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The Eyes of Big Medicine: Electronic Medical Records

Nor do EMRs appear to save much money. In January 2013, the New York Times reported that "the conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care.”

EMRs are not inherently bad. A well-designed EMR can add tremendous value to many medical practices. In a free market, doctors and hospitals would gladly purchase EMR systems that made sense for their particular circumstances. Based on their specific requirements, some practices might purchase an EMR and others might not. Over time, the free market would bring down EMR costs and improve their quality.  But the choice of whether and when to purchase an EMR should be left up to each individual hospital and medical practice. It’s not the government's role to pressure medical practices into adopting EMRs any more than it’s the government’s job to tell everyone that they should purchase a smartphone.

So why is the government pushing EMRs so aggressively? One clue comes from Dr. Farzad Mostashari, national coordinator for Health Information Technology. In a 2012 interview, he readily acknowledged that doctors could provide excellent patient care using traditional paper charts. But he explained the advantage of electronic records as follows: “You need information to be able to do population health management.” In other words, EMRs are necessary for tracking the medical care being given to large populations of patients — and the treatment decisions of their doctors.

EMRs thus provide an excellent tool for the government to control doctors. As mentioned in the first article of the series, the expenses of buying EMRs are a major factor in driving doctors out of independent private practice and into more easily controlled large provider groups. And once doctors have been herded into these large entities, EMRs allow the government to monitor which doctors are adhering to approved practice guidelines and which doctors are “outliers.”

Many privacy advocates have also raised concerns about the security of patient data in EMRs. EMRs necessarily include sensitive personal medical and financial information about patients, making them a tempting target for hackers. In a novel twist, some hackers even broke into the EMR system for a group of doctors in Illinois, encrypted all their patient data, and demanded a ransom for the password. (The doctors refused to pay and instead notified the authorities.)

Other privacy advocates are concerned that federal agencies like the IRS might misuse patient medical records for political purposes.

In theory, this is a risk. But I doubt we’ll see heavy-handed political misuses of personal medical records. We won’t see hospital administrators telling patients, “You voted for the wrong candidate last year, so no chemotherapy for you!” Instead, the danger is more subtle. Walter Russell Mead describes the appeal of electronic medical records for proponents of government-controlled Big Medicine as follows:

For some, these kinds of information systems offer the hope of a centrally guided, centrally controlled health care system. Bureaucrats in Washington will crunch the numbers and regulate the national health care system based on the numbers. They think and hope that Big Data will empower Big Government, and that armed with the information about ‘best practices’ that they get from the data, they will be able to micro-manage what health care practitioners do.

In other words, the greatest danger to patients is not that their EMR data might be misused. Rather, the biggest danger is that their data will be used as intended — i.e., to control Americans’ health care by controlling the caregivers. In other words, electronic medical records will be the “eyes” of Big Medicine.

So what can Americans do about this? This will be the topic of the final article in the series.

Coming next week: What patients can do about Big Medicine.