4 ms·

So, what you're effectively saying is that if you want to have privacy you can't get medical care?

viraptor 6y ago
You can't get medical care efficiently and accounting for your specific situation. Sure, you can have a limb set after a mild injury without extra information. But anything long term or needing specific management will get complicated.
- Aerroon 6y ago
  But we had medical care in the past that somehow worked without all of these digital systems? Was that care significantly less effective because of no digital data? It was less efficient, because you had to carry your documents around yourself, but I'm not sure that the care was significantly less effective. I'm sure that it makes a difference to some people, but so does the vulnerability of privacy. How many people will simply not see a doctor because they're worried about this?
  - monkeydreams 6y ago
    > It was less efficient, because you had to carry your documents around yourself, but I'm not sure that the care was significantly less effective. Also your healthcare providers kept their fully-identified records. And, yes, it was signficantly less effective with higher error rates, etc. > How many people will simply not see a doctor because they're worried about this? Very few, I suspect. None that I have ever heard of outside of people with significant anxiety disorders (this is literally true, and not my implying anything).
    - Aerroon 6y ago
      I don't mean that they will never see a doctor. What I mean is that when something is embarrassing they won't see a doctor, particularly when it comes to mental health.
monkeydreams 6y ago
No, what I am saying is that if you want complete privacy you can't have effective care. Effective care requires knowledge of patient history, co-ordination between providers, etc. Your general practitioner needs to identify you to a downstream specialist using a strong-identifiable source. Your hospital requires knowledge of your allergies, of your heritage, of your past medical history, etc, in order to ensure you receive the best therapies and medicines. This does not even touch of things such as funding models or holistic healthcare plans. The best any care provider would be able to do, in lieu of a trustworthy patient data source, is to offer general medicines and stabilisation.
- temp667 6y ago
  I was on the back-end of a large electronic health records implementation. I'm not actually sure better care resulted, and the security was that dystopian type, ridiculous and insecure at the same time (we had to downgrade some systems to connect). At least in this mental health practice, you charted on paper / locally to the providers systems. We had a billing team (in old model) that only uploaded key patient info (MRN / DOB / Service date / time / billing code) to a billing system. This was done using billing slips that went to someone trained on it (who could handle all the weird hassles around eligibility etc etc). Provider would actually talk to patients etc etc. The notes were pretty focused afterwards. And yes - pretty secure - it was actually hard to just browse around - providers locked up their notes in their office, and their office was locked (we had a three lock rule -> front door with alarm (metal gate), office locked, file drawer locked. What people don't tell you is with the electronic health record, they also required that all these required elements be "charted" - on EVERY visit. So in new system pretty soon charts become a pages of boilerplate per visit - copy and paste stuff. It was not useful anymore to do a case history from this chart. So we made the admin folks happy, but what a trash experience - the EHR folks are selling bills of goods and the admin folks implementing and the compliance folks mandating endless boilerplate and macro entries to get anything approved are wasting all our time and money. I got out, never felt better - the people were great, the ordered from on high decade old java app through a double VPN that worked 50% of the time with no user experience thinking - a nightmare. And in this new system, every sysadmin could basically snoop on anyone (all in the name of patient coordination) as could lots of others who just ended up with the extra permissions because the system was so locked down we all basically had to be superusers. To run billing reports you needed access to every record - so they had to give you these ridiculous permission levels. And to avoid QC issues billing staff are reading all the chart notes to make sure all the required boilerplate is in them. Such BS. This system was integrated with a lot of providers, so you could also see everything related to that person everywhere (all the office / admin / billing staff at literally every provider included). While a bit helpful if you had a billing issue (same unit type billed at an unapproved frequency) all the benefits focused on that type stuff (admin ease) and privacy was zero across that backend system.

You can't get medical care efficiently and accounting for your specific situation. Sure, you can have a limb set after a mild injury without extra information. But anything long term or needing specific management will get complicated.

Aerroon 6y ago
But we had medical care in the past that somehow worked without all of these digital systems? Was that care significantly less effective because of no digital data? It was less efficient, because you had to carry your documents around yourself, but I'm not sure that the care was significantly less effective. I'm sure that it makes a difference to some people, but so does the vulnerability of privacy. How many people will simply not see a doctor because they're worried about this?
- monkeydreams 6y ago
  > It was less efficient, because you had to carry your documents around yourself, but I'm not sure that the care was significantly less effective. Also your healthcare providers kept their fully-identified records. And, yes, it was signficantly less effective with higher error rates, etc. > How many people will simply not see a doctor because they're worried about this? Very few, I suspect. None that I have ever heard of outside of people with significant anxiety disorders (this is literally true, and not my implying anything).
  - Aerroon 6y ago
    I don't mean that they will never see a doctor. What I mean is that when something is embarrassing they won't see a doctor, particularly when it comes to mental health.

monkeydreams 6y ago

No, what I am saying is that if you want complete privacy you can't have effective care. Effective care requires knowledge of patient history, co-ordination between providers, etc. Your general practitioner needs to identify you to a downstream specialist using a strong-identifiable source. Your hospital requires knowledge of your allergies, of your heritage, of your past medical history, etc, in order to ensure you receive the best therapies and medicines. This does not even touch of things such as funding models or holistic healthcare plans. The best any care provider would be able to do, in lieu of a trustworthy patient data source, is to offer general medicines and stabilisation.

temp667 6y ago
I was on the back-end of a large electronic health records implementation. I'm not actually sure better care resulted, and the security was that dystopian type, ridiculous and insecure at the same time (we had to downgrade some systems to connect). At least in this mental health practice, you charted on paper / locally to the providers systems. We had a billing team (in old model) that only uploaded key patient info (MRN / DOB / Service date / time / billing code) to a billing system. This was done using billing slips that went to someone trained on it (who could handle all the weird hassles around eligibility etc etc). Provider would actually talk to patients etc etc. The notes were pretty focused afterwards. And yes - pretty secure - it was actually hard to just browse around - providers locked up their notes in their office, and their office was locked (we had a three lock rule -> front door with alarm (metal gate), office locked, file drawer locked. What people don't tell you is with the electronic health record, they also required that all these required elements be "charted" - on EVERY visit. So in new system pretty soon charts become a pages of boilerplate per visit - copy and paste stuff. It was not useful anymore to do a case history from this chart. So we made the admin folks happy, but what a trash experience - the EHR folks are selling bills of goods and the admin folks implementing and the compliance folks mandating endless boilerplate and macro entries to get anything approved are wasting all our time and money. I got out, never felt better - the people were great, the ordered from on high decade old java app through a double VPN that worked 50% of the time with no user experience thinking - a nightmare. And in this new system, every sysadmin could basically snoop on anyone (all in the name of patient coordination) as could lots of others who just ended up with the extra permissions because the system was so locked down we all basically had to be superusers. To run billing reports you needed access to every record - so they had to give you these ridiculous permission levels. And to avoid QC issues billing staff are reading all the chart notes to make sure all the required boilerplate is in them. Such BS. This system was integrated with a lot of providers, so you could also see everything related to that person everywhere (all the office / admin / billing staff at literally every provider included). While a bit helpful if you had a billing issue (same unit type billed at an unapproved frequency) all the benefits focused on that type stuff (admin ease) and privacy was zero across that backend system.