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Is Your EMR Compromising Patient Privacy?

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Two prominent physicians this week pointed out a basic but, in the era of information as a commodity, sometimes overlooked truth about EMRs: They increase the number of people with access to your medical data thousands of times over.

Dr. Mary Jane Minkin said in a Wall Street Journal video panel on EMR and privacy that she dropped out of the Yale Medical Group and Medicare because she didn’t want her patients’ information to be part of an EMR.

She gave an example of why: Minkin, a gynecologist, once treated a patient for decreased libido. When the patient later visited a dermatologist in the Yale system, that sensitive bit of history appeared on a summary printout.

“She was outraged,” she told Journal reporter Melinda Beck. “She felt horrible that this dermatologist would know about her problem. She called us enraged for 10 or 15 minutes.”

Dr. Deborah Peel, an Austin psychiatrist and founder of the nonprofit group Patient Privacy Rights, said she’s concerned about the number of employees, vendors and others who can see patient records. Peel is a well-known privacy advocate but has been accused by some health IT leaders of scaremongering.

“What patients should be worried about is that they don’t have any control over the information,” she said. “It’s very different from the paper age where you knew where your records were. They were finite records and one person could look at them at a time.”

She added: “The kind of change in the number of people who can see and use your records is almost uncountable.”

Peel said the lack of privacy causes people to delay or avoid treatment for conditions such as cancer, depression and sexually transmitted infections.

But Dr. James Salwitz, a medical oncologist in New Jersey, said on the panel that the benefits of EMR, including greater coordination of care and reduced likelihood of medical errors, outweigh any risks.

The privacy debate doesn’t have clear answers. Paper records are, of course, not immune to being lost, stolen or mishandled.

In the case of Minkin’s patient, protests aside, it’s reasonable for each physician involved in her care to have access to the complete record. While she might not think certain parts of her history are relevant to particular doctors, spotting non-obvious connections is an astute clinician’s job. At any rate, even without an EMR, the same information might just as easily have landed with the dermatologist via fax.

That said, privacy advocates have legitimate concerns. Since it’s doubtful that healthcare will go back to paper, the best approach is to improve EMR technology and the procedures that go with it.

Plenty of work is underway.

For example, at the University of Texas at Arlington, researchers are leading a National Science Foundation project to keep healthcare data secure while ensuring that the anonymous records can be used for secondary analysis. They hope to produce groundbreaking algorithms and tools for identifying privacy leaks.

“It’s a fine line we’re walking,” Heng Huang, an associate professor at UT’s Arlington Computer Science & Engineering Department, said in a press release this month “We’re trying to preserve and protect sensitive data, but at the same time we’re trying to allow pertinent information to be read.”

When it comes to balancing technology with patient privacy, healthcare professionals will be walking a fine line for some time to come.

November 20, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

Health Data: Little White Lie Detector

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As we bring 2012 to a close and ponder the new year ahead, many of us make resolutions to change something in our lives, and frequently, that something is our health. According to the University of Scranton Journal of Psychology, 47% of Americans make New Years Resolutions. Of those, the #1 New Years Resolution for 2012 is to lose weight. Staying fit and healthy and quitting smoking also appear in the top 10. Each of these health-related resolutions translates into quantifiable healthcare data that is, or can be, captured and measured to assist the resolution-makers in achieving their goals. Our calorie consumption and burn can be calculated, our blood oxygen level monitored, our ratio of fat:lean muscle mass tracked over time. If only we were all a bit more like George Washington, and couldn’t tell a lie, the success rate for annual resolutions would be higher than 8%.

The inclination to tell little white lies to protect ourselves from inconvenient, uncomfortable truths exists in all of us. “Do these jeans make my butt look fat,” meets, “Of course not,” rather than, “Yes, your butt DOES look fat in those jeans – but it’s not the jeans’ fault.” “Can Timmy come play,” warrants, “We already have plans – let’s rain check,” in lieu of, “Your child is a brat who cannot enter my home because I prefer to keep all my hair rooted in my scalp.”

Many, if not most, of us extend these white lies to ourselves. The dress that fit last month but doesn’t today “shrunk at the dry cleaner”. Cigarettes only smoked during cocktail hour don’t really count as “smoking”. You count the time you spend standing to give office presentations as “exercise”. You “usually” eat healthy, except for the tell-tale McDonald’s bags in your garbage showing a once-a-day burger and fries habit.

What if there were a way to identify and hold you accountable for these self-delusions – a health data lie detector? Would you change your behavior? Could you achieve your healthy resolution? And might it have a quantifiable impact on healthcare cost if you did?

I had a partial thyroidectomy a few years ago. A year after my surgery, I found I had gained 7 pounds in 11 days, was feeling lethargic and was having difficulty sleeping. As a very active adult who meticulously maintained body weight for a decade, I was disturbed, and convinced that my symptoms were a result of my remaining thyroid tissue failing. I went to my primary care physician to request a hormone test.

The nurse and doctor both agreed that, in 90% of cases, the root cause of weight gain is diet, and they asked myriad questions, capturing all my answers in the clinical notes of their EMR: had I been eating differently, had I altered my exercise routine, had I been traveling. I was adamant that nothing had drastically changed. Given my fitness and history, they agreed to order the hormone test, and a blood vitamin test, as well.

All lab work came back normal. BETTER than normal. So I retraced every detail of my routine over those 11 days. And I discovered the culprit: office candy.

A bad meeting one day led to grabbing a handful of chocolates from one co-workers bowl, which became grabbing a handful of chocolates from each bowl I encountered on my department’s floor…several times a day. Did you know there are 35 calories in a single Hershey’s kiss? 220 calories in a handful of peanut M&Ms? 96 calories in a mini-Butterfinger bar? Turns out, I was eating between 500-700 calories a day in office candy. And that wasn’t all.

Along with the chocolate snacks, I’d fallen into some poor nutrition habits at meals. I started to consume other starchy carbs regularly: the pre-dinner bread basket at restaurants, pizza, pasta, sandwich bread. I didn’t feel I ate to excess, but I also didn’t take into account the difference in nutrient density between the mass quantities of fruits and vegetables I had been eating for years, and the smaller (yet still plentiful) quantities of processed starches I was currently eating.

The changes in diet likely disturbed my sleeping pattern and led to my lethargy, which in turn made my daily workouts less intense and effective at calorie-burning.

In short, my weight gain was legit, and the two doctor visits and the lab tests could have been avoided had I been completely honest with myself. I cost each actor in the healthcare system money with my self-deluding little white lie: the office administrative staff, the LRNP, the doctor, the medical coder, the lab, the insurance company, myself. There is also a per-transaction cost associated with each HIPAA-covered request that the doctors’ office EMR and lab information system generated. Given that I have only been to the doctor three times this year, and twice was for this weight gain concern, one could accurately conclude that 66% of my annual medical costs could have been avoided in 2012.

The health data exists within Meaningful Use-certified EMR systems to capture and communicate both the absolute data (height, weight, lab results, etc.) and the unstructured notes data (patient comments, doctor notes, responses to questionnaires, etc.). The capability to automatically compare the absolute with the unstructured data already exists. It wouldn’t take an inordinate amount of effort to program a lie detector to call out many of the most common little white lies.

What would happen to medical cost if we stopped lying to ourselves, and to our healthcare providers? And how high a percentage of the nation’s total healthcare bill could be avoided by this type of analysis? Better still, how much would the healthcare industry change if patients not only took responsibility for their own action/inaction, but modified their behaviors accordingly?

I’ll tell you what happened to me. I dropped the candy and starchy carbs, and I lost those 7 pounds. Keeping them off will be 2013′s New Years Resolution.

December 31, 2012 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Patients and EMRs, EMR Value, and Healthy Food Guide: Around Healthcare Scene

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Hospital EMR and EHR

What do Patients Need From EMRs?

Meaningful Use Stage 3 requires that EMRs be accessible by both patients and providers for comments. This post contains several suggestions for what patient data must include. Some points discussed include links to medical information (to help identify unfamiliar terms), the ability to view information in different views, and mobile access to health information.

Adolescent Data Needs Stronger EMR Protections, Group Says

The AAP recently came out with a statement concerning the protection of adolescents in EMR. They believe that adolescents don’t enjoy the same protection as adults do, and this needs to change. To help with this, the AAP has presented a list of principals that should “govern” EMRs, PHRs, and HIEs. Some of the ideas include creating criteria for EMRs that meed standards for adolescent privacy, and flexibility within standards for protection of privacy for diagnoses, lab tests, etc. These new suggestions will place an added burden on EMR vendors.


EMR Value Diminished If Patients Can’t Access Care

A recent study was released that analyzed primary care practices in 10 countries around the world. While it indicated that more US physicians are using EMRs than in the past, a large percentage patients in the US are still struggling to pay for health treatments. This is well-below the numbers from other countries surveyed. This may suggest that even if EMR is in use, it doesn’t really matter if patients can’t afford getting help.

New Healthcare Facility Experiences IT Growing Pains

Jennifer Dennard recently has to visit a new facility in the area in order to treat an illness. She was pleasantly surprised with the facility, and recounts her experience here. However, she discusses some of the IT “growing pains” the facility is experiencing, such as still using paper prescriptions.

Smart Phone Health Care

Healthy Food Guide Uses MyPlate.Gov Standards to Track Calories

There are many mobile food diaries available, and a new one just hit the market. Healthy Food Guide puts a twist on the typical calorie counting idea, and helps its users make sure they are getting enough of each food group. There’s a few glitches here and there that need to be worked out, but it’s a neat little alternative to some of the other diaries out there, because of how simple and to the point it is.

November 18, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR Vendors, Patient Privacy, and Election Day — #HITsm Chat Highlights

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Topic One: When EMR vendors leave the marketplace or discontinue a product, how can usability be sustained?

Topic Two: How do we protect patient privacy with payer-based HIEs?


Topic Three: How can we draw attention to patient safety in the U.S. prison system?

Topic Four: Are we over the election and back to business as usual with healthcare?

November 17, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Clinician Adoption of Healthcare Tech, Patient Satisfaction, and Safety: #HITsm Chat Highlights

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Topic One: What are keys for successful, sustained clinician adoption of healthcare technology?

Topic Two: How can we improve patient satisfaction? #patientexperience


Topic Three: What is #healthIT’s role in patient safety?


Topic Four:  When is a low-tech solution better than high-tech?

November 3, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR Uptake, Windows 8 Based Tablet, and Medical Errors – Around HealthCare Scene

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Hospital EMR
EMR Uptake By Doctors Slowed By Lack of Time And Knowledge, Not Just Cash
Small practices are the ones having the hardest time implementing EMR. However, it isn’t just because of the hefty cost involved. Lack of time and knowledge also appears to be a big issue. There is a lot of time that has to be invested when selecting an EHR, and small-practice doctors have their hands full with other projects. There is also a lack of HR personnel available to help implement EHR as well.

Attending CHIME 2012 Fall CIO Forum
John recently attended the CHIME 2012 CIO Forum and was able to listen to Farzad Mostashari speak. He spoke on health IT, and why it needs to be used. John describes this event as the “Who’s Who” Of Health IT.

Vendor Hopes To Create Market For Windows 8-Based Tablet EMR
Microsoft has been hard at work creating a Tablet called Surface. There is an EMR that has been developed for Surface as well, and the big news is that it will be loaded with Windows 8. While most healthcare IT is run by either iOS or Android, Microsoft may be stepping up their game with Windows 8. Only time will tell how successful this will be, but so far, things look positive.

Meaningful Health IT News
Medical harm explained, in graphics and Farzad style

Medical errors cause far more deaths than many people realize. This gripping post describes how medical harm ranks in comparison to other causes of death in the US, talks about the story of Dr. Farzad Mostashari’s mother, and how correction is needed in hospitals and the care of ill patients.

Smart Phone Health Care
Managing Pain With New WebMD App

WebMD has recently released a new app that is designed to help people figure out where they have pain, and what might be triggering it. This is an innovative way for patients to be able to tell their doctors what they are experiencing, with evidence backing it up. The app is free and available for the iPhone.

October 21, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR Landmine, Mobile EMR Access, and Patient Advocates

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While it seems that many people are coming out with distaste for the Olympics, I am still on the side of enjoying the Olympics thoroughly. I’ve watched as much of the coverage as possible. What can I say, I’m a sucker for pretty much any sporting event. I hope everyone else has been getting as much joy out of the Olympics as I have gotten, but I digress.

As you know, each week I take a quick look at some interesting tweets that have been posted around the EMR, EHR and Healthcare IT twittersphere. Plus, I’ll add a little commentary that will hopefully start some interesting conversations and help you as a reader.

What a perfect way to describe the issue: an EHR Landmine. Jane Shuman is exactly right too. In fact, a local doctor recently told me the same thing. The challenge of checking and re-checking patient information from a previous patient visit is a huge problem waiting to happen. I think the doctor I talked to said that EMR perpetuates mistakes. It’s so true. I wonder what other EMR landmines are out there.

My readers agree with Melissa. As long as the iPad is a native iPad app and not just some remote desktop access to EMR software that isn’t optimized for a tablet environment.

You have to love Regina Holliday. A tireless patient advocate. Years down the road I hope that Regina will be able to stop her patient advocacy. Not because she gets tired of doing it, but because we embrace the patient in healthcare.

August 5, 2012 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: and, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.