No argument there. Paper records, though (no EHS, yet) also had their ways, and at least one apart from the obvious: My father told me of an Internist who, upon leaving their small group practice, took patients’ records with him, i.e., he snuck them out. Boxes and boxes of them, and not just those of – to whatever extent – his patients. Later, lawyers got involved. (Oh, boy.). Eventually, it was determined that the Internist was hiding the records in his mother’s house.
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We had a situation here where one of our insurers instituted a Quality Improvement (QI) program where they wanted us to sign a waver allowing them to hoover up data from our EMR. Not usually a big deal, they all do that to some extent, until my manager read the fine print and realized this allowed them to get all our records, including those of other insurers who had no relationship with them at all. I thought this was not kosher, and told them we would only do so if they agreed to a “hold harmless” clause in case of a breech. They refused, on the grounds that they had no right under HIPAA to those records and so could not agree. Seriously, that is the argument? So we refused, they booted us from their network. My suspicion is that other practices never read the agreement. EHR’s inevitably result in loss of control of access to the records, but we (the practice) remain liable for any breech. Yeah, sucks.
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Was I so wrong in lauding the notion of EHR when it was first being bandied about? It all seemed so to make sense then:
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My GP is using some kind of system. They’ve tried to get me to sign in to the patient portal, but it won’t let me register because it uses e-mail addresses as logins and it considers my e-mail address (that I’ve been using since 2006) to be invalid.
I tracked down the vendor and tried to e-mail them about this bug…but I couldn’t because their web form considered my e-mail address to be invalid.
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Just curious (for now). May I ask… what email service do you use? And (more importantly) are other users of your GPs “system” having the same problem?
It was one of those excellent in concept, horrible in execution type things. Again, if the founding principle was improved patient care, improved provider efficiency, elimination of medication errors, improved privacy, etc, all of which should be amenable to IT work, the outcome could certainly have been very different. But the founding principle was more efficient billing, claim processing, data hovering and end users (both provider and patient) were pretty much cut out of the design process. Insurance companies love it, which should tell you all you need to know.
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I’ve got a vanity domain, but it’s nothing exotic, nor is my account name (no weird punctuation, no obscure TLD). I have no idea if anyone else is having the same problem.
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In your place, I would ask my GP if any of their other patients are experiencing the same problem. If so, that would put the onus back on my GP for a solution.
My former wife used to pull me into all of the software drama at her dental office. I would do my best to help out but it always ended with me saying, this is intentionally horrible software that goes out of it’s way to make you suffer. Is there another option. Oh I see, that is even worse.
If you just want the problem solved quickly your best bet might be to create a second email someplace free and have it forward to your vanity email. Not ideal, but these vendors rarely care about the doctors giving them money every month. You are waaaaay down the pole of concerns for them.
Of course I can do that, but I’m too cussed. This is a malfeature I don’t need to accommodate.
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I completely understand the rage.
If you don’t need to use the portal then just forget it is there. I have a few providers that I call to get things done. Each time they remind me I can now use the portal. I remind them it sucks and calling and sitting on hold is actually less bad than their mess of a website.
Most recently I got an email that my doctors portal has added billing to it’s services. I needed to get a balance owed so I figured I’d give it a chance. I logged into the portal. Then clicked billing. Billing had another log in. I logged in again and the page flashed and nothing changed. I tried putting in a bad password. Result: Bad password. Ok. Tried the correct credentials again. Page flashed. No message. A long time later… found a FAQ linked from another page. Billing is not available to patients of [very long list of doctors and entire hospitals]. FFFFFF UUUUUU. So I called to get my my balance and the the person on the phone cheerily asked if I had seen that the portal now has a billing section. 
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To quote a colleague: “our EHR is the best one available. Unfortunately, it’s the cream of the crap.”
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My sweetie is an MD, nearing retirement. Nothing is pushing her faster to retirement than EHR systems. She’s gone back to paper for her office but she does surgery one day a week and has to interact with the hospital’s horribly written HORRIBLY implemented system. She’s old fashioned, she talks to her patients and spends time with them. She is also making literally zero income from her practice. I do mean literally, she is subsidizing her practice every month (gratitude to her father’s $$ estate which made it possible for her to continue at all.)
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I’m now reading the linked article. As a retired IT professional, the problem at our local hospital seems to be as much the implementation as well as the software itself. It seems as though actual doctors were not involved as much in the implementation. Decisions were made about workflows based on who knows what. (I’m assuming that the workflows are configurable and defaults and requirements for steps are definable) It makes sense that it ended up like that - I’ve been in how many implementations where the people who actually know how things work are the people who don’t have the time or inclination to be heavily involved in a software project. As it should be. So you have coders and implementers making essentially medical decisions based on their interpretations of limited feedback from teh docs. It’s hard to see a solution.
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You might want to check into the history of EHR at the Veterans Administration, which is as close to a non-capitalist health care model as anything the USA has had. It’s not a pretty history.
The whole damn health care industry “hides behind HIPAA” and not without some justification, the penalties for even an honest mistake can be brutal.
Owing to HIPAA, in the 27th century, when we’ve colonized the moons of Neptune, the American health care industry will still be using pagers and fax machines.
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No, I want to check with people who live in nations with socialized universal health care. If I wanted to know how EHRs worked at the VA I would’ve asked that question.
The VA is the only prototype we have of a socialized health care system designed and run by American politicians.
I expect that other nations’ mileage will vary to an extent that we can’t possibly imagine.
I have absolutely no experience outside the USA, but I admit I am unable to imagine an EMR that actually works. So yes, I think we agree on this. 
Could I have not been more plain that this is the information I want?
For example, Germany rolled out health cards which, amongst other things contain EHR. How do our German mutants feel about it?
The VA is an isolated social program within an otherwise private system. I want to know how EHR’s function within a system that is primarily public from the jump.
I can’t speak for Germany.
As far as the UK is concerned, we are baby stepping ourselves to much the same sort of problems.
Despite being called a National Health Service, we’re not really. It’s a bunch of separate entities covering different parts of the country and different areas of healthcare.
Getting medical information from whoever recorded it to whoever needs it now has traditionally been done the old fashioned way by sending bits of paper back and forth with all the attendant problems that paper records have.
But those are at least well-known problems.
We are making steps towards electronic records but not surprisingly, the number of software folks who can credibly claim to be able to produce something suitable for a system the size of the NHS is limited and their actual ability and track record tends to be vastly over exaggerated since this is the kind of project that doesn’t really come up more than once in people’s careers.
So we get a bunch of people who aren’t very good at it in the first place, trying to do something very complicated and not surprisingly doing it badly. All managed by a civil service with a famous track record of being terrible at any kind of IT procurement.
So, it’s going fairly slowly.
That article from 2013 quotes Conservative politicians blaming the previous Labour government for being crap and how they were now going to sort it all out - with a target of the NHS being paperless by 2018.
It will surprise no one that after several years of Conservative government the NHS is not paperless. By 2016, they’d changed the target to “paper-less at the point of care by 2020”. And not surprisingly that too will not happen. I don’t know what the current target is.
Current state of play as I understand it is that GPs will generally have your newer records electronically as will your hospital and those can in theory be made available to other parts of the NHS online but generally isn’t because one part may not talk to the others well.
There isn’t a central file which has all your interactions with the NHS in it.
In practice, the NHS still sends paper back and forth. Requests for scans, etc. tend to be paper or at least paper-like even if sent electronically (i.e. fax or email)
And of course the whole end of the system that deals with the patient is paper. Your appointment might be generated electronically but they’ll still send you a letter with the details.
We tend to have the problem that while we could in theory come up with a system that might work fairly well, we have a lot of different policy drivers that cock that up.
We have a tendency to look to the US for pointers on solutions (god knows why, since you don’t have a national health system). Well, we do know why actually.
There are an awful lot of lobbyists paid for by US concerns that would really like to make the NHS much more open to US companies and not coincidentally generate a lot more money for shareholders (and cost for patients/taxpayers of course).
We also have a lot of politicians from both major parties who are very open to any argument that someone has the answer to sorting out the NHS headache (no matter how obviously self-serving the suggestion is) and lots who like the money they get from lobbyists and lots who genuinely think the answer is to let poor people get bare minimum healthcare to keep them patched up so they can continue to be exploited for cheap labour and let everyone else pay through the nose.
So we have a constant fight not to turn the NHS into the US system which is weird because everyone including most people in the US seem to agree that the US system isn’t very good at all.
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