Do Digital Medical Records Exacerbate Inequalities?

For now, however, the health care providers with the deepest pockets have embraced digital record-keeping most quickly -- the very places that treat the patients who are most likely to be educated, have insurance ...
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So you're at the doctor. A nurse takes a history and some vital measurements. Heart rate is checked. Perhaps an EKG checks the electrical activity of your heart. You give a vial of blood, so it's typed, checked for cholesterol and sugars (and if you're a man, prostate specific antigen, or PSA).

At this point, the practice or hospital, knows a lot about you. You've surrendered the fluids, physical information and other information about yourself because you want someone who really knows about the workings of the human body to check all the info, combine it with the other things now known about you, to come to a conclusion about your overall health.

So, what happens now?

For a long time that information remained "siloed" -- maintained at the doctor's office or clinic as part of its records until the next time you came for a visit or for treatment. At that time more information might be taken, combined with earlier information to create a pattern over time, even more valuable now than just one day's information.

If you need to visit a specialist, or head to a hospital for further care, you might need to hand-carry the documents from one place to another, or wait until someone at the first place makes paper copies and drops them in the mail to be examined by the next place you visit for treatment. It's slow. It's wasteful. It adds to costs but adds nothing to the effectiveness of medical treatment.

We're told a better world is on the way. Making all health records digital will make the accumulated knowledge of patients' health and history quickly and efficiently stored and transported. When it's critical -- let's say in the case of sudden heart problems -- a patient's history can be in an emergency room doctor's hands in minutes. Cutting through the mountain of paper created in the exchanges between health care providers and insurance companies will add efficiency and cut cost. People will be able to check their own records online, breaking the monopoly of health care providers over access to that information. Medical researchers will be able to quickly and efficiently put together data bases to check on the effectiveness of drugs and surgical techniques in the treatments of specific illnesses, and further slice and dice those numbers by age, gender, racial and ethnic origin.

Sounds pretty good, right? A lot of places have already moved to store their records in digital form. It costs money and takes time, and since there's no requirement they do so, many places haven't yet taken the plunge. One proposal to speed the move would penalize Medicare providers by cutting back on their reimbursements every year, until a maximum of 5 percent is reached. For now, however, the health care providers with the deepest pockets have embraced digital record-keeping most quickly -- the very places that treat the patients who are most likely to be educated, have insurance, receive regular health care and be technically savvy. In other words, the providers most likely to have gone digital treat the patients most likely to be able to access their own records online.

I guess it's no surprise that the digital divide already evident between big demographic groups is showing up again in this new form. Latinos -- already the most underserved and underinsured American demographic -- tend to use clinics, doctors and hospitals that are less likely to move records and histories quickly, meaning that it is less likely that these patients' records will efficiently follow them through their course of treatment.

Absent legal requirements, will the places that haven't moved to digital record-keeping make the investment? Without widespread adoption of digital record-keeping, can it ever live up to its potential to make care more effective, more efficient and less costly? And as this new world of medical records really takes hold, who will get the thousands of new jobs created in the field? Will the medical divide and the digital divide combine to create a new divide, leaving Latinos out of the money in this fast-growing field?

All good questions, for which there aren't good answers yet.

The latest edition of HITN's Destination Casa Blanca brought together medical, management, insurance and computer experts to talk about the possibilities and the challenges in moving to digital medical records. They made a compelling and interesting case for making the investment, and the strong potential returns available from moving out of paper and into the zeroes and ones of computer memory. You can listen to excerpts at

There are also an array of privacy concerns when it comes to digital medical records. We'll have to leave this more thorough examination for another program. Medical records that are made infinitely transferable are in danger of being transferred to people who shouldn't see them along with those who need to see them. When an individual patient gives consent to have records sent to one practice, that doesn't mean that patient wants others to see those very private medical matters.

Been treated for a sexually transmitted disease? Don't want all the other medical professionals you consult to know? Can you or can you not control the release of the information?

Let's say you were successfully treated as a teenager for mental or emotional problems. It's now 20 years later, you are a mid-career professional and need a medical exam as part of a new job entry process. Can you pick and choose what parts of your past you choose to reveal? Once upon a time, all you had to do is simply start getting treatment from a new set of doctors, and parts of your past had no reason to follow you all through life. Will that be possible now?

And who owns the information? You? Your doctor? The insurance company that's paid claims based on information supplied by health care providers? The endless transferability and the ease with which these new records can be combined, mixed and matched -- and peeked at -- provides whole new ways they can be abused. Though there'll no doubt be new legal protections for digital medical records, brand new legal problems are bound to follow. With all the new ease, convenience and efficiency, you may have to surrender privacy and peace of mind. In medical records, as in life, you don't get something for nothing.

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