Sunday, December 11, 2011

Not in My Record!

For a while now we've been talking about issues related to psychiatry and electronic medical records.  Roy is very interested in the evolution of EHR's.  

I don't like them.  I think they have too many problems still, both in terms of issues of efficiency and time, and how they divert the physician's attention away from the patient, and they focus medical appointments on the collection of data-- data that is used in a checkbox form: patient is not suicidal and I asked, whether it was clinically relevant or not-- and will therefore serve as protection in a lawsuit, or demographic information used by insurers, the government, who knows.

From a privacy standpoint, I think they are appalling.   If you are a patient in the hospital where I work, you get no say, your info goes in to the electronic record and everyone who treats you can access it.  And anyone else who uses the medical record in the hospital can access it as well; the "check" on the system, since much of our city is treated at this hospital, is the after-the-fact threat/fear of being fired or disciplined for looking at someone's record you shouldn't.  I believe the check should be before the fact-- that a patient should have a code, or PIN number they punch into the system that unlocks the system for that particular healthcare provider.  Or something akin to that.  

But what about the fears that people express on our comments that they will be judged and dismissed if their doctors know they've seen a psychiatrist or taken a psychotropic or been hospitalized?  On one hand, there is the idea that this information is more sensitive and should be protected, so that psychiatry records have traditionally been kept out of EHRs.  On the other hand, there is the belief that calling them "sensitive" further stigmatizes psychiatric disorders and it's time to treat them like every other medical problem.  

I will tell you that last year when we did a survey of Attitudes Towards Psychiatry, 41% of respondents thought psychiatry records should not be segregated.

Electronic Health Records (EHRs or EMRs) . . .
should not contain any records of psychiatric illnesses and treatments (including medications) even though that means my primary care doc or ER doc wouldn't know about my meds or condition unless I tell them
should have separate and higher protections for mental illness than for other health problems
should exist for psychiatry exactly as all other medical records do, with the same protections as for other health condition, because adding special protections increases stigma against mental illness
should allow patients to control which information they wish to be shared and with whom for all medical specialties
facilitate better communication and improve psychiatric care
negatively affect communication and detract from psychiatric care
I have no significant opinion about electronic health records in psychiatry
People may select more than one checkbox, so percentages may add up to more than 100%.
Your thoughts?