Most of us know the Affordable Care Act (ACA) or Obamacare as a health insurance program. But weighing in at over 900 pages (about as long as Gone with the Wind), the ACA covers far more ground than just a website and new insurance plans. One aspect of Obamacare that nobody talks about might just affect you, and you don’t even know about it.
According to the ACA, hospitals and other healthcare providers have to go paperless this year. This means that not only are your medical records going to be digitized, but everything in the hospital—from MRI scans to X-rays to lab reports—has to be electronic.
Of course, you may think it’s high time that hospitals get on the electronic bandwagon. After all, many businesses have gone digital years ago. However, everything is different in medicine.
First of all, many of the “pieces” in a hospital have long been digital. For instance, a CT scan is a computer-modified image of soft tissue. Front-office scheduling is often done on computer. Hospitals order many of their supplies via websites. The hospital pharmacy maintains a computerized inventory. Computers have invaded the medical world as much as anywhere else.
The problem is that in the hospital, these computers all need to talk to each other. For instance, digital X-rays are great … but can they be attached to the rest of your electronic medical record? People with implanted devices like pacemakers generate electronic reports, but they often have to be printed out and then re-entered by hand into the electronic medical record! Not all pacemakers can talk to electronic medical records … yet.
The whole mish-mash of trying to get all of a hospital’s many systems to talk to each other is called interoperability. And it’s a pretty big headache for the people trying to fix it.
Interoperability is further compounded by the fact that electronic medical records—your digital manila folder—exist in many different and incompatible forms. Let’s say a patient was hit by a bus and rushed to the emergency room at Hospital A. Hospital A will start an electronic medical record. As the patient recovers a bit, he transfers to Hospital B, which is closer to home. Hospital B uses a totally different kind of medical record—and there is a compatibility issue. So Hospital A can send over the patient’s records, but Hospital B cannot open the file.
Furthermore, electronic files raise the big issue of patient privacy. In the United States, your medical history is personal information and not released without your permission, even to a spouse or family member. As more and more hospitals shift their data to electronic files, we have to wonder how secure it is.
The ideal is that your medical records and all related information is one electronic file that can zip around the hospital with you, be emailed to your primary care physician, and be forwarded, as appropriate, over the course of your lifetime to other clinics and physicians. But is it safe?
And in the mad rush toward electronic medical records created by Obamacare, nobody is thinking much about it. Most hospitals are struggling to get multiple incompatible systems to talk to each other. Other hospitals are transitioning from one type of electronic record to another. In many ways, it is reminiscent of the early days of computers when there were many available software programs that all did the same thing but did not necessarily work seamlessly together.
If your medical history, prescription drug records, and other data become digital, who is going to guard it? The main goal of electronic records was to facilitate accurate transfer of information, but that can also open the door to leaks.