My first electronic medical record encounter was in 1975 at a not-for-profit hospital in California. I could enter orders for my dialysis patients and retrieve lab test results. I thought it was" better than sliced bread." I don't remember any negatives about the system other than not being able to connect to it from the private medical office I shared with another nephrologist. So there were lots of "pros" and no major "cons" as far as I was concerned.
Of course, it wasn't a complete Electronic Health Record (EHR) and I couldn't dictate the results of a physical exam or anything else into the system.
In mid-1988 I became the commander of a small Air Force hospital in Texas that was a test site for the Composite Health Care System (CHCS), a Department of Defense effort to have a system-wide EHR. During the preceding six months, when I had been the deputy commander, I was aware there was a rudimentary system in our x-ray department, one that let our radiologists dictate a report. But they had to speak slowly, in an absolute monotone, for it to work.
I attended my first CHCS meeting, with the Assistant Secretary of Defense for Health Affairs (ASD/HA) and all three military Surgeons General seated at the front of a large room. CHCS had morphed into an endless series of blah-colored screens that my docs, nurses and other medical personnel could use to retrieve and enter patient data. At that point I thought it was an elephant designed by committee, a prototype that had a long, long way to go before it was a viable EHR.
I was the junior commander in the room, having been a bird colonel for only three years. Many of the others were long-time colonels or one-stars and even, in a few cases, two-star generals/admirals. After a few introductory remarks, the ASD/HA said, "Colonel Springberg, you're the new kid on the block; what do you think of CHCS?
All eyes turned to me and I blurted out, "Frankly, sir, I think it sucks."
Shocked silence for a moment, then he asked, "What do you mean?"
"My docs hate it, sir. It needs to have a touch-screen or a mouse-able interface or be on a Mac with some colorful screens. As it is, there's row after row of green lines of questions that can easily put you to sleep."
I survived that meeting (perhaps just barely) and my own Surgeon General showed up in my office back in Texas a few weeks later. That wasn't unusual, as he fairly frequently came to the base for events at the Medical Service Training Wing and stopped to talk to me on the way. This time I was concerned he'd want to chastise me for my remarks.
"Peter, do you remember that CHCS meeting?" he asked somewhat rhetorically. "Do you remember what you said?"
My heart skipped a beat or two.
"Well I agree with you. I just can't say those kinds of things. Keep it up!"
Twenty-plus years later, DOD was still using a version of CHCS for healthcare administrative purposes and had something called AHLTA (the Armed Forces Health Longitudinal Technology Application; DOD does love acronyms) as its EHR.
Then in May, 2013, the Secretary of Defense announced a plan to replace AHLTA with a commercial EHR with a short-term goal of coordinating with Veterans Affairs to "develop data federation, presentation and enhanced interoperability."
After I looked up the term "data federation," it made sense. We're talking about software allowing an organization to use data from a variety of sources in a number of places with the data itself remaining "in the cloud."
If you're speaking about medical records for people who move around the globe and often later stay in an allied system (the VA) after they retire, it would be great to be able to access all or part of an EHR without the need to move physical patient charts.
I've got part of my old military health record sitting on a file cabinet in this room, but what I really would like is for all my records to be accessible to any doc I see. whether it's my own ex-Air Force Family Practice physician here in Fort Collins, someone at a VA clinic I might happen to stop at on a trip, or a civilian doctor in Canada or Europe I see in an emergency room
My left shoulder has been painful for six weeks. I saw my physician, got a referral for physical therapy and drove nearly twenty miles to see the PT who works for the local hospital chain (now a part of the University of Colorado) and was moved sometime back to an outlying location. She's really good, so I became one of her groupies, patients who, when they need physical therapy, decided they'd follow the PT they liked best.
If I were still on active duty (it's been nearly sixteen years since I retired), she might have been sent to Italy or Guam. But twenty miles was doable.
After her usual thorough exam she started entering data into a computer. Epic, the EHR used by University of Colorado Health (UCH) meets the 2010 Patient Protection and Affordable Care Act standards, was adopted at the main UCH hospital in Denver in 2012, reached the affiliated northern Colorado hospitals and clinics in July 2013, and will extend to other UCH locations by mid-2014. So if I'm seeing a practitioner at any UCH location, they can pull up my EHR onscreen.
There's now a non-profit Healthcare Information Management Systems Society (HIMSS) an organization that was formed with goals to improve healthcare through information technology. As I thought about the issue on the way to the gym yesterday, I realized one problem is defining who can see my medical data.
Medical data privacy is crucial to many and my first thoughts along this line were rapidly discarded. I don't want Joe Ripoff in Otherplace, Elsewhere, to easily access my records and couldn't initially think of a way that all medical personnel anywhere could have easy entry to my EHR without some hacker also being able to duplicate the necessary passcode. And if I carried a card in my wallet, it could be pick-pocketed. Even if I had my own personal code, I might forget it or be unconscious.
Then I had an idea that could safeguard my medical record while allowing any practitioner I see while traveling to gain entry to all my stored records. It turned out not to be a new idea at all; others have suggested it for the last fifteen or so years.
My dog has an implanted microchip so if he's lost someone can scan him and find who he belongs to. I would be willing to have such a chip in, for instance the flesh of my arm, modified to contain my entire EHR.
If that technology would allow a medical team anywhere to scan my arm and then retrieve my medical data, it might be worth considering.
This sounded like science fiction, but apparently it's possible and it also caused a furor. I Googled the idea and found that Snopes.com had debunked the rumor that the Affordable Care Act mandated such microchips be implanted in everyone. Supposedly, according to the canard, the chip, about the size of a grain of rice, would also link to your bank account (It's not true.) However, an-EHR-microchip, while conceivable, has been resisted by some religious groups and by many who are concerned that they would lead to Big Brother government being able to track all of our movements. Some have even said the data would be accessible to anyone with a scanner.
I think those objections, except for religious ones, are a stretch. And the data could be encrypted.
So my level of paranoia on the issue being quite low, I'm ready for a microchip.
It should absolutely be your choice, of course, whether you get one or not.