Electronic Health Records were a game-changer — but a new proposal could be deadly

Things like this happen every day in emergency departments across the country. Patients who cannot provide a consistent medical history are hospitalized, and attendants also fail to provide adequate medical background.

Our job as emergency physicians is to diagnose patients quickly and provide appropriate treatment. The challenge is particularly difficult when we do not know the patient, and as is virtually always the case, when they cannot tell us their medical history.

The Electronic Health Record (EHR) is important progress Provide complete and accurate patient information. In fact, my colleagues and I have been vocal about its implementation and use. The days of literally calling the medical records department to view paper records are thankfully gone forever.

A current medical history helps establish an accurate diagnosis and treatment plan. Obtaining the patient’s medical history allows us to determine whether a patient with chest pain has ever had heart disease, whether a patient with gastrointestinal pain has chronic digestive problems, whether the patient has You can know if you are taking drugs that are considered contraindicated. Part of a treatment plan.

The importance of physicians having access to a patient’s medical history is well recognized at the national level.of U.S. Department of Health and Human Services (HHS) has made great efforts to make medical information more accessible.of HHS Office of the National Health Information Technology Coordinator (ONC) website To tell“Patients receive better care when providers have access to complete and accurate information. … EHRs ensure that providers have access to complete patient health information. A more comprehensive picture will help providers diagnose problems in their patients sooner.”

Therefore, it is difficult to understand why ONC is the way it is. Suggestion of rules That way, you can hide your medical information from your doctor. ONC proposes new rules that require clinicians to have the ability to redact some medical information from medical records created during previous visits, at the request of patients. This proposal essentially legalizes the falsification of legal medical records, thus reducing transparency and increasing risk in subsequent care events.

While the proposal is a well-meaning effort to give patients more control over the confidentiality of their medical history, the practical effect would be to increase the likelihood of inaccurate diagnoses and treatment plans. deaf.

For example, if a patient conceals past opioid use, how would an emergency physician (or physician) know how to avoid prescribing opioids? Your team could be in danger. If a patient has a hidden mental health history, doctors may prescribe anticonvulsants without knowing that the patient is already taking medications that may interact with each other. ONC’s proposal could also shut down the EHR’s automated system, including flagging adverse drug-drug interactions, if a patient requests to hide a prescription.

With so many variables in healthcare, the risks that patients can take if doctors don’t have access to complete medical information are endless. Moreover, rather than reducing stigma, the policy may reinforce stigma by reaffirming that a history of depression and sexually transmitted infections should be kept secret.

As physicians, we have a duty to protect the confidentiality of patient information. but also legal issues, including fines, do no harm is central to our oath as physicians. For emergency medical teams (or doctors), limiting access to a patient’s complete medical history only delays diagnosis and treatment when prompt diagnosis and treatment are critical. Hiding medical information can lead to less effective outcomes for patients.

Throughout its history, ONC has taken several steps to build a culture that promotes EHR transparency and value. Despite being bipartisan, twenty one^cent cure of the century While great progress has been made recently in making patient information available to clinicians, this regulation is moving in the opposite direction and should be revisited, revised, or preferably removed. Giving patients the option to hide some of this information from their doctors is a setback to sound emergency medicine and medical care.

Dr. Kevin Baumlin is Chief Medical Officer at the University City Science Center in Philadelphia. He is a former professor of emergency medicine at the University of Pennsylvania School of Medicine. He is professor and director of the Department of Emergency Medicine at Mount Sinai Beth Israel. Associate Medical Information Officer for Mount Sinai Health System. He holds certification in clinical informatics and emergency medicine.