First off, I am in no way left-leaning, nor do I support the decisions of the current administration in any form (and especially when it comes to healthcare and the Affordable Care Act). However, as a Healthcare IT professional (with a recent Master's in Healthcare Administration and Technology) that is deeply immersed in electronic medical records systems, I would like to clarify a few points for the purpose of continued honest discussion. EPIC is a privately held firm, based in Verona, WI. Although the technology originated 35 years ago in a state-owned (UW) teaching hospital, the company is in no way owned by any government entity. Outside of the ability to subpoena medical records via court order (no different than paper medical records), DHS has no access. Every EPIC database is separate. Even hospitals within the same system frequently have problems sharing data on patients due to this. The $50k bonus you mention is called the Meaningful Use program. It was passed as part of the 2009 American Recovery and Reinvestment Act. It is actually a tiered incentive program, worth a total of $48k over five years, distributed and overseen by CMS (Medicare). Healthcare providers had to purchase their own electronic medical records system. Epic was just one of over 300 vendors eligible for purchase within the program. These systems were definitely not “pushed out” to medical groups. Large hospitals frequently paid in the $100s of millions to acquire these electronic medical records, with large health systems like Kaiser paying well over a billion. Annual maintenance alone can reach millions of dollars; definitely not “no charge”. There are indeed penalties for not successfully participating in the Meaningful Use program. However, any of the 300 certified vendors may be used to meet the program not just Epic. Also, the data that is reported in the program is not data on individuals. Rather, the questions ask for a numerator and denominator. For example, one measure says that you need to send appointment reminders to 20% of your patients. When I report this, I don’t submit a file saying, “I sent John Doe a reminder on x day”. Rather, I submit a file that says, “of 100 patients in our practice, 25 were sent reminders”. This is how the whole program works. There is no formal national health database outside of Vista, which is the health record used by the VA.
No problem, glad I could offer some insight. You are absolutely correct in that the main goal of electronic medical records is to be able to easily access and share the data across providers and systems. Health data interoperability was just named as the number one national healthcare IT goal going forward, and a roadmap was produced at the federal level to achieve this. The foundation of this has been in place for several years, and is called the Health Information Exchange (HIE) program. Basically, the federal government distributed $500 million to the states to set up a central health data hub for each state. Each of the 300 medical record vendors I mentioned earlier writes it data in a different language. The job of the HIE is to retrieve this data from individual hospitals and clinics, translate the data to a universal language, and make that data available to other healthcare providers within their own electronic medical record. The next goal of these state HIEs will be to link them across states. This is exactly where your scenario of being in an accident in another state but retrieving your health data from back home can play out. This is where the double edged sword comes in. On one hand, the benefit of quickly and easily being able to retrieve critical medical data in an urgent situation, regardless of location, is very valuable. However, if there was information about gun ownership (or non-violent mental health issues, or inaccurate data, etc) in your chart, it would be visible to others as well. As an example, for the CO state HIE, if you have been seen in a hospital in the past 30 days, a red flag pops up in your universal chart. This is to indicate to ER personnel that there could be previous complications to research, but it is also used as a tool to track drug seekers. If you broke your leg a week ago, and showed up at my ER a week later for something else, I may falsely presume you are seeking prescription drugs since I saw the little flag in your chart. On a side note, as a patient you cannot remove your data from the CO HIE. You can request to limit access to it to just “your” doctor, but you have no ability to remove the data. There are 3.5 (out of 5) million unique patients in the CO system currently, and I guarantee that 99.9% have no clue their data is even in a central database, much less that they can’t remove it. One thing you can control (and should) is what is in your chart. Per federal law, you have a right to request and review your entire medical chart. If you disagree with any part of it, you can request that the information be reviewed/reevaluated. Even if the physician refuses to change his documentation or diagnosis, your appeal becomes a permanent part of your record to be shared with other medical providers. In our case, if a doctor made a note that said, “Guns in the home, may be threat to child safety”, your appeal stating “Patient indicates guns are for hunting and self defense, and are securely locked and separated from ammo at all times” would become a permanent part of the chart as well.
I think this ^ is one of the issues. Its not a liberal or conservative thought process. Mental illness has a social stigma, blaming one political philosophy or the other is counterintuitive. In fact, the same republicans (Blunt, Ayotte, Rubio) that are now so gung-ho about mental health reform as opposed to gun control are the same ones who voted against the parity law of 2008 that would require that insurance companies cover mental health care the same as physical health. The mental health spin is what they are being ordered to push by their lobbyists. Its disgusting that our politicians are so low to use mental health and our 2nd amendment rights as pawns for their own monetary gain. That said, its nobodies business if I own firearms.
