February 27, 2010

Electronic Health Records

Not sure if everyone knows or remembers, but my position at work has me installing and caring for an EHR at my hospital. The record is all inclusive and integrated from the doctors office too the hospital, for all of its short comings, its really quite nice, but it is open too all who have access. Now what doe that mean, well it means if I want to look at your medical records I can, all of it, and can do so rather easily. Now I will say that we run audits, but we actually have to audit the record individually so unless we are looking for it, well it isn't that apparent. Not to mention my office is already overburdened with other implementations so we don't audit much at all. Now we do lead the masses to believe that we do, and we have fired individuals for looking at records but once the secret is out, well its out.

So what do you tell your physician about your condition? At my physician's office he has a similar set up, but I do not see a physician that is associated with my hospital so I am safe. I will say that I have talked with him about this and said that I do not want transsexual in my discoverable medical record. Actually the one he uses has a hide feature which is nice, where mine does not. The same way with my psychiatrist and counselor, my "condition" is coded depression anxiety disorder, no mention of transsexualism. Actually my counselor turned m on to this in the past as she said she has had clients denied if their diagnosis was coded under transsexualism as the insurance discriminated against it. If you have never read all of the fine print of your insurance I highly recommend it some time, when you get to the exclusions it gets interesting. Now a good practitioner will know what is and what is not included and will code effectively. Those who are clueless do not. It is all about reimbursement. Now I will say one of my other worries was getting hormones from my local pharmacy, which I do, although my wife changed once I started to get me medications there as she personally knew the pharmacist. Who by the way has never let on. If she ever did I would ask for a review in a heart beat and would make it a big deal at the time.

I know some may say isn't there some sort of professional ethics, well yes there is and well people and they do snoop, things that aren't there business they happen to make it theirs. Or they make it Jesus's business and they have to be the messenger to all, like they have been called by god. Which is one of my big beefs with religion, those who hurt others with it are just evil. Anyway my point here is just an FYI, if you have any questions as I know my thoughts run through my brain faster than I type, let me know. I am curious of those across the pond with a universal system and how all that works out, especially if the health record is computerized.

Eventually I do believe that we will all be outed in some way as I am sure privacy is so 20th century, there is something to be said for anonymity, but there are also arguments against that too, that would be another blog. Have a good day.



Melissa said...

When I first saw a psychiatrist for GID relate depression, I thought it wouldn't go beyond his door, but a few weeks later, the clerk for our section at work said something to me that indicated she knew I had been to a psychiatric clinic. She was responsible for coding our disability pay, and apparently there was some sort of feedback from the clinic or insurance company, to the employer. I was mortified, because I didn't know just how much information she had. Was I outed? I'll never know, because no one ever told me anything.

Melissa XX

caroline said...

My experience of the UK system is limited to my own experience.

We have been slow adopting computers often spending billions on a new system only to declare it useless and not even install it!

We still have all paper records which nobody is trying to download into the system, all new records seem to go into the electronic system. Our doctors don't work the hours that were worked 10 or 20 years ago, it has become a 9-to-5 job and out of hours work has been outsourced starting with a 24-hour helpline often staffed by people who haven't got a clue. I made the mistake of getting a kidney stone and thought I was dying, this happened on a Sunday afternoon of course so I called the system to help, the first thing they do is ask if you will give them permission to access your records so they obviously don't do it as a matter of course that accesses their for anybody who has the password.

I've recently encountered various parts of the health system and nobody seems to have looked at any of the records, paper or electronic! I personally don't care who knows since now the time out in the system and make it a matter of fact to anybody I encounter, this has to be a learning process for them, we are not monsters and the sooner they see that the better. I am expecting a prescription for hormones to arrive sometime soon and have been wondering exactly where to take it to have it made up. We live in a small town with just one pharmacy and I was not sure my wife would be too happy for me to go there. I asked yesterday for her thoughts on this and she just said why not. They should be quite professional about this but you never can tell, I would be surprised if they don't know already.

Caroline XX

Leslie Ann said...

I was scared to death when I wanted to get therapy. I presented on the phone, and on the paperwork, with depression and social anxiety, then was straight into TG as soon as the appointment started. She has told me that there isn't a hint of TG in her notes. She codes for depression and social anxiety, and it's not a lie. She just leaves out the cause. It is likely that the insurance company would cut us off if TG was coded.

Gotta play the system or it will play you.

Stace said...

I Holland they have a fully computerised system, it works well I have to say. When I had a panic attack last year the doctors knew about it when called them a couple of days later to find out about after effects of Valium (strong stuff, hope I never have to take it again) she knew why I had been given it and how much they had given me. That allowed her to tell me what I needed to know quickly.

In my notes it says exactly what the problem it (but in Holland it's less of an issue as TG treatments are covered under the legally required base insurance) the only thing is I have two doctors who share the working week, and I have seen a third when one of the two was ill. Both the second of my two doctors and the locum I saw with mt illness recently looked at my recent notes (which I could see on the screen) and said 'Oh' with a slight look of shock on thier faces. Both were fine with me afterwards and didn't mention it explicitly.

As for the clinic? The official name of the clinic is 'Zorgcentrum Geslacht Identitiet Storinis' (Health Center - Gender Identity Disorder). I don't think it would matter what they put in the notes, the name of the clinic would give it away...


Calie said...

This is a very interesting post, Bree. I have never mentioned being TG to my doctor. So far, there has been no need to, but I do worry about privacy, especially when I seen him writing like mad while I talk.

I have told him that I suspect I am a 47XXY mosaic and that is probably in the record but doesn't bother me. So far, he has brushed it off. Next appointment, I am going in armed with information and names of TG friendly doctors who can test and verify my suspicians. To cover this under my insurance, however, requires a referral from my MD. Nevertheless, I am keeping anything regarding my transgender issues out of this.

Good post.

Calie xx

Anonymous said...

The UK is adopting a centralised system that can be accessed by any hospital or surgery.
It is well behind in its implementation and was subject to a lot of discussion from groups against this information being so freely available, effectively to anyone in the health service.
When I first visited my GP and told him about this, he explained that we are able to opt out and have the information only accesable by your own surgery.
This is what I immediately did, to ensure my privacy cant be invaded by people who dont need to know.