2009 is a year of hope and change. However, it is not certain that change will be positive when rushed through congress at break-neck speed. The economic stimulus bill that President Obama just signed includes legislation that will establish a national computerized medical records database that will contain data on every citizen. In addition, the legislation will force physicians to adopt electronic medical records (EMRs) that meet government standards and specifications.
There are three main problems with this new legislation. First, it eliminates patient choice regarding disclosure of their medical records. Second, it creates a high-value target for online criminals. Third, it eliminates freedom of choice for physicians.
A national database containing data on “every American” by definition proscribes patient choice. Although the legislation states participation is voluntary, it does not contain any measures for opting out of the system. Furthermore, the database will be used for biosurveillance, public health, as well as research purposes. It is unclear what “biosurveillance” means at this time. However, it is clear that any citizen in this data base will have no control over their records.
Online databases of medical information have traditionally been high-value targets for e-criminals. Medical databases are desirable because they usually contain the information necessary to perpetrate identity theft. Additionally, there are many recorded incidents of hospital record systems made available on the internet through poor server configuration or administrative error. The government has a lackluster history regarding computer security. The Federal Information Security Management Act (FISMA) was enacted to improve security, but its success has been marginal.
The government will use Medicare and Medicaid reimbursements to force physicians to adopt an EMR that meets government specifications. Although we do not know what those specifications will involve, they will probably be of a “one size fits none” nature. Specifications designed by committees tend to change rapidly and be unnecessarily complex. Implementing medical records is a difficult task without being forced to adopt an overly expensive and complex system.
While there is certainly a need to encourage physicians to adopt EMRs, the current strategy of implementation through legislation has many problems including patient privacy, security of medical information, and freedom of choice.
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