a lefty’s log

MB, a good friend of mine in the health care field, asked me to complete a survey about electronic health records (EHRs). in the middle of the “check-here-if-you-strongly-agree,-here-if-you-somewhat-agree,-here-if . . . .” type of standard survey questions, there was a little box available for a free-form response. if i may say so myself, i thought my submission was quite good and worthy of publishing. the following is what i wrote, including the prompt:

Feel free to make any comments on your expectations or your experience with paper records or electronic health records:

I understand the difficulty of paper records for all parties involved, and welcome the versatility of digital records or EHRs. However, I am generally predisposed to distrust large corporations and government, especially with personally identifiable and such sensitive data as health records. This sentiment weighs heavily on my skepticism of participating in and advocating such a scheme.

Just because data is digital, it is no panacea. Digitisation is not magic, nor will it erase the possibility of human error. In fact it introduces the possibility of more error in several degrees. I may have agreed to anonymously share my patient data with any or all of a number of entities, and my health care organisation may have agreed to allow this, but an error as simple as unchecking an “anonymiser” button on the interface at the time of submission or an error as complex as compromised digital security at any one of the server farms upon which my data is stored could easily, completely and permanently nullify this agreement. Once that bell is rung, it cannot be unrung. There is no undo button on the telling of a secret.

Digital files can be at the same time more rich (good) and complex (baffling). The sophistication of the consumer is steadily increasing, but not everywhere and not universally. To different people and at different times to that same person, information may be of useful, or may contain too much data to be useful or contain extraneous data (there is a difference) at the time of use to be of service. This could occur at home while researching family or personal records or at the time of admission or at the time of billing.

This same problem can manifest itself to either simplify or complicate patient care, e.g. while tracking within or between facilities. Depending on what, when and how data is served up can, and at the same time, be of use, disuse, extremely offensive (say in the case of missing religious preferences because it’s on an obscure tab of the interface) or fatal.

It may be safe to assume that because certain data is available digitally, i.e. instantaneously, completely and without regards to geography, that it will increase either efficiency or quality of care. But I’m not so sure. Say that, ignoring the caveats of the previous paragraphs, this is true. Suppose that EHRs will increase quality of care because the physician spends less time waiting for or researching records. Now she can more fully attend to the needs of the patient. This cannot be guaranteed. Once it becomes apparent that the pre-visit research can be made more efficient, that trade off will be reflected in higher patient turnover. More turnover = higher efficiency = more money, not necessarily better (richer) patient care.

I welcome the modernisation of record keeping to include EHRs. But a heavy dose of skepticism may keep me from fully participating in its use.