Monday, October 16, 2006

For The Record




Dr. A wants to talk about Electronic Patient Records.
Who can blame him? It's all the rage.

Okay, so psychiatrists don't do Electronic Patient Records, at least none that I know of. I work part-time in a clinic associated with a major hospital center, for every department except psychiatry, notes go into an EPR system. From my point of view, this is terrific, when a patient comes in and says they're on the white pill for their blood pressure, I can access the primary care note and see which little white pill. When they say a lump was found in their you-name-the-body-part, I can look up the radiology reports and see whether this is worrisome or not. Need labs? Maybe they were done last week and don't need to be needlessly repeated, I can look them up!

So what's the down side? Privacy, I suppose, and really I don't think about this from a health care point of view, but from the perspective of being a potential patient/employee of this major medical center. There are safeguards on the system: employees are told never to access the records of those who aren't their patients, we are told that who accesses the info is easily traceable, and the sanctions are considerable, but there isn't a full-proof guarantee that someone who is curious won't access someone else's records.

Somehow, my baseline is to be fairly paranoid about my own medical information. This is an interesting concept given that my existence has generated a minimal amount of medical information, none of it too colorful, and it mostly boils down to I never want anyone anywhere to know what I weigh. Still, some of my patients Google me, and some of my patients have access to the EPR; might a curious patient do the Google equivalent of checking out their own docs in the EPR?-- Just as an aside, how does confidentiality work if a health care worker patient confesses to a psychiatrist that he has illegally accessed the psychiatrist's private medical information? Can the shrink break confidentiality in order to stop the patient from continuing to violate his own confidentiality? Hmm....let's not even go there and I'm sorry if I gave anyone a headache thinking about this.--- And what about my co-workers, my supervisees, and a good number of my friends and neighbors, many of whom can enter the EPR? The bottom line is that I'd have to be pretty sick to seek care where I work.

So no, I've never looked up any one in the EPR out of curiosity; when I see a patient in my private practice who has had care at the hospital, I ask permission to look up their medical information. Invariably, I'm told, "You're my doctor, of course you can look at my records." It seems to me that I need to ask permission, given that they are seeking my help in an isolated setting and wouldn't naturally assume I'd have access to this information. When I see a patient in the clinic, I never ask permission, I often have their medical records printed out in front of me before they even arrive. By getting care at this hospital, a patient implicitly gives consent to have their information entered into the EPR.

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