Will Your Doctor Refuse the Government EMR?


January 22, 2014
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Intrusions sometimes surprise. I was at the doctor’s office recently when into the exam room walked a physician assistant and a young man in a tee shirt pushing a computer on a waist-high rolling stand. This “scribe” was introduced to me, but no one asked me if it was okay for him to stay. As I answered questions he silently typed away, taking down every word.

Because of what I do, I needed to fully experience this intrusion. Next time I’ll ask for privacy. I’ll let you know what happens. If you have a “scribe story,” please share it with me.
The New York Times recently discussed scribes, including a study showing 10 percent of patients uncomfortable with the presence of a scribe. Doctors are tired of being data-entry clerks for the government’s computerized medical record system so they are now paying $20 - $25 an hour for a scribe. There are nearly 10,000 scribes working nationwide, listening in on private patient-doctor conversations – and recording everything.
I don’t think doctors are thinking of it this way, but I’m reminded of Big Brother.
The intrusion is bipartisan. Blame Hillary Clinton, Presidents, George W. Bush and Barack Obama, Congress, 2004 Executive Order 13335, 1965 Medicare, Health Insurance Portability and Accountability Act (HIPAA) of 1996, the Healthcare Research and Quality Act of 1999, the 2009 American Recovery and Reinvestment Act (ARRA), and the HITECH Act within ARRA -- at least. Between them we have:
  • A new government agency to build a national medical records system (Office of the National Coordinator of Health Information Technology (ONC))
  • Medicare payment penalties for physicians and hospitals that refuse to install government-certified interoperable electronic medical records (EMRs) by 2015
  • At least $27 billion for doctors and hospitals that use EMRs “meaningfully”
  • Physician “quality” reporting for Obamacare exchanges
  • No privacy, except in Minnesota and Iowa, which have stronger privacy laws. More than 2.2 million entities have access to your private medical record.
Doctors should refuse the government EMR. This may mean refusing to participate in all government and insurance contracts. Patients will have to learn the value of paying for care by cash, debit, check or charge and submit their own bills to insurers. More doctors are moving that direction. More doctors should. And patients should follow in droves.
But doctors may say they’re only following the law. They may discuss Medicare reimbursement penalties. They may say hospitals and insurers will refuse to contract with them. All true. But what a good idea. No contracts. No outside controls. We need doctors who will build a cash-based practice that is ethical, private, patient-friendly, based on freedom, affordable for patients with or without insurance, and charitable to boot.
One doctor declared his refusal publicly. Dr. G. Keith Smith, head of the cash-based, very popular Surgery Center of Oklahoma, writes the following in his blog:
“As of this moment, right now, this very instant, I am declaring the absence of EMR at the Surgery Center of Oklahoma part of our marketing strategy. … Your medical secrets are safe with us at The Surgery Center of Oklahoma. We have no plans to adopt an EMR system. Ever.”
Dr. Smith calls the EMR a “rationing tool for the government goons.” He is marketing patient privacy as a selling feature of his center. Doctors who refuse the government EMR should do likewise. Let patients know where they can go to be safe from health surveillance and rationing.
What’s the worst that could happen if doctors refuse? Will doctors be imprisoned, blacklisted, forced out of hospitals? Maybe. But how long could that last? A physician shortage is coming. Everyone needs doctors: patients, Congress, hospitals, government. Everyone. Physicians forget their power. They could draw most if not all their patients into their camp if they only let them know what is happening.
Physicians should tell patients that federal and state bureaucrats will use the government EMR to:
  • Tracking patient’s behavior
  • Build individualized risk scores on patients
  • Conduct behavioral modification schemes
  • Build profiles of patient lives
  • Direct medical treatment
  • Reward doctors for limiting access to care
Physicians may be happy to have scribes helping them collect data for government tracking and analysis, but I’ll wager some patients no longer say what they would have if the scribe wasn’t in the room taking notes. What if patients figure out the scribes are recording in a government EMR?
What is the cost to patient trust? What is the cost to medical excellence? And is the cost to medical ethics and integrity? The government is counting on physician acquiescence and silence about the government’s EMR tracking and rationing system. This is a huge violation of patient privacy and medical ethics.
Working to protect medical privacy and ethical care,
Twila Brase, RN, PHN
President and Co-founder