Matthew Holt

So I’m on TV, unfortunately in piece of crappy reporting

So last month the nice people from KTVU (the local Fox affiliate in SF) came by to interview me and last night it aired. They’d been over at web-based EMR vendor Practice Fusion and had found out about EMRs. Then they came to interview me. I should probably have got the hint when reporter John Fowler kept on asking me about privacy concerns. I spent 20 minutes giving a balanced nuanced view about the advantages and problems of adopting medical records which is not exactly represented by the 6 second soundbite I get.

Unfortunately—despite the producer’s stated desire to use Bay Area people—Texan nut job Deborah Peel gets almost half the piece including almost all the interview content. (Apparently Deven McGraw couldn’t be tracked down? Maybe DC is too far away) And what does Deb Peel say? Well you know what she says…

The casual viewer seeing this piece would believe that paper records are completely safe and that identified patient records in the Practice Fusion system are being sold to evil marketers and insurers. Oh and by the way that somehow it’s their fault that John Muir Health System lost a computer.

And other than my one sound bite, a very brief mention of a Kaiser study that EMRs improved care and outcomes, and the doctor interviewed saying the EMR saved him time, every single innuendo was about how some big evil was lurking within the electronic records to steal your data and do something terrible to it. Oh, and Practice Fusion was helping with the connivance of stupid or malicious doctors. And apparently Deb Peel has a $5 per person per year solution to the whole problem. Perhaps this is the other shoe dropping and we’ll be hearing from her pimping her product soon. After all Microsoft bit.

This really was crappy journalism. Not least in not challenging Peel on her contention that selling de-identified medical data is somehow new and a “nightmare”—both statements are total crap. Of course research on de-identified records precedes computers by decades, and I’m still waiting for Peel’s spotlight of the case of the de-identified data being re-identified to harm a patient. Of course identified records (mostly on paper) are moved/sold in our health system everyday for purposes I don’t approve of (underwriting).

Nor did Fowler try to distinguish between research on de-identified data versus use of identified data for all kinds of care processes….something Peel also thinks is a nightmare.My wife’s comment was “none of those interviews supported their story other than that one nut job”.

Still our home office looks nice, and the Health 2.0 logo got on TV. So you can watch it here if you can stomach the bullshit that surrounds it.

Categories: Matthew Holt

17 replies »

  1. Putting aside all of the political rhetoric associated with healthcare policy “on the whole”, we can be far more objective about the eHR, eMR, and HIT general systems. As is the case with all evolutions (or revolutions as some may see it) of a process from paper based to computer based technology, there are trade-offs. Let’s examine some of the more popular “buzz words” in light of the trade-offs.
    EfficiencyMost likely, a practice that is currently using a paper based workflow to conduct its business, will need to modify their workflow to accommodate the eHR (or if you are a salesperson, “to utilize more fully the capabilities of the eHR product to enhance your processes”). Depending upon the eHR you select, how you choose to implement (and whom you choose to do the implementation), among other factors; you may have a lot of process change to “swallow”. Once implemented, the system will do what its been programmed and subsequently configured (set aside whether it is properly programmed or configured for now) to “do” with nauseating efficiency. This does NOT mean that the practice becomes more efficient. That only occurs if the program has been properly configured and is a good match for your practice.SafetySetting aside FDA licensing (or need to license) the software product for use as a medical device; this buzzword can mean many things depending upon the context in which it is used. I’ll attempt to stimulate discussion surrounding the various contexts in which it can be used.PatientPresumably, the technology would need to perform its process without harming the patient. Just the same as a thermometer, should take reasonably accurate temperature readings from the patient without causing the patient harm; so too should the eHR. This means that the tool should accurately record and return (possibly more important is the return) patient data to the user. It is possible to obtain incorrect data about a patient in both systems. Speaking totally about process, and suspending the question of whether the program was well written, the potential error conditions that would affect patient safety are the same or similar between a paper method vs. a computerized method. The differences are the vulnerabilities to error specific to either of the two processes (paper vs. computerized).A computerized error will repeatedly return “bad” data, while a paper-based method has the potential to be more random. Though most persons are creatures of habit, we don’t perform with the same reliability as a computer in this respect.Data Integrity & SecurityIt is arguable that the security and integrity of the data will rely heavily upon its users. A well written program should not impede a user from adopting security “best practices”. As an example, data should be strongly encrypted for storage and the platform should enforce reasonable password restrictions to access of the data. Bank systems are one of many examples that provide an example for both “things that work” and “things that don’t work”. The system itself should be “backed up” periodically (ideally nightly) to insure both the security and integrity of the system as a whole. I would argue that a computerized method makes it easier for a user to enforce (system wide) these safeguards. In a paper based scenario, should backups need to be retained, the files are copied and carried to offsite storage. Access to files usually requires getting to the file itself, a decidedly more physical approach than typing a password to retrieve a file from a computer. Security of the file itself is based upon layers of physical deterrents (locked buildings, camera systems, locked filing cabinets, and personnel). The files found in a filing cabinet generally are not encrypted, so once you “lose” the file it is available for all to read. In a computing environment, if you encrypt the file and then “lose” it, it generally isn’t readable to the mass populace.There is a lot to this topic, and rather than spill it all out in a single post; I’ll wait to see if it is even interesting to the readers before continuing.

  2. Mr. Seeker: The thesis advanced in The Shallows to the extent that I know it from reading about the book, rather than reading the book itself, is that the nature of Internet-based human interaction lessens rather than increases knowledge. That is an empirically-testable hypothesis, but creating an accurate testing model is difficult, if not practically impossible, if one wants to draw valid conclusions from any test.
    The hypothesis has some plausible validity, but the hypothesis has nothing to do with digitizing of clinical data in usable data elements which in essence is what any EMR system does. In other words zero relationship between the hypothesis in The Shallows and use of a tool such as an EMR system.
    What is this? The fury of the modern-day physician-Luddites?

  3. Interesting book out there called the Shallows. Wendell and others should read to affirm what praeorius stated.

  4. “An EMR wastes time and impairs quick thinkers.”
    Classic Ludditism and not from the positive aspect of what the original Luddites did.
    One could state this about any “technological” advance for humankind, including presumably the invention of human speech millions of years ago.
    Does praetorius use a telephone device to communicate or is he/she still using smoke signals for remote communication or still walking everywhere rather than using powered transportation of one sort or another and on and on and on?

  5. Not worth the bitching and moaning from Mr. Holt.
    Mr. Holt at least got some attention. The great unwashed out there will be propagandized about EMRs as they are about everything else, so nothing new.
    TV news outlets, particularly local stations that offer so-called “news”, as opposed to publicizing accidents, murder and mayhem or sports or weather which are their bead and butter, do a pathetic job on any reporting, so nothing unusual about Mr. Holt’s experience.
    Never heard of Dr. Peel before, so will check her out.
    I see PractionFusion is using this as an opportunity to self-promote. Okay, I guess. The “free” aspect of PracticeFusion is exemplary. The web-accessible feature is nothing exceptional, so not a feature to promote in my estimation.
    I do not have adequate knowledge of PracticeFusion’s full set of features, so do not know how it compares to the many good-quality “installed” EMR/PM software products out there, whether FOSS or commercial, but I assume it compares favorably.
    As I always note, any “installed” software, i.e. software resident on a provider’s own hardware, either is now or can be readily made “web-accessible”, so web-accessibility is not a distinguishing characteristic, just an alternative means of presentation/delivery of content to the user.

  6. Peel is for real. A quality physician and protector of the rights of patients.

  7. I was modestly amused that the local TV station was totally fixated on the SF Bay area reaction, that they rejected my patients from out of town, & interviewed some no-nothing hijacked consumers on the street — then had out of towner loony Deb Peel on making more random accusations, and passed her off as some type of expert.
    Margalit I’ll look into that meeting and figure out who was there
    And Maggie, this wasn’t Fox News–I would have thought twice about going on that non-live.

  8. Emily,
    Are you the same Emily who says: “If your doctor does not have an EMR, switch doctors to one who does”?
    I say, would anyone ever buy an EMR from a company that provides such meningfully useless advice.
    These devices are disruptive to most thoughtful doctors who think about complex pathophysiology to cure their patients. Comparing multiple interactive variables of treatment, diagnostics, signs and symptoms is imminently efficient with a well organized paper chart and perhaps, with on line reporting of lab results and radiographic. An EMR wastes time and impairs quick thinkers.

  9. Matthew & Lynn-
    Lynn is right that media coverage of healthcare has been heading South as the mainstream media runs out of money and resources.
    But I understand why Matthew went on FOX: It’s an opportunity to reach the unconverted. Folks who watch FOX know very little about EMR.
    I went on Lou Dobbs in order to reach an audience that would never read my blog. I’ve had many experiences like Matthew’s, but that one time it worked out. So you never can tell. It’s worth trying.

  10. Oh, this is priceless, Matt… LOL
    The $5 figures comes from one of the presenters at the ONC consumer technologies meeting in DC that I wrote about on this very blog
    One of the cutting edge vendors showed a pretty cool add-on that can manage privacy policies, regardless of software, and said that it should run at about $5 per year. I assumed that was per policy, which means per patient, which means that for the doctor, it would be over 10K per year.
    Dr. Peel asked about that price several times during the meeting. There were other blunders as well. You should listen to the recordings.. That’s what happens when non technical people try to evaluate software.

  11. Matt, you’re surprised that you didn’t get “fair and balanced” news from a Fix News station. I’m shocked, shocked, shocked.
    I’ve spend hours over the years working behind the scene to educate reporters, both print, radio, and TV, only to have the good ones be moved out of the healthcare beat. Local stations and newspaper unfortunately no longer have the resources in reporter experience or time to do good and thorough piece on all the issues in healthcare. That’s why Death Panels live.

  12. Agreed, Matthew. As I wrote Emily:
    The nutcases are out in force. I saw a news comment this morning that, because Certified HIT will have to be able to calculate BMI ((w/h^2)*703), “the government will be telling you what you can eat.”

  13. Bobby, you’re probably right, but they were a vaguely respectable local TV news show before they became a Fox affiliate–and I dont think this is a right-wing slant, just a dumb one

  14. Great comments Matt! We’re with you in fighting the good fight. I’ll chime here in with the response Practice Fusion sent to the KTVU producer this morning:
    We were extremely disappointed to see inaccurate information about patient privacy reported in last night’s segment on Electronic Medical Records. Several facts stated in the piece or quoted by Dr. Peel were misleading:
    “Peel said many patients and doctors don’t know the federal government quietly eliminated patients’ privacy rights for electronic records. “It’s a free-for-all. It’s the wild west,” said Peel.
    If anything, the federal government has been tightening standards. The use of health data for research is strictly regulated and monitored. It is far, far from being a free-for-all. HIPAA regulations require extensive de-identification of health data – to the point where it can NEVER be re-identified. Identifiable patient data is exquisitely sensitive and is protected as such. Electronic Health Record systems like Practice Fusion protect patient data well beyond paper systems at several levels – from permission controls that regulate access in the practice to audit trails to encryption at rest.
    “With paper records, you have to agree in advance to share your medical information. Not so with electronic records.”
    This is false. The regulations for paper and electronic records are exactly the same and equally strict.
    “Anything that’s in there, any information that’s in there, can and will be used against you in the future. It’s very important to know that in the electronic health world,” said Dr. Peel.”
    This is also false. It is illegal for medical data to be accessed in this manner whether from paper medical records or electronic. Numerous regulations protect against exactly this.
    This type of fear mongering from Dr. Peel only works to set back life-saving innovation in healthcare. Of course a consumer would be anti-health IT after hearing an inaccurate story like this reported on TV. Along with the inaccurate privacy data, nowhere in the piece were EHR benefits mentioned. Electronic Health Records help to prevent medical errors, prevent drug interactions, promote collaboration of care, promote preventative medicine and give patients access to their own medical records. Imagine the power of having even a simple allergy record instantly available to an ER physician when an unconscious patient arrives. Or the power of being able to track adverse drug reactions nationally in real-time instead of waiting years for data for lawsuits to bring the issue of a dangerous drug to light.
    Kaiser and others have conducted extensive research on the clinical benefits of EHR systems and Practice Fusion works daily with medical providers and patients who see the value of these systems firsthand. I would be happy to connect you with more information about these benefits or with our clinical team to learn more about patient data privacy measures.
    Emily Peters
    Director of Communications
    Practice Fusion EMR