The Mayo Clinic has announced a Health Manager, hosted and powered by Microsoft Healthvault, to help you manage your own and your family’s health and medications. It is a "security enhanced" online interactive personal guidance system that allows you to track and graphically monitor specific problems, and access Mayo Clinic advice about diagnoses and treatments.
You can enter your physician’s names and telephone numbers, organize immunizations, charts, chemistry studies, and tests then customize and print relevant information to take to your doctors. In coming months, persons with Type 2 diabetes, hypertension or high cholesterol will find help managing those conditions, and the site will be updated regularly to reflect best practices in health care.
This allows you to become more pro-active in your care, print out material to take with you to your doctor, and get the most out of your doctor’s visits.
Warnings about electronic health records: Inaccuracies can have serious consequences and a list of medical conditions should have starting and ending dates on them, as this article points out. "For example, ... an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug." If a doctor knew that was 20 years ago, not 2 years ago, that may be a mortal difference.
Yes, you type that in. Be careful. One small zero, one typographical error, one person's life.
I would raise a word of caution that no personal information is that safe on the web. Even top secret military websites have been hacked. Consider using code names, or at the least make certain that no medical record numbers are on any of those reports. Use long passwords and change them often. That would help. Medical Identity Theft is a very real issue that may never be untangled if it were to occur.
Here's more on that from today's Wall Street Journal; note comments below the article: Are Electronic Health Records Worth the Risks?
Risks for Patients ---Liability for Doctors:
More importantly, this excellent article by Dana Blankenhorn in ZDNet Healthcare points out the 2008 Riegel vs. Medtronic decision ... gave tech companies immunity from most state lawsuits, if their software is placed into a device.
....The Journal of the American Medical Association, which has its own problems with criticism, has now published an editorial decrying the immunity, which is based on a doctrine called “learned intermediaries.” Present law assumes that faults lie with the user, writes Ross Koppel ... a sociologist at the University of Pennsylvania. “Health IT vendors claim that, because they cannot practice medicine, clinicians should be accountable for identifying errors resulting from faulty software or hardware,” he said in a press release.
~~~“But errors or lack of clarity in HIT software can create serious, even deadly, risks to patients that clinicians cannot foresee.”~~~
In his article, Koppel and David Kreda, a Philadelphia software designer, offer examples of software bugs causing mistakes in drug administration, and failures to carry over warnings about drug allergies to the clinicians using them.
All this hit like a thunderclap for Scot Silverstein of Drexel, the health IT skeptic profiled here last month, who blogs at Healthcare Renewal under the nom de blog MedinformaticsMD.
~~~ Along with your patients you are nonconsented beta testers and experimental subjects
of the health IT industry,
and potential victims of the computer industry’s arrogance and dysfunction.~~~
Silverstein believes that legal threats are necessary to end the “mission hostile user experience” he finds so often.
Dr. Koppel writes "Even when their products are implicated in harm to patients, manufacturers of healthcare information technology (HIT) currently enjoy wide contractual and legal protection that renders them virtually "liability-free." His work on the benefits and the liabilities of HIT has been the subject of international focus.
In one example, a trauma team did manage to catch an error in a piece of faulty vendor software that miscalculated intracranial pressures. Had they not, patients would have been severely threatened and the hospital would have been responsible for the resulting harm. "From an equity standpoint," says Dr. Ross Koppel, "This is unacceptable."
Other examples of internal software mistakes include confusing kilograms and pounds used to derive medication doses based on a patient's weight, and software that erroneously remove warnings about fatal drug allergies. In both cases "learned intermediary" clauses hold that clinicians are responsible for noticing the mistake before prescribing.
Equally unfortunate and unacceptable are the provisions in most HIT contracts that prohibit healthcare organizations from openly disclosing any problems caused by vendor software, even to the other HIT licensees using the same products, e.g., clinicians, hospitals. Such stipulations defeat patient safety efforts and are contrary to the principles of evidence- based medicine, says Koppel.
The authors also identify circumstances where HIT vendors should not be held accountable for patient safety failures arising from their products' misbehavior, e.g., user misuse and medical circumstances not knowable in advance. "Legal and contractual changes must not reduce incentives to vendor innovation," said Koppel. "We must achieve a better balance among patient safety concerns, fairness to clinicians, vendor responsiveness, and vendor marketing." The authors suggest moving the HIT industry toward this balance may require several changes to the status quo, including:
- State and national organizations with responsibility for inspecting hospitals would have additional power to set rules affecting HIT contract terms.
- Professional medical organizations taking a stand that HIT contracts containing blanket "hold harmless/learned intermediary" clauses are inconsistent with professional practice. Vendors would then have to focus more strongly on patient safety concerns.
- Healthcare professionals and their associations lobbying Congress for changes in federal law that would recognize a range of HIT vendors' safety responsibilities--much as with auto manufacturers and seatbelt laws.
- Altering legal standards to facilitate rather than frustrate disclosure of HIT product shortcomings that have patient safety implications.
The American Recovery and Reinvestment Act of 2009 (ARRA) - What it means for doctors
The New England Journal of Medicine this month published a detailed article on Health Information Technology [HIT] pointing out the "significant barriers to their adoption and use: their substantial cost, the perceived lack of financial return from investing in them, the technical and logistic challenges involved in installing, maintaining, and updating them, and consumers' and physicians' concerns about the privacy and security of electronic health information."
Experts estimate the cost of a system for a medical office to be about $40,000 --- startling indeed. That may explain why so few have invested. And there will be sticks and carrots to get this going. Starting in 2011, doctors will receive financial incentives from Medicare for the "meaningful use" of a "certified" system "that can exchange data with other parts of the health care system." And if they do not have a system, reimbursement from Medicare and Medicaid will be reduced. Obviously this does not apply to private insurance, nor does it apply to the growing numbers of doctors who opt out of Medicare because of low reimbursements that are not adequate to cover overhead.
To get the most out of the fiscal incentive, an MD must have the system fully operational by 2011. The incentives are reduced every year until they end in 2016.
The law currently requires health care organizations to promptly notify patients when personal health data have been compromised. But should tech companies be given immunity from lawsuits if their software causes problems in your health or if data is not secured, resulting in Medical Identity Theft?
Enjoy this music: Louis Armstrong and don't miss the video. It's magical.
The bright blessed day, the dark sacred night.
§
Posts
No comments:
Post a Comment