Interoperability so their notes can easily "Import" to your chart is one thing, My CD plays in a Disc player in NYC or LA; Great!!! No problem.... But now picture this... If records are no longer kept at the doctor's office, separate and probably for the most part not on most people's radar to be looking for them... Low probability of Daniel Elseburg's Psychiatrist being repeated in the near future ala Nixon Administration. One would have to know which doc, where they are and attempt to find their way backwards into their server, thru hopefully at least one hardware firewall and one software firewall, like most of us have today with our routers acting as a basic hardware firewall and then a good well rounded internet security package acting as the more intelligent and robust software version.
But if Three US Senators all of whom were running for President of the United States at the very same time, can all have their travel passport records hacked and accessed "AT THE STATE DEPT!!!!" and then leaked and or posted for the entire world to see, what chance in hell do any of us have in feeling the least bit sercure in knowing that any of our super personal, medical history is safe while Millions, literally Millions of Medical Employees at Hospitals, clinics, private offices, no less Insurance Carriers, clearing houses, billing companies, forth party administrators now like Care Core, the doctor head hunters looking to gain from trying to make us look bad and naughty, and all the other players out there that will have access to these very well connected, intentionally pretty wide open so LA can look at NY's records if you are from NY and get sick in LA, RIGHT??? Not exactly "Tight as a Drum" there now is it... What a crock of CCHIT.
Everyone can has a flash drive RIGHT NOW with a CCR or a copy of their entire families records for travel and late night purposes, and then WE the Public are personally responsible for our own PHI, not some faceless middle management gov't employed Nobody.. and if that drive is lost, then only that person or family got violated not the 3. something million people whose privacy has already been compromised, lost and violated. I will try to get the NYT's article posted on that, it is very real and very frightening because with the data that was lost people's careers could be ruined and their credit rating, Personal ID could be compromised for years if not almost forever... I'll take my chances on making sure my docs are in the loop with one another, thank you very much....
BUT to me the single most important reason to NEVER, EVER have One Single Chart for life that is always "Additive" and never able to be separated out is the following. Hang with this story.... I knew a young man who was pretty intelligent, had some basic learning disabilities but was creative as all hell, raised by 1950's - 60's retired semi-radicals now living the normal middle class life... This kind was a chop buster, it was like 1976 or so and Psychodynamics was still the main thrust of mental healthcare (frightening in and of itself... go blame your mother for not properly resolving your Anal phase... OK Edipus.. :-) and this kid was smart enough a couple of years post Vietnam and Nixon, gas crisis and embargos, inflation, Ford telling him and his entire city and school system that educated him and employed his two parents, to "Go Drop Dead" and he played hard rock guitar in a garage like band.. this kid Knew that the world sucked and that he honestly wanted no part of it..
It was actually a very intelligent choice no less an ethical one based on good solid values that his own parents taught him and raised him on.. To care for his fellow man without the fear of god telling you that you had to... To try to get along with others and reach a win-win when possible, but to be a tough stand up for yourself and your rights lefty and NY'er... and couldn't stand the hypocracy of almost everyone in adult life who were so quick to sell-out especially the once radical now studio 54 cokehead babyboomers and other assorted disco heads.
This teenager prayed to wake-up Stupid and Dumb because then he too could live a life not caring and just be a schmuck on Auto doing whatever and danm the real world consequences.... And unlike today where we understand kids with learning disabilities and assist them, develop IEP's for them and allow them to go easy or skip a bit of what they are weakest in without it ruining their overall averages and grades, this poor kid who kicked butt in science and political science and performing arts as a functionally illiterate musician was forced to repeat subjects like Spanish over and over again no matter how much it refused to imprint in his brain both written as well as spoken... Later on at CUNY in the early 80's the same injustice was impossed upon his transcripts and so in the 90's when he returned to college to finish his degree, he only had like a 3.6 cum. (oh and CUNY refuses to allow any A+ grades so all CUNY students are a competitive disadvantage to their Ivy League competition) and those same just slightly older Studio 54'ers who smoked dope and blew tons of coke and cut classes and themselves had modest Cum's, judged him right out of ever getting accepted into a Clinical Psych Graduate program with grades better than those who sat in judgement over him....
So imagine the trouble of speaking his mind, not being able to stand the world that he was smart enough to know he didn't fit in to and was not ethical not to want to just sellout... so he's doing poorly in school, smoking a lot of pot but not too much of the other crap besides a small amount of drink because he got drunk easy and could easily get sick.... started cutting classes and feeling more and more disenfrancised.... and starts telling his folks where to stick it, and hates the fact that he is forced to go some place to not be appreciated for his skills and abilities but certainly has to suffer repeated failures...
So his folks sent him for some well recommended mental health evaluations and care where instead of first winning the patients trust and breaking thru the adult teenager barriers, they insisted upon all of those stupid intake tests including Rorschoch (pardon my spelling) and other almost meaningless subjective tests... so guess who knew he had to get stoned to deal with those stuffy twead suited idiots who didn't understand him at all and that he didn't trust worth a darn??? yeah he did. So he got silly and was refusing to say anything because honestly he didn't see much worth reporting in those stupid pictures, so he told the guy that most of them reminded him of a women's privates because of the symetry and the even folds.... Can you imagine what a Psycho Dynamic stuff shirt must have thought of all of that????? Oh and this kid actually read Psychology Today and liked it as his family had a regular script to it... So even at about 14-15 years old, he was already into and learning about what he eventually wanted to do professionally. So as to make sure other kids didn't suffer the inginities and injustices of an out of touch mental healthcare system that didn't get it...
So this poor kid who was also a darn Excellent Hockey Player, starting Center for his Bantam team even as one of the smallest kids in the league, he played stronger and harder, bigger than his stature and never seemed to run out of gas..... before the days of the Energizer Bunny, his sort of respected but dispised nick name was "Heartless" not because he had not heart, just the opposite, but because he was always forechecking and backchecking, busting by and around the defenders, a buzzing annoying pest, "He never stops skating, he can't have any blood in his veins, because he never gets tired like the rest of us... I swear he's got not heart, no blood, his "Heartless"... Top 10 scoring sheet, starting power play and starting penalty kill, first line center iceman with two of the best wingers in the league he felt proud just to be on the same line with them but he worked hard to be as good as them to make great plays with them and be a contibutor instead of an hinderance to his linemates... They won two championships in a row that team lead by an injured volunteer college player who unlike the other teams was young and hip and understood in Bronx working class inner city kids and players....
So this kid, he got labled by those "Wonderful" so wise and full of their Psychodynamic selves (now all of it disproven and unrepeatable and not valid or significant, but they had the authority back then to make or break you, lable you for life.. just as today)as having "Borderline Personality Disorder" the kiss of death lable.. just about the hardest to "cure" diagnosis in the entire long list of lables.... he parents were running out of options and out of ideas and patients but they knew these folkd didn't know their [censored] from the elbows and soon after they were done with all their wonderful testing, they walked away from that place, that so many other nice middle class families and professionals so highly recommended, knowing that they needed to continue shopping and struggling to figure out their son and his problems....
And so they left that place and left those horrible no good tests and evaluations, and that chart to rot never to see the light of day again... many years later after majoring in Psych and being a leading member of Psy Chi and presenting posters at local conferences, he had to be watching Phil Donahue to finally figure out his own finishing touch on his real DSM Valid Diagnosis, because even in undergrad school they teach it and explain it like most of the other problems so poorly, even in Clinic Abnormal Psych classes... Yes that day Dr. Hollowell of Driven to Distraction fame, Hardard Medical School was a guest on Phil's show discussing his then fairly new book of that same title... and the light bulb went CLICK after all the specialists and all the horrible life altering misdiagnosis, all the near misses that almost ruined his life back before he found a med that worked well for him that he takes to this day almost 20 years later.... Wellbutrin... He has a modest amount of dyslexia, a learning disability for things like spelling and handwriting (today kids all use computers and MS Spell Check) and foreign languages, even though he is pretty darn well spoken and personable in public face to face with others.
So now imagine that very same kid and young adult with all the spits, fits and false starts and slips backwards. What would his FOREVER Chart look like and would any doctor ever look at him the same way that they do today because his parents left those horribly off base Dx's and charts to rot, to never be spoke of again except to say, thank god we had to the good sense to cut our loses and leave while the getting was good.... NO Chart should ever be this written on stone tablets, never to be gotten rid of like an anchor around one's neck... Doctors and mental healthcare professionals Mess-Up and get things wrong all the time. And if and until there is NO financial prejudice from insurance carriers and the like, again let's just put the Titanic's Anchor around a large minority of the populations neck and wonder why they drowned after we did that to them.... That poor kid would have been ruined... probably for life... Instead as an undergrad watching afternoon talkshow TV while half studying to finish up his second time round at college after ruining his shoulders on the job, at just about 30 years old this guy finally knew what was up and that he had to go find a compentent doctor or shrink to double check his well founded theory that he simply had ADD with a bit of those other frustrating and only slightly relavent problems that today we casually deal with and simply understand, and don't allow them to ruin someone's entire academic career and track....
Can you guess after this super long post, who that kid now 50 year old adult is???? Yeah, its Me.... Today I have a child who may have some of either his father's or his mother's issues and we have a counselor who is progressing very slowly in not over Dx'ing him because she knows her hospital is EMR and REC'ed and she doesn't want to jump the gun and mislable or even Properly over lable our son for life... So instead she undercharts and undershoots his Dx for his own long term protection... Is that anyway to collect Meaningless Use data when docs and mental healthcare professionals are going to ALL TOO Intentionally under chart and under report for the long term real life consequences that a more honest or harsh Dx and charting, rating of symptoms might otherwise honestly deserve???
Like WTF have we done here???? Now instead of lost, misplaced and parts missing charts leading to inaccurate medicine, instead we have good natured and well intented parents, professionals themselves agreeing with this wonderful and helpful counselor who has already done so much for our son in less than half a year with him and our family.... What is a medical chart for?? What is its real purpose and what the hell does the federal gov't or any insurance carrier have to do with any of that???? It is supposed to be a decent and not overly done, record of the encounters to record what happened and was discussed, and to remind the doctor what happened so over time he or she can review it and hopefully find patterns or the lack there of... to assist their memory and to assist them in Dx'ing the patient.. and unfortunately now today it is a way too legal document to protect the doctor from accusations from the gov't and insurance carriers of fraud and abuse, and from overly agressive "let's all hit the lottery" patients and lawyers.... not what a medical chart is really supposed to be for...
As I love to tell people about the insanity of the present system and why insurance carrier have nothing of value to return to the system and are only a drain and a barrier to care.... "A pre-existing condition should be nothing more than a medical concept for your doctor to know your history and a note or two in your medical chart... Not what the insurance bozos use it to mean and how they apply it today"
Medical charts are a dangerous thing... last thought... and then we should all go here.... If Mccain, Clinton and Obama can all have their passport histories violated from inside the state dept and to this day nobody was held accountable, imagine what is going to happen as millions of employees listed above are going to have access to everyone's medical charts and histories.... I bet you good money that in the next 10 years when a Democratic Women attempts to run for President there is at least a 50% chance of her personal choice of Birth Control getting leaked and posted.. god forbid she had an abortion at anytime in her past, watch out... and even a bible thumping conservative who might actually use modern birth control or had an abortion too.. Don't tell me if Pallin or Backmann has such things in a centralized server REC like E-Chart that a good number of Carl Rover like people in either party wouldn't love to be able to get their hands on that kind of info and ruin one of them with it... perhaps hold it out until the last moment as a November Suprise like, last minute attack without enough time for their target victim to do much if any damage control....
No thank you please not for me and not for my family and other loved ones.... I still believe in privacy and the constitution and the Bill of Rights and NOT allowing some Orwellian Police State to know anything and everything about me all too quickly and without any control over it, no less the negative impacts such releases will have one me or my family.... One day this Facebook, always public posting generation is going to wake up and finally understand why some of us older radicals from both sides were so up in arms about search and seizure, and privacy and warrents, and protecting the 5th ammendment too...
have a great night and sorry if I went on and on, but this one really strikes way too close to home, and more people need to wake up to the all too real threat to one of the last places where we should have just about an Iron Door locked and bolted Super High, "Expectation of Privacy"... in that exam room, with our doctors, with our patients....
Paul
