Home Forums Discussions Meaningful Use Does One Need to Sign-On with their local REC?

Folks,
We have avoided Meaningless Use for many reasons including some that are very important and personal to us... But that being said, does the process or the requirement demand, require that we open up our system to, and activate the connection to the REC, Regional Exchange Center in our local area????

I might be willing to take the money and run as long as we are not required to open up our system to, connect to the regional Exchange to submit, attest, or as one of the hoops to have to Met, Jump Thru... And then if and when we are required to connect up to "Big Brother's" Orwellian Super Invasion of Medical Privacy that once in there, can never be taken back or undone... that is when we would stop chasing the incentive money...

The REC's and the singular, general, centralized chart, one chart with all provider's notes in it, One chart for Life This is our Main issue and problem with the present push to this frightening "Brave New World Medical Order"...

Only wish more concerned citizens and provider docs would "Get It" and join us in our protest and resistance to the Borg..... The possibility of the Level of the Futility is directly proportional to the level of our "Resistance" my fellow Humanoids....

Resist and Question Their Authority to Violate and Have Complete Access to ALL of OUR PHI!!!!

Paul

Paul,

Others can answer your question, but I'd like to know why you think the "One Chart for Life" is a bad thing. It seems to me the only potential advantage of the EHR is to eventually get away from the mis-mosh of records as they currently stand. I'd give anything to know what the cardiologist or cancer center is actually doing for my patient without having to spend 30 minutes of the phone trying to get an illegible copy of an explanation why they changed my patient's medication all around.

Thanks to the government and insurances, privacy is already dead. Might as well make the most of it.

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

As an aside - you do not have to sign up with a REC, they are an organization funded by the government that is designed to help you achieve meaningful use. You don't give any data currently to the government (I don't know for how long) - you report numbers, not pt. data.

I unfortunately believe in state vaccine registries and HIE - anything that allows me to provide good care - how many patients say I have an allergic reaction to some med ? Pt. feel no obligation to provide any information and feels - "it is in my record" they do not bring any meds from other doctors, and make me hunt to find out aything. Many do not even know who did their colonoscopy - I tell them I would at least want to know someone's name if they were doing that to me.

That was a quite astonishing post, Paul. In your shoes, I would feel exactly the same. I picture the Yin and the Yang.. privacy vs. the free exchange of important information among those who would treat it with respect. I have no solution.

Way before I ever thought about my medical privacy like this I already thought about these kind of things. Honestly, why not put the power of these wonderful machines in a more "One Way" kind of form... People can send lots of data and important information to the provider or clinic, hospital of their choice, much in the way our lab interface does right now. We could use something like individual provider numbers to only "export" data that then could be routed to the correct provider and their office. But the idea of a "Two Way" interface where we have to open ports and grant the REC and therefore basically the entire healthcare industry if not the entire WWW, that is just Crazy and so totally OVERKILL and so dangerous...

So we could practically properly and safely "Dial Up" any provider via a one way routing system with those ID Numbers to CC doctors and hospitals that need to be in the loop.... And so we could send a referal with most recent labs and the MidMark Ritter run ECG from our AC interfaced EMR and have AC have a record of who we CC'ed by the name and number of that provider just as our pratice rolodex does for us much right now....

Honestly, why would anyone want to let the government (perhaps the largest insurance carrier in the country already) have full and unfettered access to their medical records as a healthcare consumer and American Citizen.... What if it was a drug screening or a wound care provided that might show proof of your being in need of repairs post some possible crime or accident.. This is your 5th amendment being violated as you are being asked to wave your right not to have your own data and words used against you.... and as the doctor charting the notes and coding the encounters the same kind of risks to violating rights apply...

I am concerned that with massive amounts of data storage getting cheaper and easier every day, how long if and until the carriers have full access to any chart 24/7 when in fact right now we have many situations where we are not required to answer or cooperate with carriers requests for notes.... Remember as I was taught by one of the best pro-doctor lawyers from one of the best healthcare attorneys in NYS... When it looks like they are spying on the doctor they are also spying on the patient and when it looks like they are spying on the patient they are also spying on the doctor. Every note you send a carrier when they request them is an opportunity for them to collect data and information on YOU and YOUR charting habits verses your Coding Habits.. It was his contention when addressing the Medical Society who brings this guy in specifically to teach us how to protect ourselves and our patients, that they are ALWAYS using this information, assume that they are, because they really are, compiling records on all doctors like this, to one day come out from behind the curtain and say, "Ah Ha, Gottcha!!!" and start running you ragged fighting coding and give backs and worrying about being refered to the state or the feds for further investigations of fraud and abuse.... and once one of them gets the scent of blood, they are allowed to and they do collude together to share information like this and then once UHC is done with you, then Aetna or CIGNA will be coming after you next... by the time they all get done with you even if you never have to give back a dime, you will be ready for the funny farm, been drinking in excess, lost so much productive time, and have spent all of your modest saved funds that you might as well simply roll over and play dead.... and you just might have to default and declare bankrupcy....

So either give patients regular updates of their charts to take with them to then share with their other providers from their personal very tightly encripted and locked down flash drives ala this link "IronKey" flash drives and other interesting solutions.... or only have folks send data one way to those that they know have permission to recieve it or are otherwise HIPAA covered because we share a patient and their care like in a referal situation....

https://www.ironkey.com/

There is absolutely no need or good reason to create these massive hackers delights except so the carriers and the gov't can go to town on providers and citizens and further errode our actual and expectations of privacy.... and then one has to stop and ask and wonder why???

Paul

It's all for Wellpoint and Watson and whoever stands to profit from Wellpoint and Watson. The winners have already been chosen and we are the losers.

That is roughly how I envision a REC is going to work. Your concern seems to be with the ability to hack that data. I like Ironkey, but I do not for a moment think that it is "safe" from a really skilled and dedicated attack.

All that information is already out there in the hands of GS-8 medicare workers and insurance clerks, unless you have managed to live totally off the grid and out of the system. Every time I change insurance, I am forced to release all my records from the last insurer. My medical history, right, wrong, good, bad or indifferent follows me like a starving dog. Did you ever admit to a provider that you drank 4 or more ounces of alcohol daily during times of a divorce? It's right there. Want to fly a plane? You have to reveal to the FAA every significant medical event including counseling that has EVER happened to you; failure to do so is fraud. The only people in the system at the moment who cannot push a button and find your medical history are your doctors.

David,
Yes that might be all too true but it does not mean that we want allow it to continue, allow it to expand and grow, or make it right or wrong.... It simply is. History is full of "Wonderful" rules, laws and common practices that we now look back at with horror and wonder how such times existed.... Sweat Shops and Child Labor, Slavery, Scabs and Company Men Bashing Union Members Heads in with the support and protection of the police. Dread Scott ruling, the present supreme court's ruling in Citizen's United that only unrestricted spending is total free speech, making free speech a commodity to be purchased and traded that most citizens can no longer afford to play in even semi-local elections to be heard... Or many years ago and still touted today by Mitt just the other day that "corporations are entitled to all the same rights and priviledges of actual living breathing human beings".... So many Wrong Headed, illogical, selfish, misguided rules, laws and SOP's all the time...

I am fighting our present personal health insurance carrier right now on a number of issues of how the attempt to control, manipulate and limit customer's ways of paying and then the way that they apply it so that they can inappropriately deny coverage and dismiss patients, members from their roles. A year and a half ago we sent them a payment for April not realizing that we still owed them the previous month as even their statement had a line that said, $0.00 in previous balance, so I guess we are good up to this point. We used and consumed services and then the termed us retroactively as of Feb 1st sayiing that we certainly did pay for April but never paid for Feb or March.... Instead of doing what ALL businesses do as SOP of applying most recent payment to oldest outstanding balances.. So we were not that far behind but sure we did owe them some premiums at the time... So in early April they Term us retroactively back to Feb 1st???? After we have consumed services when I went on line and confirmed coverage and policy was in effect on the days in question???

But this was simply "Their" internal policy and how they do things. And to synch the deal of admission of guilt, guess who like 6 months later sent us back a check for the entire amount of our premium that we paid labled April 2010???? yeah this Carrier Emblem, HIP, GHI did.... Gee I guess you really did pay us good money. Oh and they wanted us to first pay them for the months that had past that we could never go back in time and use when we had to punt and do without certain care or meds, raid our samples closet and make use of second level choices from the less expensive generics list... Like past premiums and months of coverage is something that one can put away in a closet to save and then use on a rainy day like canned goods...

So to have federally run, servers that now store and compile, are the one and only central repository for a centralized, single chart, no less a chart that can never go away, is insane. Again this is much like so many other things that we forget and just allow the new tech and it's capabilities to create new standards and policies instead of insisting upon that although tech and databases have a great and meaningful role to play in improving the preservation and the movement of important data, information, We need to insist, Demand that many of the great original old fashioned rules of how and what to share remain in place, and NOT to compromise them simply because the means of creating, storing and sharing has changed.... So we went from quill pens to typewriters, that doesn't mean that our expectations of privacy and how we handle them and address them, enforce them, and penalize them should change..... And so IMHO and those of other well respected electronic privacy experts the same kind of sound and reasonable logic should apply here as well....

Did you ever expect when you were using a credit card back in the 1980's that one day a prespective employer would be "Legally Allowed" access to your personal and private credit rating and that it would be a protected behavior to look at that credit rating and even use it as part of a basis as to whether or not to hire or not hire you???? You're not even their employee yet, not even on their payroll system, insurances and there they are allowed to rummage thru your credit history and see what magazines or hobbies you have, who you purchase what from and whether or not you pay your monthly bills how??? Give me a break, that is Insane and should never be allowed to stand, and yet, there you have it, today in Modern America.... So then how long until we just allow our slippery slope of Medical Privacy to slide so low that the same kind of scenario will soon be playing out in human resources dept's all across the country, with potential employers rummaging thru our medical records just to get a job as a tech writing software, processing labs, teaching kids, collecting garbage for the local city???? How long and how low should we go????

http://www.nytimes.com/2011/09/13/opinion/protect-our-right-to-anonymity.html?_r=1&scp=69&sq=sept%2013,%202011&st=cse


Here is a link from an article in the NYT's from yesterday, an op-ed about using GPS's to track our whereabouts and not just on one single car chase or to find a fugative for a day or two... But to actually track a man's movements for a full month to build a case based upon his movements to prove he was engaging in certain illegal activities... Letting the GPS do the leg work and detective work for them, and NOT being required to at least get some sort of a warrent to prove probably cause before collecting and monitoring this person so percisely and over such a long period of time... That is what bothers me so much.... One can watch for cars, familiar faces, the same car or truck keeps showing up..., but to listen in on my coversations you should need a warrent, and to plug into my cell phone or my car's GPS, to do long term more than perhaps 24 hour chasing, one should need a warrent for that too... Do we and should we have an expectation of privacy and to not feel constantly watched and monitored, our whereabouts constantly monitored and Recorded too via GPS's on our phones and cars, police and security cam's with very accurate facial recognition software???? When have we allowed the gov't to go to far that we no longer recognize this once great and "Free" land that we used to be able to be so proud of and now personally I am very ashamed of and worried about.... This stuff is so frightening...

And then if one were able to start piecing this all together, the GPS's, the Cam's, the purchasing history and credit ratings, and the medical records.... Like is this not the supposed Stalinistic horror of a police state we supposedly fought an entire super tense, dangerous and expensive Cold War to defeat??? And now here we are only 40-50 years later we have become a much more efficent and modern version there of???? What the Hell is going on here, and why the Hell doesn't this bother almost any and ALL Americans is the question I have???? I should not be in the minority, I should be in a super majority here. I have history, case history, the constitution and the Law on my side of this arguement...

The cost of freedom really is constant vigilance and we have fallen asleep at the wheel, warm and soft in our cyber beds and fed our cyber drugs to dull our senses...

Beware, and don't say I didn't tell ya so.....

Paul