It’s Personal … well, not so much

I am extremely fortunate to have a household which openly welcomes guests. My wife has endless energy when it comes to Shabbat. Despite working a very heavy week, she barely blinks when we have over 15 people for both meals on Shabbat. And we’re not talking about store-bought schnitzel. She puts together a gourmet meal every week.

So, as the food is being eaten and the wine is being poured, someone eventually makes a comment that is challenged. It doesn’t matter if the subject matter is religion, politics, security, Israeli-American relationships or anything of the like. It’s pretty much a given that there will be two people at the table that very much disagree on the point raised.

We live in a unique age when arguments can be settled far more often based on data. Admittedly, there will be those who question any published data and argue that it has been manipulated. I long ago stopped arguing with people who insisted that Neil Armstrong never left the earth. It’s not that there isn’t data to support humanity’s trip to the moon; it’s that there are many people who simply believe it is ALL faked. Trying to argue with someone like this is ineffectual. At times, I have had similar types of arguments with patients who refuse vaccinations for their children. I can even sometimes get them to agree on various points that I make about vaccination safety. But when I actually suggest giving a vaccination, they immediately returned to their initial argument that vaccinations are dangerous and the truth is being hidden from us.

Let me be clear: sometimes when a paranoid schizophrenic says that someone is chasing him or her, there is someone who is really chasing them. Many a blockbuster movie has been made based on this principle. I cannot argue that suspension of belief is required to accept every fact presented to us. Even when we see a photo or a movie of an event that “happened”, this doesn’t prove much. Rather than belabor this point, I simply refer people to the movie “Wag the Dog”. It’s a semi-comedic political movie, which is probably entirely true – which is what frightens  so many people who have seen it.

This long introduction is intended to make a very simple point: “no data” is not the foundation for an argument. If someone claims that he or she heard or read that a particular medication can cause infertility, but that same “someone” cannot quote a source and cannot email you a link to the webpage, then you cannot base an argument on such a premise. Before the Internet and even before newspapers, the average person had little access to information outside of their immediate circle. As such, any discussion on any broad topic was almost, by definition, conjecture. But today, when a mother shows me a single webpage arguing that there is a conspiracy amongst the Pharma companies to sell useless vaccinations, at least I can refer this mother to countless articles in highly respected journals that would challenge such a statement. And if the mother still refuses to believe anything but this single conspiratory webpage, then I am lost.

One of the recurring arguments over the use of electronic medical records [EMRs], is that patients are not comfortable with the risk to their privacy. This is a reasonable argument even without a formal study being done. No person would happily open their door to allow a stranger into their house, to rummage through their personal medical records. As such, it is reasonable to say that such a person would not want someone to rummage through their online medical information. To be fair, this is still not a black and white issue. One only needs to have seen one episode of “House”, and one realizes that the illegal rummaging through a person’s personal items is very possibly what ends up saving the patient. Just because a patient thinks that something is personal, doesn’t mean that it shouldn’t be shared with their doctor [unless that patient is willing to die rather than share the information].

Ultimately, conjecture on the issue of patient privacy is just as valid as conjecture on most other issues, i.e. it is effectively useless. Just now, I read a fascinating article that quotes data from a poll released this past week from Truven Health Analytics and NPR. The poll’s results included the following:

  1. 68% of the polled Americans were willing to share their health information with researchers
  2. Interestingly, only 22% of this same polled group were willing to share their purchase history or social media activity with healthcare professionals
  3. 74% of the polled group stated that their doctor uses an EMR
  4. In patients 65 years and older, 90% stated that their doctor uses an EMR
  5. Only 16% of the polled group said that they have worries about sharing their health information with their health insurer
  6. Less than 16% of the polled group had such worries about sharing information with hospitals, physicians and even employers
  7. 56% of the polled group had reviewed the information kept by their physician

A conclusion by the poll takers was that “it appears that Americans are becoming increasingly comfortable sharing this type of information”.

The significance of these results is dramatic. Firstly, it seems that a large percentage of Americans have had some form of exposure to electronic medical information. The fact that older patients [who will become the focus of many healthcare initiative over the next few decades] have such a high contact rate with an EMR [via their doctor], is incredibly encouraging. The only hope of effectively handling the American baby boom population as it passes retirement age, will be to maximally utilize any digital assistance possible. So, if this population is already well-connected to an EMR, then future digital health programs will have a chance of making a difference in this group.

I always find it fascinating that people in general, are so much more protective of their financial information than their medical information. Most people have very boring medical histories. They may have had a couple of operations and maybe taking medications for high blood pressure or diabetes. Contrarily, access to a person’s financial records would allow a person to deduce most of the medical history of that person. In addition, it would expose the payments to morally problematic websites that certain people might be regularly utilizing. In other words, if you want to know the secrets that a person truly wants to stay hidden, follow the money and not the pharmacy.

No one should base an opinion or a policy on a single poll or study. These results need to be confirmed by further research. But if the results hold true, then the time has come for physicians, hospitals and health funds to stop using the excuse of “patient privacy” to hold back from digital health initiatives. For example, whenever the issue of sharing medical information amongst healthcare institutions comes up, there will always be a significant number of naysayers who argue that the risk to patient privacy is too great. The EMR companies themselves say that they cannot guarantee the privacy of the patient if they are forced to share medical information with other EMRs. What all of these institutions and companies failed to mention is that it is financially beneficial to them, to keep patient information silos within their [fire]walls. When the patient knows that transferring to a different health funds will mean the loss of their chart with their decades old medical history, they are understandably hesitant to do so. When a hospital is told that switching from one multi-hundred–million dollar EMR to another would mean the loss of previous medical records, the hospital is understandably resistant to such a change.

Whenever I work with a new client, the first thing I tell them is that there is no such thing as “no” in the computer world. Basically, within reason, anything can be done. Admittedly, the technology for building automated movie reviewers that actually produce reviews that I agree with, is still beyond us. But I have rarely  said no to a client. What I explained to them is that the answer is yes, but the remaining question is one of time and money. If a client is willing to invest significant funds in a project that may take years to come to fruition, then more often than not, the project will succeed. If the client, on the other hand, has a totally unrealistic expectation as to the cost in terms of dollars and time of a project, then it is critical to correct that expectation. Let me just share a quick personal anecdote, that the reason I developed my own EMR, which thankfully was a very successful project, was because the company CEO of the previous EMR being used by my previous employer, laughed at me when I said that a certain update should not be difficult. This CEO told me that the update would in fact be very difficult, if even possible, and that I had no understanding of such things.

The world is primed for the digitization of all medical records. Enough people have read articles about the potential benefits of exchanging medical information in a digital format. Despite doctors endless gripes about the ineffectiveness of present-day EMRs, the EMR companies are literally racing to make physician requested changes. The first EMR that receives high positive ratings from the medical world, will become a serious challenger to all other EMRs, no matter how entrenched they may already be. In 10 years from now, I would wager that physicians will struggle to remember how they could ever have been against the implementation of EMRs. It seems that the public is just as eager to live in this future reality.

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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