Fraudulent billing. Identity theft. Greater expense and inefficiency. Loss of privacy. And campaign donations from the companies benefiting most.
Electronic medical records (EMR) came into mainstream consciousness after a hardcore lobbying effort by the EMR industry. The result? A $19 billion (yes, that’s billion with a B) government incentive package was built into the 2009 economic stimulus bill just for electronic medical recordkeeping.
This package benefits the three largest EMR companies the most. The annual sales of Allscripts have more than doubled, going from $548 million in 2009 to $1.44 billion in 2012. Cerner’s sales increased 60% in the same period. Epic doubled its revenue to $1.2 billion from four years ago, making its founder a billionaire.
That EMR companies should be so favored will come as no surprise when you learn that the then-CEO of Allscripts, Glen E. Tullman, was the health technology advisor to the Obama campaign in 2008. In 2009, before the stimulus package was finalized in 2009, he visited the president at least seven times as Allscripts CEO, and personally donated over $225,000 to the campaigns of legislators like Sen. Max Baucus (chairman of the Senate Finance Committee) and Jay D. Rockefeller (chairman of the Commerce Committee).
Judith Faulkner, a controversial figure at the center of the electronic records mandate, is described by columnist Michelle Malkin as “[President] Obama’s medical information czar and a major Democratic contributor [who] just happens to be the founder and CEO of Epic Systems—a medical software company that stores nearly 40 percent of the U.S. population’s health data.”
In December 2008, the chief executive of an EMR trade association wrote an open letter to Obama calling for government investment of at least $25 billion to adopt EMR. The government ponied up $19 of the requested $25 billion.
Despite all the government funding, EMRs haven’t lived up to the promise of lower cost and increased efficiency—something we predicted back in 2009. On the contrary, the new approach seems to be increasing costs through overbilling. Electronic recordkeeping makes it easier to overbill for services. For example, the percentage of the highest-paying claims at Baptist Hospital in Nashville climbed 82 percent in 2010—one year after it began using a software system for its emergency room records. In general, hospitals that received government incentives to adopt EMR showed a 47% rise in Medicare payments from 2006 to 2010, compared with a 32% rise at hospitals that did not receive any government incentives.
Fraud is a huge problem with EMR. Some EMR programs can automatically generate detailed (but fake) patient histories, or allow doctors to cut and paste the same examination findings for multiple patients (a procedure called “cloning”) so it looks like they conducted far more examinations than they actually did. Doctors can also click a box indicating that a thorough review of patients’ symptoms had taken place, even though the exams Medicare is paying for were rarely performed.
Dr. Donald W. Simborg, who was the chairman of federal panels examining the potential for fraud with electronic systems, said, “It’s like doping and bicycling. Everybody knows it’s going on.” The Office of the Inspector General is studying the link between electronic records and billing.
While creating a nationwide records database might seem at first glance to be a good idea, the whole EMR policy was implemented quickly without anyone doing a careful study of potential problems. Patients and and their health records have become guinea pigs in the EMR experiment.
There are many serious difficulties with EMR, even outside of the fraud issue. Doctors have complained that the system is very time-consuming and inefficient. It can actually increase rather than decrease required paperwork. They say in addition that it’s not tailored to physicians’ needs, but instead fits the more narrow vision of Washington bureaucrats. Technological glitches and human errors have, for example, resulted in the wrong prescriptions being issued. Privacy issues make it difficult to get reliable data on EMRs, but it is estimated that EMRs will be linked to at least 60,000 adverse events. There is no industry standard of liability if a patient is harmed by EMR software problems.
In addition, computerized systems are vulnerable to crashes, and the larger the system, the greater the crash. Networking between EMR systems even within the same hospital system can be problematic. The internationally respected Mayo Clinic, which treats more than a million patients a year, has serious unresolved problems after working for years to get its three major electronic records systems to talk to one another, according to the New York Times. The technologies of different service providers—say, between the hospital and pharmacy—may be incompatible.
Even more worrisome, the EMR system is ripe for medical identity theft, as we reported two years ago—a problem that will affect an estimated 1.49 million people in the US, at a cost of $41.3 billion. And since the healthcare system is so fractured, it often requires going from hospital to hospital to get a billing problem resolved—something that can take years. Privacy issues complicate matters further: victims and their families sometimes can’t get files from doctors to clear up the issue. Most medical facilities simply don’t have policies in place to deal with medical identity theft.
Bloomberg reported the story of Arnold Salinas, a 53-year-old maintenance worker whose identity was stolen when someone took out medical care in his name. He’s been fighting his case since 2002, and fears his valid medical records will get mixed with the thief’s, possibly leading to dangerous confusion.
In 2009 we were promised that the EMR system would “cut waste, eliminate red tape and reduce the need to repeat expensive medical tests…it just won’t save billions of dollars and thousands of jobs; it will save lives by reducing…medical errors.” None of those promises have come true. The government, pushed by special interests, has rushed through an EMR system that costs American taxpayers more and makes our medical records—and possibly our health—far more vulnerable.
As we noted in 2011, allowing hundreds of thousands of parties to access your records, including mental health and other sensitive information, is by definition a serious invasion of privacy. When you apply for a government job, they ask you if you have seen a psychiatrist in the last five years. People who need help may be reluctant to seek it with their records available to the whole world. If everyone’s records are open for others to see, who will confide to their doctor anymore?
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Drs. often misdiagnose physical problems, almost as much as they diagnose correctly. How does patient get their mistakes off their records?
That is the problem, they don’t and it could mean the difference in getting well and getting worse. Medicines alone can kill if they are the wrong ones. You hear the horror stories of people loosing homes, jobs, etc. from the credit Berea being wrong and mistakes never being corrected. Well wonder how many has died because of the wrong information on a medical record. Wonder how many people will never get a job or loose a job because of medical records. This is frightening and I will be brought in on a slab before I’ll go to a doctor now. I’m scared to death now because of this. I’ve been misdiagnosed several times and I wold go to a different doctor and not tell him I’d been before because I didn’t want him looking at old records. I wanted a fresh thought. It is like adding a math problem wrong over and over. Someone else see it the first try. Looking at records will cause a Doctor to come to the same conclusion and if he/she has to start from scratch, they may find what is wrong. This record passing around is very dangerous and especially if the information if flawed.
I would be VERY, VERY cautious about signing on to ANYTHING Michelle Malkin says when she opens her right-wing mouth. I’d take the above with a grain of salt as a result….
#6
Personal privacy is paramount….computers get hacked all the time….THERE MUST BE A HUGE PENALTY WHEN MED.REC. ARE REVEALED…MAJOR PENALTIES!!!! That stuff is AS DANGEROUS as ‘informational PLUTONIUM’….can DESTROY LIVES….
As a retired computer consultant who worked within the healthcare industry, I understand your concerns. However, we must weigh privacy concerns against our desire for quality care – and online medical records would certainly improve care under many common scenarios. I’m all for privacy, but I’m also for financial stability (personal as well as governmental); quality care must trump all other considerations. Nothing is totally hack-proof, but we can come close, and must continue to devise ways to discover and track hack attempts, just as we do for banks and other critical applications.
I think the point of the article is that this system, this idea, is terribly flawed. It provides not only the risk of loss of privacy but is fraught with possibilities for abuse. Fraud and error that do not enhance medical care. It will create jobs, another layer of overhead and an opportunity for the same government who mismanages the postal service to bungle medicine and compromise the most important asset any of us has: our health.
I for one take my privacy very seriously and I don’t do on line banking, on line bill pay, and any on line that requires my personal information. I will take my Dr.’s brain working over all computer data anyone can cram into a machine (i.e. program) I don’t think everyone and his brother needs access to my personal information. The worse thing is how once things get into a system it is seldom corrected and that is across the board. This is dangerous and needs to be stopped. Computers are known addicts of mistakes and the bad part is the mistakes are rarely corrected and it takes forever to fix them. When like a Dr. you are doing the physical and trying to get a sick person better, messing with technology slows down the process and interferes with doing the job at hand. When you are at a desk you don’t see this but when you are physically doing the work, you see how the computer is really causing more problems than it is solving. That time the Dr. is on the computer could be the time needed to save a life.
The “secure email” web portal through which my doctor wanted me to communicate with him was hacked and the FBI’s cyper crimes unit sent people to his office to investigate, even though the hacking did not occur at his office.
In addition, the tech support personnel at this “secure email” web portal could not help me gain access to their system – apparently, they required the browser settings to be insecure for access to occur (I had to figure this out on my own).
Also, the functionality and features of the “secure email” portal are very much lacking and poorly tested.
And I have had similar issues with my health insurance company’s online portal. But of course, if you call on the phone, they hassle you with why you aren’t using the web portal. But the portal does not provide a way to ask questions in special cases or questions that are not covered in the FAQ.
And there was another case in which the doctor was trying to submit a prescription to the pharmacy via the computer and the medication doseage and form information was not available – he had to have known already which option on the software would give the patient the required prescription. No human can memorize all the options on prescriptions – especially a primary care doctor who may be called upon to prescribe any of hundreds of medications, and all the constantly changing medications available (drugs may be discontinued, etc.).
All of this is basically to say I am very disappointed with the medical software and “secure” portals.
I was under the impression that the Veteran’s use electronic records and that is very efficient. It worked in my father’s case that his physician could see all of his visits and meds. Is the system now just messed up and is there a way to use electronic records successfully?
I work as a professional in the VA system and think that our EMR is far superior to the commercial ones out there and I have worked in medical informatics. It is what brought me back to the VA, however our problem is that we have so many entries into the medical record that say NOTHING, repeats of med lists and exams that are simply templates pulled in from another record entry. It takes a hunting expedition to find out what is currently happening with a patient. A flurry of useless information you must weed through to find what you are looking for. The commercial EMR’s I find to be dangerous as they bury and silo very pertinent data that the MD/PCP needs to know to chart the medical course. The VA EMR was created by the same people who need to use it and the commercial ones not so much..The VA EMR is also free (open source) and could be adopted by any medical organization. The commercial companies are very unscrupulous, they get the contract signed and the tech support is hard to negotiate and updates cost big bucks. Once again the free market gouging the system for profit…You can tell where I stand.
Imagine receiving a copy of a hospital emergency room bill of $6K for a 2-hour visit which included
x-rays(6), an anesthetic, and a splint for a broken wrist and written instructions for home care.
The doctor (MD-not orthopedic specialist) did not supervise the splinting of my arm. We were shocked.
I wonder what the cost for these services would have been had we not had medical insurance?
The clinic and drug store, which I use regularly had a serious problem with my last visit, whereby I was prescribed a medication, which I wasn’t suppose to receive, and one of my regular RX renewals was duplicated [I got two prescriptions for the same medication], and to top it off, the refill information at the pharmacy end did not match the hard copy received from the clinic. On my next visit, I am going to request hard copies of my RX’s to take to the drug store, instead of having them e-filed. I discovered the duplicate RX issue on my hard copy, before I left the clinic, and I had it addressed, but the incorrect refill info was correct on my hard copy from the clinic, but incorrect at the pharmacy end. I am a retired programmer of Pharmacy systems, and we never had such problems in the day, except, when I and the users (customers) found out, that their pharmacy data was being data-mined and sold to pharmaceutical companies without their knowledge and without the option to opt-out. All the while, the company I was working for was selling patient, doctor, and RX info for millions a year. Once the word spread through the user base of customers (RpH), they called, called, and called, until they were able to opt-out of the data mining scheme.
My medical records were stolen from the hospital and now my account has been frozen for the last three years. The information on the computer is not safe. To many people have access to all your records. I had to change my credit card numbers several time in the last 3 years. This is the worse kind of invasion of privacy.
Obamacare is the worse kind of medical insurance. Medicare not paying the bills. We have lost our Ambulance and I have two doctors who had to close their doors because of non payment of Medicare and Medicaid in CA Many doctors are not taking Medicare! I have to appeal almost every statement from Medicare because they are not paying my doctors and blood test. Lots of fraud!
I was very interested in this piece. I am a physician and I find that the EHR that I use takes up at least 25% more of my time. That is to say, I can lose a day’s worth of patients every four days (.25 X 4 days= 100% patient-time lost)! So, it makes one less able to see patients (less efficient). It also, in my opinion makes it easier for a doctor to get sued or sanctioned by an insurance company. Finally, although I agree that it makes notes easier to read, there are other drawbacks. It is easier to read a typed note when it comes to reading the concluding paragraph. That is good. However, trying to follow signs (found by performing an examination) over time is difficult because the examination portion of the note is just a bunch of checked off items that are chosen out of a template that was not created by the doctor that performs one’s specialty, it LOOKS as if one did a full exam, but in fact it prevents one from writing out what the real findings were because it is too labor-intensive to type in the actual findings.
I chuckled in a humorless way when you noted that some of the EHRs cannot talk to each other. Good Luck! with sharing the information across systems. It basically only benefits a LARGE PROVIDer to have a system like this because all the physicians and nurses who are involved in one large organization (ie, who work for one large provider) can see exactly what the other doctors have done for the patient. However, if you are working for one provider and trying to access information from the system of another provider, GOOD LUCK! It isn’t going to happen. And when I can’t access their information easily, I just order another study because I can’t afford to go chasing down someone else’s info and most patients are not willing to do it themselves. Thanks for the alert and the research you did on this issue!
Please fire them all and let our President of We The People make a sane decision. Thank you.
As a former RN (with a BSN) of nearly 30 years, and being a cancer survivor with many months in hospitals and nursing homes, I am well aware of EMR. I continue to have problems with false entries in my EMR. People who know nothing(allegedCNAs) input data and even tho I print out my diagnoses, medications with route and frequency, and allergies, every visit has incorrect data printed out from my doctor. Once it is in the system, no one wants to correct it. There is no way to identify who put what information in, nor is their a correct way to change information due to errors. I have had to chart extensively for every patient I have encountered, even ‘just a bathroom visit’ and every interaction has to be accounted for as the RN. I do not see any accountability in the EMR based on the reports generated in my visits to my many doctors. While this happens in nursing homes, at the doctors office and at the pharmacy too, in the hospital is the most concerning. I have been listed as allergic to Benadryl when I am allergic to Bentyl-a potentially life-threatening mistake. Likewise Tylenol instead of Percocet-it is the Oxycodone I am allergic to. Blood type, name, medications, allergies, all can kill a person and all have been miscoded for me. I am able to verbally point out these mistakes but because of procedures and medication, people prefer to rely on the chart than the verbal information a patient states, in case they are confused. On a paper chart, you could cross out an entry and state error or wrong chart, but the EMR is not as easy to correct. Because it disseminates information widely, every error is magnified. I would like to see the system work, as it could make things easier and more secure, but haste does make waste and mistakes. Computer systems, largely depending on price, are all different, based on when installed and at what price. I have rarely seen a hospital or office have the same systems for billing, appointments, charting, diagnoses, and labs. Different systems do not communicate easily on purpose, being from different competitors. Privacy is easily compromised due to the huge number of people with alleged permission to access each chart for different purposes. I find unwanted offers in the mail from companies who got my personal information, which they can rarely tell me how they got this information, except from a list bought by the company. Every time I attempt to purchase something on a computer, I have to sign long privacy notices…
I thought when the idea of electronic reords was first offered that it seemed to be another enormous invasion of our personal privacy and another way government could track us. It sounds so conspiratorial that I cringe in writing it but it does seem more and more like corporate profits and invasion of privacy go hand in hand
My primary doc thank goodness faxes refills to the pharmacy so there would be a potentail paper record. This is good. However, the printout handed to me after every visit has several errors on it.
The portal he uses makes one change the password almost every time one uses it. Maybe that’s a protection against hacking, but it sure is annoying.
IMO the more that private enterprise in the form of huge corporations gets involved with medical records, the less efficiency and benefit to patients, the greater danger of persistent errors.
It would improve matters if large providers paid programmers to do their OWN digital record keeping instead of relying on the quirks of corporation products like EMR. thus the medics and hospital managers would be able to input the data they want to see while also providing for CORRECTIONS. Large providers (united hospital systems) do have the necessary bucks, despite erroneous claims to poverty 🙂
This is only the tip of the iceburg and once again we have been lied to. Your medical record is more than likely being transcribed by a huge conglomerate corporation such as Nuance, INC by grossly underpaid and overworked Medical Transcriptionsts. These companies do not have to abide by labor laws as their workers are employed as Independent Contractors. Hospitals are being forced to lay off their entire transcription departments to comply with the law. How does that save jobs? These huge corporations also send large amounts of your medical records overseas to countries like India and Pakiston for transcription because of the huge cost savings. Your record is being sent via cyberspace overseas to countries not entirely friendly to the United States. Your health history and personal information is available to whom? We may never know until it is too late. In the future we will have to look for the “Made in USA” label and seek out physicians who display a “Medical Records stay in the USA” sign.
I was in the hospital for a week. A couple of weeks after I got out and received my medical bills that my medical insurance paid, new bills started coming in for things that were NOT done in the hospital. A few months later I got a scam bill from a “company” that had my name and address. They had the wrong zip code and errors in the name of my medical company. They had the gall to call me and ask me for the correct address a few days before I received their bill. It is likely that many retired persons would have paid that bill. I did not and I haven’t heard from them. The company name they used was bogus. BUT HOW DID THEY GET MY NAME AND PHONE NUMBER AND MY ADDRESS (except for the incorrect address)? I want to report them, but I don’t know who to call. Does anyone know. Isn’t there an agency that investigates these scams?l
Yes, first you do an on-line complaint with the FTC regards to the company, Then the BBB.org of the company that is doing this so it will NOT effect you credit, insurance in any way. As far as dealing with insurance companies, they are backed by Obama, the house, and all that has put some of these laws into place. And of course our attorney general.
“If everyone’s records are open for others to see, who will confide to their doctor anymore? ”
I am doing my part by not creating any Medical System records. If a few tens of millions abjure from visits to this Medical Industry that is bringing us poor or worse health perhaps something may change.
The electric records are not being created to help us but to target us on a massive scale. Unfortunately your doctor no longer works for you. HHS stopped working for us many decades ago.
We figure out MOST of our health problems on our own or IMO we grow ever more unhealthy.
I’m with you. I am 72 and I go once every 5 or 10 years. I think I know a lot more about taking care of myself than the doctors that are available to me.
Nancy
As an IT professional who worked in the area of electronic health records several years ago, I was interested to see this article.
In my experience, there are two main reasons EMRs are resisted by healthcare professionals and the government has had to resort to bribes (“incentives”) to get these implemented:
1. The systems are horribly designed, usability-wise, and the end users are not always computer literate. During implementation, some doctors and nurses needed to be taught how to use a mouse. One doctor yelled in frustration, “I didn’t go to medical school for 6 years to use a damn computer!”
2. Healthcare professionals are terrified at the heightened accountability and loss of autonomy computerized records bring to an already over-litigious field. With EMRs, it becomes blatantly obvious how allopathic medicine is more of an art than a science, and how little of this medicine is actually “evidence based.” EMRs enforce specific workflows that make it much harder for any one professional to divert from a pre-existing flowchart, and much more vulnerable to being questioned about those decisions.
On the IT side of things, I was dismayed to see how once a record was entered in to a database, that information could be immediately propagated throughout several different systems, with no informed consent from patients. One private company I worked with copied our patient records into their system without our permission and we had to insist that they delete that data. (And did they, really?) There were so few procedures for dealing with these records at the system backends that even well-intentioned people got it wrong sometimes.
Many individuals working with the databases have direct access to records and it all comes down to us just trusting that all involved will exercise sterling judgement at all times and will honor their confidentiality agreements.
Today, I specifically seek out doctors who do not use EMRs, based on my experiences.
Is anyone really surprised?!? NO THANKS to anyone who was dense enough to vote for OBAMA, especially if it was for the SECOND time!
If anyone would actually research past voting records, how could Obama ever have been reelected?!?
America has officially dumbed down. God help us!
I agree this blows my mind that people do not check the records but believe the garbage put out by the Obama supporters as “fact” when it isn’t. Then they attack the person who states the records as idiots and want them to prove it by where we read it ? If you give them the information they still don’t believe it in black and white. I am very uncomfortable with anyone reading my personal information. We have no control over who reads it. Kept confidential is a thing of the past we are cattle being lead to slaughter with Obama Care.
Very frustrating can’t fix stupid.
OMG, they’d make a killing of my old military medical records then
“Medical identity theft” is very serious because, in addition to causing financial problems, identity theft can lead to inappropriate care when incorrect information is included in a patient’s medical record. For example, if the blood type of a person who misused your health insurance information is listed in your record, you could be given the wrong type of blood in an emergency. If you believe you are the victim of medical identity theft, you should ask to review and make appropriate corrections to your medical record so that you receive appropriate care. Therefore, for your health and safety, it is very important that your medical records do not contain information about another person. We request your assistance in ensuring that our records about you are correct.