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Thread: Ethical Dilemmas in EMR Decisions?

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    Ethical Dilemmas in EMR Decisions?

    I've posted a new blog on " Ethics in EMR Decision Making" on EHR Net. Please take a look at http://ning.it/avEfAu
    Richard Hom, OD, MPA Candidate
    http://grandrounds4ods.com
    Twitter "grandrounds4ods"

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    Electroinc Medical Records clearly have some issues related to ethics, Dr. Hom. I am pleased to see your post, however from a slightly different perspective, patient confidentiality may present an even greater concern. I think that while the IT industry does have some, shall we say "less than ethical" players, there are folks who can help make providers make the correct purchase. From my perspective, maintaining confidentiality may weigh a bit more heavily on this landscape. Your thoughts?

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    A reply to Dr. McDonald

    Dr. McDonald,


    1. Because HIPAA confidentiality is a standard, this would be strictly a technical issue and what Holton's law would say is either an operational or mid managerial attribute. Since most EMR sales are targeting the "C-level" manager, Protected Health Information (PHI), is an uneqivocal requirement.
    2. My post was meant to familiarize medical professionals at even the office-based level that the vendor may be disingenuous to some degree when they say that they are holding the customer in their best interest. Software vendors and sales people who come from software sales approach sales the same way regardless of their environment.
    3. Because the medical world is RELATIVELY naive about sophisticated sales and marketing techniques and of technology, most buyers are at the mercy of vendors for credible information. I am proposing that software vendors either foster trust and medical professionals check for trust before even contemplating a buy/sell of an EMR. I think the question is whether my precept is scalable downwards (most scalability questions are upwards) to the office-based provider or optical professional.
    4. Another question is whether the features that are important for the buyer. In most circumstances, the buyer wants something that fits them. On the sales side, the vendor is trying to convince the buyer that the buy has to fit the software.
    5. Do you believe that the question of rigor in PHI protection warrants more serious consideration higher up?


    Thanks for the question and post.
    Richard Hom, OD, MPA Candidate
    http://grandrounds4ods.com
    Twitter "grandrounds4ods"

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    While this may be an interesting academic discussion the laws regarding EMR will be made in Washington, DC over the next few months as ObamaCare is implemented. From the perspective of the eye care business it remains to be seen what business processes will come under the new law and how HIPAA will fit into the picture.

    One of the issues to be addressed will be whether refractions and eyeglass and contact lens record will be considered as "medical records" or not. I believe that strong case can be made that they are not and the optician will therefore not fall under the influence of the law.

    In any case, with the large sum of money being placed in the EMR trough we can expect to see quite a bit of scrambling and squealing in the near future. Thank God that I no longer in the fight although I due somewhat regret that I will not be able to get my snout into the trough.

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    Dear rbaker,

    Ethical dilemmans in EMR buying are not academic discussions. They are a "real-life" phenomena that enters into any kind of EMR sale. No kind of federal, state, or local ordnance governs the sales process or contract. That's still under the auspices of contract law and the Uniform Commercial Code (UCC) and not the HITEC/ARRA acts.
    Richard Hom, OD, MPA Candidate
    http://grandrounds4ods.com
    Twitter "grandrounds4ods"

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    Quote Originally Posted by Richard Hom View Post
    Dr. McDonald,


    1. Because HIPAA confidentiality is a standard, this would be strictly a technical issue and what Holton's law would say is either an operational or mid managerial attribute. Since most EMR sales are targeting the "C-level" manager, Protected Health Information (PHI), is an uneqivocal requirement.
    2. My post was meant to familiarize medical professionals at even the office-based level that the vendor may be disingenuous to some degree when they say that they are holding the customer in their best interest. Software vendors and sales people who come from software sales approach sales the same way regardless of their environment.
    3. Because the medical world is RELATIVELY naive about sophisticated sales and marketing techniques and of technology, most buyers are at the mercy of vendors for credible information. I am proposing that software vendors either foster trust and medical professionals check for trust before even contemplating a buy/sell of an EMR. I think the question is whether my precept is scalable downwards (most scalability questions are upwards) to the office-based provider or optical professional.
    4. Another question is whether the features that are important for the buyer. In most circumstances, the buyer wants something that fits them. On the sales side, the vendor is trying to convince the buyer that the buy has to fit the software.
    5. Do you believe that the question of rigor in PHI protection warrants more serious consideration higher up?
    Thanks for the question and post.
    I think this is something that deserves attention, but HIPAA is now commonplace and not as great a burden as we thought initially. The military and the Veteran's Administration, in particular, are the national models for EMR. They are closed environment, unlike private offices, which are open. Transferring records between open environments can present greater risk. Keep in mind, however, EMR is implemented at the operational level but affects first line health managers, as well as senior folks who make decisions about buying such sophisticated software. I do feel that PHI is important and should be protected from disingeniuos vendors, but I also feel that there are people who can assist in purchasing these kinds of things at the Health System level, but may be an issue for practitioners that are seeking to change to EMRs. At my institution, I have access to sufficient data to help make such purchases, and I will be pleased to offer any advice to practitioners that you may feel necessary. Let me know if I may ever be of assistance.

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