Editor’s Note: Government-mandated tracking of electronic health records (EHRs) has made life worse for patients and doctors alike, changing the way patients are cared for in exam rooms, says Twila Brase, president and cofounder of the Citizens Council for Health Freedom and a policy advisor at The Heartland Institute, which publishes Health Care News.
Brase, author of the new book Big Brother in the Exam Room: The Dangerous Truth About Electronic Health Records (Beaver’s Pond Press, 2018), says the Health Information Portability and Accountability Act (HIPAA) of 1996 is largely responsible for the federal government’s ability to access personally identifiable medical information, which in Brase’s opinion exposes people’s private information to potential misuse and abuse.
Health Care News reporter Leo Pusateri spoke with Brase about her book and what she characterizes as the government’s misleading patient confidentiality law.
Pusateri: Your book notes the original intent of HIPAA was to protect privacy, but the law codifies government’s ability to share private and personal information, you argue, and much of the records access is done without the patient’s consent. How does HIPAA work, and what dangers does it pose for individuals?
Brase: Contrary to popular belief, HIPAA does not protect privacy. Under HIPAA, different government agencies can share personally identifiable information without the individual’s con- sent. There is nothing in HIPAA that prevents clinics from sharing EHRs with government agencies.
Because HIPAA does not protect privacy, personal information is allowed to be put into electronic health records systems and shared broadly without consent. The plan for all those who are pushing for the integration of all our data into a longitudinal health record is to create a national health information network that will connect all the EHR systems, called an “E Health Exchange,” and it’s about halfway complete.
And because of HIPAA, we will have no control over all the folks who can access our records and no way to stop them from going in there and pulling them up.
Pusateri: In your book, you say a con- sequence of physicians using EHRs to make prescription decisions or diagnoses is that it cuts back on the likelihood patients will shop around for the best medical prices. In addition, you write that EHRs require health care providers to spend an inordinate amount of time on records compliance with federally mandated rules, reducing the amount of time doctors can spend actually diagnosing patients. How do EHRs cause these problems?
Brase: Providers have to use electronic health records to do computerized physician order-entry and to do e-prescribing. That’s why the doctor will often ask a patient what pharmacy he or she uses, even though people should be able to take a prescription and shop it around to any pharmacy and determine where the best price is.
EHR regulations also interfere with regard to what are known as “clinical decision supports.” Clinical decision supports are really all the different things that pop up on computer screens saying, “You didn’t ask your patient about this,” or, “They don’t appear to be vaccinated,” etc. Doctors have to document these things. They have to record all the demographics of the patient, including smoking status.
Pusateri: Your book argues federally mandated EHRs have little to do with best practices for patient care and are more focused on making sure health care providers meet government- imposed and insurance-imposed quality standards. How does this hamper the provision of health care?
Brase: There were electronic health records in existence before the government-mandated EHRs, and they worked for the patient, but government EHRs do not. Government EHRs are really made for reporting, billing, tracking, and profiling.
And it’s not just the government doing it, it’s also health plan providers. The primary purpose of the government EHR is to exert control over what happens in the exam room. And that control is being exerted both by the government and by the health plan providers.
Pusateri: Your book argues federal EHR mandates have led to the creation of a whole new cottage industry that handles the regulatory aspect of electronic record keeping. How has that affected doctors?
Brase: The secondary purpose [of the government imposition of EHRs] is profits. That comes in a variety of ways. An entire industry has been created as a part of complying with government mandates, to show that they are “quality providers,” even though all they’re doing is proving their compliance, not proving their quality.
When regulations were implemented, doctors had a very small period of time in which they had to figure out how to comply with the mandates. Now, because of EHR mandates, some doctors who go to five, six, or even eight different hospitals, not all of which have the same system, have to learn all of those different systems so that they can take care of their patients.
So, all of these companies sprang up overnight, all different versions of EHR, doing different things different ways, with different choices for doctors to pick from. It has made it very difficult for the physician to practice effectively.
Twila Brase, Big Brother in The Exam Room: The Dangerous Truth About Electronic Health Records (Beaver’s Pond Press, 2018; 464 pages; ISBN: 978159298706): https://www. itascabooks.com/big-brother-in-the- exam-room.html.