Samaritan Ministries member Twila Brase is president and co-founder of Citizens’ Council for Health Freedom, an organization organized to “protect health care choices, individualized patient care and medical and genetic privacy rights.” In her recent book, "Big Brother in the Exam Room," she explores government intrusion into patient privacy through electronic health records. We asked her some questions about EHRs and what you need to know about them.
Q: What’s wrong with electronic health records? Aren’t they a lot more efficient?
A: There are two kinds of electronic health records (EHRs): the kind essentially mandated and designed by the government to do what the government wants them to do—I call it the government EHR—and the kind that were developed by or for doctors that do what doctors and patients need them to do—private EHRs. The government EHRs are not made for patient care. They are made for billing, data collection, data reporting, physician profiling and data analytics, research, and control over the practice of medicine. The government EHR is a tool for control, not a tool for clinical care. As a result of financial penalties, the government EHR is in nearly 100 percent of the hospitals today and most clinics. It is not efficient, it detracts from the critical history and physical, it changes the focus of the visit from the patient to the “paperwork,” and it is the leading cause of physician burnout and what has been called “moral injury.” Many physicians are troubled by the ethical conflict that the EHR has created. The patient is no longer the primary point of the interaction. The EHR is. As physicians and nurses have often complained, their primary job is to tend to the computer. One recently retired nurse told me she spent 85-90 percent of each work day on the computer. This is not efficiency, quality, or good patient care.
Q: What options do medical providers have regarding EHRs? Can they opt out?
A: Physicians and other practitioners can opt out of the government EHR, but they will be paid less for every Medicare patient they see. Contracts with health plans may also mandate the use of a government EHR to receive electronic payment. In addition, if their patients are hospitalized, physicians will be forced to use the hospital’s government EHR.
Q: You write that “The real goal of this … project is … data mining, the control of the physician population, and the ultimate rationing and control of patient services.” How would government be able to accomplish that?
A: The government EHR in combination with the federal HIPAA (Health Insurance Portability and Accountability Act) no-privacy, data-sharing rule facilitates data-mining by countless outsiders. Although those who hold patient data are not required to share it, HIPAA permits disclosure and use of the patient’s identifiable data without patient consent. The federal government lists more than 702,000 clinics, hospitals, health plans, and other “covered entities” plus 1.5 million of their business associates who could have access without consent. These 2.2 million entities do not include all the government agencies with access without patient consent for a myriad of purposes, from public health to judicial proceedings to law enforcement. HIPAA is not and has never been a privacy rule, but its perception as a privacy rule is evidence of one of the greatest deceptions foisted on the American people.