When I retired, our government clinic was just starting to become completely “paper free”.

If I was leery about the idea, it was because we worked in central Oklahoma where power surges would periodically blow my computer, and to make things worse, the entire area’s computer system, along with our computerized patient information summary of medical problems, medicines, and tests, went down with it.

I mean, if a hacker could cause this many problems, when we still had paper records to fall back on, what would happen if the entire system crashed?

Paper records have other problems: They can get lost, misfiled, snooped into by visitors, your druggie patients can change the number of narcotics on the prescription you just wrote, and of course, they can burn up in a fire. (A lot of Veterans records burned in an infamous fire years back)

But electronic medical records have an advantage: Paper records are bulky and copying them takes time, as does carting them out of the office.

Ah, but electronic medical records? As Corporal Manning showed us, all it takes is a thumb drive and a person who wants to get even with you or a patient to steal all the information their little heart desires.

And every week or two, there is another small item in the news about medical records being stolen.

But why should someone steal a medical record?

For drugs, or to get money by using your information for fake billing.

From HealthCareTech Review:

Breaches of patient health data are on the rise, and they’re not likely to slow down, as reports show health information is one of the most lucrative types of data for cybercriminals to steal…According to the Federal Trade Commission, that data can be used to file lucrative false insurance claims, buy prescription drugs and get health care at the victim’s expense, among other things.

Ah, but it goes beyond that.

Most of us have insurance with a “co pay”. And a lot of doctor’s offices bill your credit card.

So far so good. We used to do this in our office. You could pay cash, check, or we would swipe your credit card and send it in to get paid. It cost our office a fee, but some patients wouldn’t have the cash on them, and it was worth it for convenience for both of us.

But now we doctors are being advised to keep that credit card information with the other information on your medical record.

From FamilyPractice News: Keeping Credit Cards on File

How do you safeguard the credit information you keep on file?

The same way we do medical information; it’s all covered by the same HIPAA rules. If you have an EHR (electronic medical record), it can go in the chart with everything else.

So there it is.

Your credit card information is right there, along with your social security number, your medicaid number, and the results of your latest pap smear.

So no problem. Just give them enough cash to cover the copay.

Whoops. Not good-enough for this beancounter:

How do you handle patients who refuse to hand over a number, particularly those who claim they have no credit cards?

We used to let refusers slide, but now we’ve made the policy mandatory. Patients who refuse without a good reason are asked, like any patient who refuses to cooperate with any standard office policy, to go elsewhere. Life’s too short. And “I don’t have any credit cards” does not count as a good reason.

So there you have it folks.

In the good old days, Doctor Welby saw you, wrote one line on an index card with the diagnosis (“cold”) and treatment (“penicillin”), even though you talked to him for half an hour about your sick spouse or personal problem.

You paid him five dollars and that was it.

Now, you not only risk your personal medical information being put in detail for anyone who has access to the record, but you also risk your identity and your credit card being stolen, not to mention a lot of personal information that in the old days we docs didn’t put on the charts at all.

Yes, I know: There are huge lists of how offices can stop computer theft. Stronger laws and regulations are fine: If they are followed. The problem is that we keep hearing of patients’ records being stolen,

InformationWeek says that “health care breeches” of information are up 97 percent, and involved 19 million customers in 2011.

So take care when you go to see your doctor…

That is, if you see a doctor at all:

When patients walk into a NowClinic at any one of nine Detroit-area Rite Aid pharmacies, they can choose among multiple physicians to see about what’s ailing them.

Not see in person. See on a computer monitor.

Sigh.Me thinks I retired from medicine just in time…


Nancy Reyes is a retired physician living in the rural Philippines. She blogs at HeyDoc Xanga blog.

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