassle of having to request records from my old doctor.

Jan. 07 2009 11:28 AM
Lance from Manhattan

Jan. 07 2009 11:25 AM
(Mr.) Lynn Lander from Northern NJ

One of the potential benefits of electronic medical records isthe collection of large scale data on the efficacy and negative effects of pharmaceuticals. Clinical trials used for clearing drugs cannot pick up low frequency, serious side effects. A nationwide data pool would flag deadly side effects quickly and allow provisional approval of drugs with strong posiitve indicators to bring them to the market more quickly.

Jan. 07 2009 11:24 AM
Lance from Manhattan

for Emily

Jan. 07 2009 11:24 AM

If i do have programming skills, how can I get a job in this effort?

Jan. 07 2009 11:23 AM
David from Brooklyn

There are obvious privacy concerns with this type of technology and transitioning would be difficult. However, the clinical and research potential is huge.

In the research context:
- Time spent on data entry/data-base development could be huge.
- IRB approval could likely be streamlined.
- If the technology used by different sites is compatible, huge samples could be used, thus increasing confidence in research findings.

If time for questions:
How are research considerations being integrated into the development of this technology.

Jan. 07 2009 11:23 AM
Dr. Steven M Emmett from brooklyn NY

How many of the groups surveyed were small groups with single offices. Unfortunately the insurance debacle has necessitated large groups with multiple physician who will not know their patient without the help of a computer

Jan. 07 2009 11:23 AM
AG from Bk

Modernizing our health care system would be getting rid of HMO and returning to a competitive health market where people can actually choose their doctors, doctors can charge competitive, affordable prices, and doctors can actually rekindle some type of altruistic desire. This bueracratic system is just more big government trying to control patients and doctors. Socialized med is an awful idea, and spits in the face of doctors that want to make a difference but can't extricate themselves from the system. Insurance was originally a measure to provide assistance in case of a dire emergency, not for going for a basic check up or to pick up basic medication. We wouldn't need insurance if their was competition. I'm sure we'd all be able to afford to see the doctor then.

Jan. 07 2009 11:22 AM
MaryAnn from NYC

I work at a major medical center in NYC. Electronic medical record usage is scrutinized by electronic surveillance and if someone should venture into a person's record w/o professional necessity, there are very harsh consequences. ie. staff, including physicians, have been fired for perusing charts for which they have no professional need to review. While concerns may be real, on the balance, I think they are overblown.

Jan. 07 2009 11:22 AM
Sam from Upper West Side

Is Dr. Farzad Mostashari familiar with the health department's collection of information on diabetics' HA1c data directly from labs? It has *all* the names attached; it does not protect the patient's privacy at all.

In the interest of public health, this info could be collected with the doctor's name attached, and work through them to reach the patient, without violating the patient's confidentiality.

Jan. 07 2009 11:20 AM
O from Forest Hills

What is to stop people from cut and pasting electronic data and e-mailing it or copying it to a blackberry or other electronic gadgets?

Jan. 07 2009 11:19 AM
Joanna from NYC

My previous doctor, he turned out to be a sex offender, is holding my records unless I pay .70 per page. He insisted that I get all the records from previous doctors, so he must have hundred of pages-I paid nothing for the previous records. My question: Will the consumer have access to their own online records?

Jan. 07 2009 11:18 AM
Emily from Amherst, MA

I live in Massachusetts, and my children's pediatrician practice just switched to electronic records. There were some hiccups and inconveniences at first, but I've been impressed by how easily the doctors can now access and respond to their ongoing health issues. They used to page through the charts in front of me, trying to refresh their memories, and often missed major things. Given how little time we have for each appointment, I think it's worth the potential privacy issues. (Though I honestly can't imagine how privacy concerns would come up.)

Jan. 07 2009 11:18 AM
Lance from Manhattan

I am also EXTREMELY concerned about privacy and security issues.
The brokerage companies have been hacked (eg TDameritrade). Even the Veterans Affairs Hospital system has had SEVERAL episodes of compromised privacy data in the past couple of years. What guarantee is there that this new govt bureaucracy on the one hand, and the doctors' offices/hospitals on the other, will protect these patient data adequately?

And that's not even mentioning Verizon, ATT, et al rolling over and funneling your private data to the govt when the specter of national security is raised.

Jan. 07 2009 11:16 AM
Carol Friedland from Park Slope, Brooklyn

Another way for Bloomberg to control individual initiative. Rather, he should educate people to monitor their own health care.

Jan. 07 2009 11:15 AM
Joanna from NYC

Will the individual have access to their own health records. I have been unable to get my records from a previous doctor-unless I pay .70 per page-record that I got for free from previous doctors at the demand of this doctor.

Jan. 07 2009 11:15 AM
Haley from Astoria

Private practice doctors are faced with unpredictable income, and many other expenses. Money to upgrade, maintain and protect electronic medical information is simply out of reach for most doctors practicing alone.

And privacy is also a huge concern. I don't want the government checking to see if I've filled a prescription if I have decided it is not the way I want to address my medical issue. That is a slippery slope.

Jan. 07 2009 11:15 AM
Abigail from midtown

One problem is that multiple doctors give the same person prescriptions, and that person may fill them at multiple pharmacies. As a result, any one doctor or pharmacist doesn't know everything the patient is on, leading to potentially dangerous drug interactions and possible problems. Would the electronic records prevent that problem? I.e., how integrated will the records be?

Jan. 07 2009 11:14 AM
rae from flatbush

Question: Will this make my records more portable if/when I change doctors?

Jan. 07 2009 11:13 AM

This is terrible. Basically they want to make a huge federal bureaucracy to monitor everyones medical history. Essentially all the big brother aspects of "socialized" medicine but without the socialist part! Now immigrants, people who owe back child support, have an arrest warrant for a fine they can't afford or maybe even just owe some big recently nationalized bank a bunch of money is going to be scared to go to a normal hospital. Now we will all have to look for "underground" doctors who will treat people without reporting it all back the government. And this whole thing will be bankrolled in the name of "economic stimulus". Of course rich people will be able to get all their work done by "private" doctors off the books but most normal people are just going to have another incentive to not go to for regular medical care.

Jan. 07 2009 10:20 AM
RJ from Brooklyn

Ah yes, the holy grail of technology to cure what ails the finances of the medical system. Let's continue to ignore the amount of input errors that are made constantly in the input of data and other uses of technology.

And assuming the pure motives and integrity of the current administrators of *every* part of the medical system (insurance companies, hospital administrators, and, most important, employers), who will swear up down and sideways that our personal, intimate information will be secure we can certainly be utterly assured that future administrators will as well.


I'm just *thrilled* at the prospect of having my entire medical history at the hackable fingertips of any with a few Web 2.0 classes under their protruding belts.

No, these aren't the concerns of a pure Luddite. No doubt there are ways doctors and other providers would find added uses for technology. Subsidized training to learn how to make better use of it themselves; encouragement to use it among doctors they make referrals to and take them from. But widespread, required use?

Not for me.

Jan. 07 2009 10:19 AM

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