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Electronic health records advance quality care for all Minnesotans

REUTERS/Jim Young
All patients, whether they visit a small clinic, need mental health treatment, or receive care from multiple providers, stand to benefit from Electronic Health Records and the improved care coordination they make possible.

As Minnesota’s health commissioner, I work to improve the health of all Minnesotans. As a physician, I’m dedicated to providing the best care possible to patients. Secure electronic health records help achieve both goals by enhancing the safety, effectiveness, and efficiency of our health care system. With that in mind, I have been concerned to see some recent pushback on Minnesota’s requirement that all health care providers use electronic health records (EHR) by 2015.

Dr. Ed Ehlinger

Minnesota’s law on electronic health records was enacted in 2008 by a bipartisan majority and signed by Republican Gov. Tim Pawlenty. Instead of imposing penalties or fines on doctors and nurses, the law created a collaborative effort to meet its goals.

Today, small and large clinics and hospitals have succeeded under this approach: 93 percent of Minnesota’s clinics and 99 percent of Minnesota’s hospitals have adopted EHRs and see their value. When surveyed, 95 percent of Minnesota’s clinics said EHR technology enhances patient care and 92 percent said EHRs alerted them to potential medication errors. Four Minnesota hospitals reported that over six months, using EHRs helped them collectively avoid 560 duplicate procedures.

All patients stand to benefit

These are important benefits at a time of increasing specialization and demand for team-based health care. Minnesotans will see additional benefits in settings such as nursing homes and mental health clinics. All Minnesota patients, whether they visit a small clinic, need mental health treatment, or receive care from multiple providers, stand to benefit from EHRs and the improved care coordination they make possible. 

This coordination is very important for patients facing multiple health challenges. Evidence shows EHRs can prevent patients from falling through the cracks as they get care for different conditions from different providers. Given that Americans with major mental illness die 14 to 32 years earlier than the general population, due greatly to a lack of coordinated medical care, the American Psychological Association has noted that, “Health information technology is the bedrock of any effort to coordinate and integrate care.”

The benefits of EHRs are not disputed, but there are four myths I would like to address.

Myth 1: Patients lose control over their mental health records such as therapy notes.

Fact: Minnesota has one of the strongest privacy laws in the country. Patients must consent before their information can be shared with another provider, and there is a standard consent form any patient can use to specify with whom their data are shared, what types of data are shared, and for what purposes. For psychotherapy notes or chemical dependency information, an additional level of consent is required. The form is available online [PDF]. State law requires all providers to accept this form and respect patients’ wishes about how their data are shared.

Myth 2: Private information is stored online where anyone can access it.

Fact: EHRs do not make patient data accessible online or to every provider. EHRs are secure systems that exist within health care systems. Communication between these systems happens using secure, encrypted methods, and only after patient consent. Significant penalties exist for inappropriate releases of private medical information.

Myth 3: The government is creating a database of electronic health records.

Fact: Not true. Clinical data are in separate private systems belonging to providers, which communicate with each other via encrypted, secure messages, and only with patient consent.

Myth 4: Any clinician in the state can access anybody’s electronic record.

Fact: EHRs allow health care organizations to limit access only to employees who need the information to provide care. The systems also track who is accessing the records. In comparison, paper records do not provide this level of protection because anyone with access can view them without leaving a trace.

Minnesota’s approach to electronic health records strikes a responsible balance of patient privacy protection with key system improvements. The technology offers a strong public health benefit, and processes are in place to prevent problems. Minnesota’s EHR law sets our state on a sound course leading to better care coordination and service; this benefits all of us.

Dr. Ed Ehlinger is the Minnesota Commissioner of Health.

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Comments (7)

I Agree that EHRs Are a Tremendous Benefit

My only concern/regret is the lack of compatibility between various EHR systems.

It seems to be very difficult, if not impossible, (or at least this is what patients have been told) to electronically move records and MRI, CAT scan, x-ray, and other large image files directly from one system (your primary provider's, for instance) to another system from a different EHR vendor (the specialist you've been referred to or the clinic where you're going for a second opinion).

Perhaps Minnesota's law needs one additional provision: a specification which requires either interoperability between systems or universal standardized file formats for alphanumeric and image files to facilitate the access to a patient's records by whatever health care provider the patient chooses to use.

Perhaps the providers of EHR systems would be opposed to that simple change, since it would prevent them from locking their existing customers into that company's OWN system once it's purchased, but such a change would greatly simplify access to records for patients and their medical professionals, as they move between various clinics, specialists and hospitals,...

and would likely help eliminate the expensive necessity of repeating scans and tests at each provider's chosen facility(ies).

Patients should own their health records

A national health records clearinghouse would be a great idea except for the security issues

Ask the French and Germans how they do it

The key is a national health care system.
Note: the German system is funded through private insurance companies, but with much more tightly regulated procedures.

Care Everywhere

Care Everywhere is a system that allows healthcare providers to access patient data from other systems. The following systems were part of the network as of last year and I think additional groups have joined in the meantime. Check to see if the system you use has added this additional interactivity, IF not encourage their participation so more data can be available to those who are treating you.

EHR mandate

The fact remains, electronic dental records are both more expensive and more dangerous than paper dental records. It's no wonder that so many Minnesota dentists want to be exempted from the law.

What's more, EHRs have been receiving very poor press lately:

“Report: Medical data breaches are rising with no end in sight - From 2010 to 2013, the number of reported breaches — from the theft of a laptop with confidential patient information to employees walking off with patient files — involving more than 500 patients increased 23 percent while those involving hacking or a technological glitch that exposed or could have exposed sensitive information doubled in that period, according to the study published Wednesday in the Journal of the American Medical Association. What’s more, the study estimates that more than 29 million health records were affected by breaches during that three-year period, but that number has already been dwarfed in the first three months of this year, researchers found.” By Victoria Colliver April 14, 2015. (more).
http://www.sfgate.com/bayarea/article/Report-Medical-data-breaches-are-r...

So where did Minnesota lawmakers go wrong?

In 2007, those who voted for the half-baked mandate were fooled into expecting savings of more than $80 billion a year as promised by a 2005 RAND study. In 2011, RAND discredited their study - confessing that the vendor-friendly results were funded and influenced by Cerner and other HIT stakeholders. (See: “In 2nd Look, Few Savings From Digital Records,” by Reed Abelson and Julie Creswell, New York Times, Jan. 10, 2013).

You've been had, Minnesota.

A physician responds to Minnesota’s EHR mandate

“Open Letter to Minnesota's Heath Commissioner Dr. Edward Ehlinger on ill-informed health IT puff piece,” by Scot Silverstein MD, April 25, 2015.
http://hcrenewal.blogspot.com/2015/04/open-letter-to-minnesotas-heath.html

Dr. Silverstein’s letter is in response to Dr. Ehlinger’s April 23 MinnPost article, “Electronic health records advance quality care for all Minnesotans.”

Silverstein:

Congratulations Dr. Ehlinger. With your puff piece "Electronic health records advance quality care for all Minnesotans" (http://www.minnpost.com/community-voices/2015/04/electronic-health-recor...) you just flunked my introductory course in Medical Informatics.

Kindly refrain from writing on subjects about which your knowledge clearly lags common knowledge in healthcare information technology (IT).

You must not know about the following, although you should have known, or should have made it your business to know, about these at the very least:

ECRI Institute Deep Dive Study on Health IT risks (2012) http://www.healthit.gov/facas/sites/faca/files/STF_Deep_Dive_Health_Info...

Letter to ONC from 37 Medical Societies (January 2015) http://mb.cision.com/Public/373/9710840/9053557230dbb768.pdf

Joint Commission Sentinel Events Alert on Health IT (March 2015) http://www.jointcommission.org/assets/1/18/SEA_54.pdf

Accenture - Despite Increased Use of Electronic Medical Records, Fewer U.S. Doctors Believe It Improves Health Outcomes (April 2015)
www.businesswire.com/news/home/20150413005148/en/Increased-Electronic-Me...

I don't mean to sound insulting, but it is earned on your part. My mother is deceased in 2011 as a result of an EHR error.

When did you plan on informing the citizens of your state about the risks of bad health IT?

Not giving your citizens opportunity for informed consent regarding the use of these medical devices in their care seems a violation of human rights. The most impacted are the disadvantaged, who go to organizations with lesser budgets to make the IT work safely, I add.

Sincerely,

Scot Silverstein

Medical Evidence

Where is the medical evidence to support the claims and opinion of the good doctor?
To my knowledge, the EHR and electronic ordering systems he describes are medical devices, and as such, have had zero vetting for safety, efficacy, and usability. Taking this one step further, any medical device that has not been approved by the FDA is experimental.

So why would he and the lawmakers demand the use of a medical device that is experimental?

If I used an experimental device and billed for it, I would be accused of fraud.

Thank you for the opportunity to provide my opinion.

Dr. Gupta