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As part of an omnibus health care bill passed a year ago, state lawmakers almost as an afterthought ordered creation of a unified statewide electronic records system for virtually all types of patient information. Stock photo
California FocusOpinion

Elias: Dangers lurking in fully electronic health records

If you’re in Southern California and get laboratory workups at UCLA Health Services, any Providence Health Center or the Cedars Sinai hospital network, the results are quickly available to every doctor linked to any of those systems.

The same in the San Francisco Bay area if you’re a patient getting lab work at any hospital in the Stanford University system and the University of California’s San Francisco network of medical centers.

But if you visit an independent specialist or a mental health professional, reports on your visits may not make it onto either of these or any other large computerized health care network.

For there now are few official links between the major regional hospital systems around the state.

This reality, this little bit of privacy, figures to end on Jan. 1, 2024, whether patients like it or not. Among others, that could affect women coming to California for abortions from states where they are now illegal. It will also create computer data when patients visit psychologists and psychiatrists, where office visit reports mostly are not now computerized.

That’s because, as part of an omnibus health care bill passed a year ago, state lawmakers almost as an afterthought ordered creation of a unified statewide electronic records system for virtually all types of patient information.

Also in the bill was a well-publicized expansion of Medi-Cal’s patient population to include many undocumented immigrants. So were expanded payments by Medi-Cal to physicians, aiming to give them parity with doctors paid by the federal Medicare system. And much more.

But little attention went to Section 1862 of the bill (known as AB 133), which required just one public hearing about the rules and operating principles for the largest-ever state compendium of private medical records.

The high-minded idea behind this was to make all medical data and treatment plans for any patient seeing any California provider instantly available to all eligible practitioners. Taking medical histories on first visits would become very simple.

But it will also end the concept of patients keeping any secrets from doctors, psychologists or other medical folk.

All this information will supposedly be available only to  those who need it, including hospitals, health plans, provider groups and doctors.

But less than two years ago, thieves used the nominally confidential records of the Employment Development Department to steal upwards of $20 billion.

Just last spring, hackers pried open supposedly confidential state lists of applicants for concealed weapon permits.

So no matter what anyone says, there’s no guarantee of privacy for medical patients under this system, even if doctors respect patient confidentiality.

If a husband sees a psychiatrist and doesn’t want his wife or friends to know, reports on the visits will appear in the system.

If a patient seeks a second opinion but doesn’t want the original doctor to know she’s checking up on his diagnosis or treatment plan, the original doctor can eventually see details of the second opinion session. Visits to abortion clinics may not remain secret from officials of other states, either.

Under these conditions, how many people will forgo treatments they now get? No one can predict, especially when input on the new plan all has come from “stakeholders,” the same people and companies who will legitimately access the new system.

The “guiding principles” of this plan do look benign: Ensure that everyone gets state-of-the-art treatment, regardless of race or finances. Make maximum data available prior to vital medical decisions. Give patients access to all their medical records. Reinforce data security. And make sure every provider enters all information on every patient visit.

But there has been too little public input into all this, no formal venue for individuals to express misgivings or make suggestions. A lone (poorly advertised) public hearing is not enough input for something so far-reaching.

Proponents of the new system gripe that too much medical information now resides in isolated “silos” where it usually doesn’t help save lives or trauma.

But when only so-called “stakeholders” — and not the patients whose records will be compiled — are consulted about a change this big, trouble inevitably awaits, and will probably arrive sooner rather than later.

    Email Thomas Elias at [email protected].