Health and Medical News and Resources

General interest items edited by Janice Flahiff

Electronic Medical Records: Privacy, Accuracy, and the Digital Age


An October 20, 2010 blog item from  Free Government Information – Because Information Wants to be Free

My brother is a surgical resident. A few weeks ago he was complaining about the difficult Electronic Medical Record (EMR) software his hospital is using, particularly the unintuitive user interface. Then I read
an article in the New York Times about the business opportunities that are growing in the world of electronic health records.
According to this article, two brothers, who have already developed a software EMR package for small-practice doctors’ offices, are waiting for the Obama stimulus package to essentially kick in, as the medical community will eventually have to migrate to digital patient records, or pay the penalties for failure to do so.

To me, there are two primary issues: privacy and accuracy. In extolling the benefits of the EMR (Saves lives! Lowers costs! No more pesky paper!), what will prevent the doctors’ offices, hospitals, and health insurers from abdicating responsibility over the care and quality control of those records? I realize that the e-document movement is permeating all levels of our lives, from the personal to the professional, but I cannot help but feel that an attorney’s e-discovery litigation case papers are better protected than patient information in a hospital.

Further, not everyone knows that HIPAA entitles you to your entire medical record, doctor’s notes and all (which is why, from what I understand in talking to several medical residents, doctors are usually instructed to take care in how they write about the patient in the medical record, for subpoena purposes and patient record requests; it probably is not a good idea to write “this patient is an idiot”). But in the same DHHS website, HIPAA privacy rules seem to have a series of caveats. A Washington, DC public interest research center has the same concern: Apparently, the DHHS proposed rules required that privacy breaches need not be reported to patients unless the provider or insurer felt that there was a “significant
” of harm. So then the discretion for the standard of “significant risk” is left to a large impersonal corporation or a doctor who does not have the time to return phone calls? Not good. DHHS is currently reconsidering that medical breach notification rule, but this caveat that the covered entities determine whether “significant risk” exists, does not appear on the DHHS’s website summary pages.

Accuracy is another issue, and I believe it will be a growing concern as records are increasingly kept in digital format. With the health care companies pushing the doctors and hospitals to get patients in and out of the hospitals as quickly as possible, the quality of time spent with the patient will inevitably be reflected in the patient EMR. Case in point: I visited the ophthalmologist a couple years ago for a routine check-up. I advised the technician that I had scar tissue on my left cornea from an old boxing injury. The technician then inserted the eye pressure gauge into my left eye and the instrument tore into my cornea. The doctor treated me for this second injury but my medical record has no indication of this new injury from the doctor’s office. How do I know? When I mentioned the injury to my GP in a routine checkup, he had no idea what I was talking about. I obtained the medical record myself and added notes for my own records, indicating the date and type of this new injury; I may need this information for future eye care.

Another example: my GP’s EMR for me does not include the list of drugs to which I am allergic (it also does not include any reference to the eye injury from above). I have called his office, but I have yet to see that information added to the EMR. This information is in his paper record on me (I know because I filled out the “patient information form” upon my first visit years ago), but the problem with the EMR is that it can be replicated to any doctor in the country with one phone call, and the information will be inaccurate – even though (or because?) it is digital.

So the government will monitor the transition to EMRs, a “cost-saving” and “patient care” measure, but just who benefits here?

Johanna Blakely-Bourgeois, Pratt SILS

Some Electronic Medical Records Links


October 25, 2010 Posted by | Consumer Health, Finding Aids/Directories | | Leave a comment

PubMed® Display Enhanced with Images from the New NCBI Images Database

PubMed Abstracts of biomedical articles will soon include images included in the articles.

From a US National Library of Medicine Bulletin posting (Oct 22, 2010)

The PubMed (**)Abstract display for PubMed Central® (***)articles will be enhanced to include an image strip generated from the soon-to-be-released National Center for Biotechnology Information (NCBI)(****) Images database…

…The image strip will display thumbnails of the article’s first several images. The image strip will also include a See all images link to display all the article’s images in the Images databases, as well as a Free text link to the article. Right and left arrows on each end of the strip will allow you to rotate through the images.

Mousing over an image in the image strip will generate a preview display of the image with its figure caption . Click on the image in the image strip, or the mouseover preview display, and go directly to the figure’s page in PubMed Central….

Images Database

The Images database will allow you to search millions of scientific images from NCBI full text resources; the database initially includes images from PubMed Central..

….You will be able to search the Images database with terms or detailed search parameters, such as image height, width, and caption. The complete list of search fields is available from the Images Advanced search page. Image results initially display in a summary format (see Figure 4) but may also be viewed in a thumbnail display. Retrieval display order is based on a relevancy algorithm.

**PubMed is the largest indexer of biomedical journal articles in the world.  The home page includes links on how to search (tutorials, quick start guide). For further searching assistance, consider consulting with a public, academic, or medical reference librarian. Many articles indexed by PubMed are not freely available on the Internet. Again, check with a local public, academic, or medical library for access to journal articles. The library may charge a fee for some articles.

***PubMedCentral is the U.S. National Institutes of Health (NIH) free digital archive of biomedical and life sciences journal literature. It is part of the PubMed database (index).

****NCBI (National Center for Biotechnology Information) advances science and health by providing access to biomedical and genomic information. It includes PubMed and PubMedCentral.

[Editor Flahiff’s note: Many postings in this blog, especially Reuters and Health Day press releases, are based on articles indexed in PubMed]

October 25, 2010 Posted by | Biomedical Research Resources | , , , , | Leave a comment


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