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Cosmetic/Elective Health Care and Electronic Health Records

Thursday, June 30th, 2011

The Cosmetic Patient and Electronic Health/Medical Records

We’ve been hearing a lot about Electronic Medical Records and Electronic Health Records in the news lately, and there’s an upcoming governmental mandate slated for 2014.

I’ve been wondering to what extent, if any, the mandate of 2014 may affect our patients at Cosmetic Plastic Surgery.  First of all, you can rest assured that the confidentiality of your personal health record within our facility is our first priority.  Since Dr. Castillo’s practice is privately owned and operated, and we don’t participate in any governmental insurance programs, state or federal, we should not be mandated into the EMR pool of health providers.  The sharing of any information from this facility is carefully handled in compliance with HIPPA guidelines and the business policies of Cosmetic Plastic Surgery.  Dr. Castillo has never computerized medical records because if it’s not stored on a hard drive, it can’t be electronically stolen or manipulated.  Cosmetic Plastic Surgery is a fee-for-service facility that does not participate in any governmental programs, or accept private insurance assignment.  So, our cosmetic patients should not have to concern themselves with a 3rd party gaining access to their elective medical information unless they, themselves request, in writing, for it to be released – i.e., requested filing of private health insurance for benefit reimbursement.  (Be aware that any information you share about any procedure or condition cannot be removed from your electronic health record once reported, and can effect you in the future in ways that you cannot predict today).

So, now that we’ve covered how this will not impact your private cosmetic/elective health record at Cosmetic Plastic Surgery, let’s delve into what the differences between an EMR and EHR and how should this new electronic health record system work?

According to Electronic Medical Records vs. Electronic Health Records:  Yes, There Is a Difference A HIMSS AnalyticsTM White Paper By Dave Garets and Mike Davis Updated January 26, 2006, The EMR is the legal record created in hospitals and ambulatory environments that is the source of data for the EHR. The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual. Stakeholders are composed of patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government.”

Whoa, sounds like I should have taken Healthcare Lingo 101 somewhere along the line, doesn’t it?  How about those of us without an insider’s understanding of what “modalities of care engaged by that individual” actually means to you and me – the average citizen on the street?

Let’s use an analogy that anyone can visualize.  Think of your overall health record as a wagon wheel.  You have the hub, which represents your EHR (electronic health record) – this is where your healthcare information is stored.  The EMR (electronic medical record) represents the spokes of the wagon wheel – healthcare providers and businesses that feed the hub information; i.e., doctors, hospitals, pharmacies, laboratories, etc.

My understanding is that the hub (EHR) will manage all the information supplied to it by the spokes (EMR) for the benefit of you – the patient.  This should assist in avoiding obvious problems such as possible drug interactions, etc.  Symptoms may be correlated and interpreted because the information is housed in one location, and expensive duplication of efforts such as lab tests can be eliminated.  Ideally, all the information your family physician or specialist requires to meet your healthcare needs will be available in a timely and cost-efficient manner.

A lot of benefits have been mentioned in the blog and healthcare articles that I’ve read – immediate access to your own health record, more efficient healthcare and, in particular, lowered healthcare costs.

Obviously, in a perfect world, this would seem win-win, no?  Problem is, this is not a perfect world and there are bound to be glitches to be worked out and ramifications of others gaining access to personal health information that have not yet been foreseen.

Personally, I see no reason for an employer to have access to the doctor’s notes from my last physical, do you?  When I read that employers, the government and insurance companies are stakeholders with possible access to my EHR, the personal red flags start flying.  The possibility for abuse and discriminatory issues are, to me, undeniable.

Presumably, there will be checks and balances to limit access to only the relevant information – but exactly who or what will be making these decisions?  If it’s a program, who is writing the program(s) that guide the decision-making process and what conflict(s) of interest are bound to occur?  Can you imagine the potential for abuse if an insurance company owns the software company developing these programs?  How do I know that the software designer is qualified to make decisions about streamlining my health history and what information is relevant to which query?

Let’s presume that the data is always accurate and the programs/systems are in place to prevent abuse; then I must ask – will all providers outside of an elective medical situation familiarize themselves with patient health records on screen?  If not, we’re giving up privacy of our most intimate information for nothing.

I’ll have to do more research to qualm my own personal fears of an informational blank check to anyone remotely associated in some way to our healthcare warriors wearing the “white coat.”    I don’t doubt the potential advantages of electronic health records, but the potential for misuse and/or abuse is also beyond doubt.

It’s difficult to stuff the genie back into the bottle, folks.  Thankfully, we have until 2014 to investigate.

 

G. D. Castillo, MD, FACS

Cosmetic Plastic Surgery, Skin Rejuvenation & Laser Institute

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