Cloud computing, your patient information, and privacy

In the not too distant past, healthcare providers sometimes worried that reliance on technology might put private patient information at risk. For example, they might have debated whether having a computer technician restore information from a damaged hard drive might be unethical, as the technician would see confidential patient information.

Gradually, both patients and providers became comfortable with the burgeoning reliance on digital storage of patient records. It was, in fact, the convenience of being able to share the information with specialists, pharmacists, specialists, and so on that made electronic medical records so appealing. Further, patients enjoy being able to access their records online, communicate with providers through email or other web-based technology, and make scheduling and payments over the Internet.

When I first heard the phrase “cloud computing,” I was excited to think I might be able to put things in “the cloud” and access them from various devices. Indeed, I do enjoy being able to access the music and videos I have on iTunes from my laptop, desktop, and handheld devices. I assumed, though, that my files were in the cloud because I wanted them there, but I was surprised when someone told me of having all her files restored by a technician who got them from the cloud. She had no idea that her files were in the cloud in the first place. As excited as she was to have these important files restored, it was a bit disconcerting to know that they were in the hands of third (and fourth or fifth?) parties in the first place. How many technicians in how many companies have access to our information?

So, now we move to electronic medical records, a digital archive of our most private information. As noted in the American Medical News blog, in 2011 55 percent of office-based physicians used electronic health records and 41 percent of those were in a cloud-based system. The blog, by Pamela Lewis Dolan, cites information from Jonathon Padron, senior client service analyst for comScore, and Internet analytics company. From the blog: “Because EHR data give marketers the ability to target messages in a more granular way to the specific physician, it’s very effective for marketers, Padron said. For example, the system can identify the condition a physician is looking at and automatically pup up a drug that can treat it.”

These ads are linked to keywords, of course, just as you see ads related to a condition you search on WebMD. We trust that our searches, the doctors’ searches, and our names and medical records are not combined for nefarious reasons. Howard Burde, a health IT lawyer, offers this assurance: “The technology is improving such that data is more and more secure all the time. The problem isn’t the technology, it’s the people.” Everything is all right then, see?

I see two bits of take-away information in all of this: 1. Our private health information is being spread further in cyberspace than we might care to think about. 2. Pharmaceutical and device manufacturers will aggressively use any means available to insert themselves into our healthcare decisions by targeting healthcare providers and patients with intrusive influence at all levels. Of course, if access to healthcare, or at least health insurance, is actually guaranteed by the Affordable Care Act, we may be less concerned about our information being shared. I don’t want to be embarrassed by my private information, but I prefer being embarrassed to being uninsured.

Curmudgeon Rant: “We don’t have small.”

I went to see a movie yesterday, which is something I don’t often do, and I decided to order a coffee, which is something I do even less frequently. When I got to the counter, the menu said “Cappuccino, $4/$5.” It was refreshing to see that the sizes didn’t have silly names, really.

So, I ordered a small cappuccino, and the cashier told me (I should have predicted it) that they do not have small cappuccinos. I would have to choose either a medium or a large. Of course, I do know that the United States, as a group of people, has become addicted to diabetes-inducing portions of food and drink.  I also happen to think they shouldn’t force us to choose between oversized drinks and super-oversized drinks, but that isn’t what makes it the most annoying.

The most annoying thing for me is the fact that I truly do not believe anyone ever asked for a small without wanting the smallest size available. No one ever said, “Oh, you don’t have small? I will have a large then.” No, it is quite clear that anyone who asks for a small wants the $4 drink and not the $5 drink. Why rub our faces in the fact that we can’t actually order the size drink we want?

We are the 85 percent

Over the years, I have had several people in healthcare tell me that about 85 percent of patients in doctor’s waiting rooms have no medical problem that won’t take care of itself with a little time and patience, but patients have been trained to demand treatment for every ache and pain. I’m sure this made-up statistic does not appear in print or as part of any official statement, but there is a feeling that mildly sick people are a drain on a system that is already overloaded.

 It isn’t a small concern, and doctors are not entirely to blame. Patients do sometimes demand treatments that are counterproductive, which has led to the excessive overuse of antibiotics, for example. Of course, patient perception is that doctors prescribed the antibiotics, leading them to believe they are effective for mild earaches and colds. Doctors say they feel pressure from patients to “do something” about their mild condition. Patients and doctors both feel they are doing what the other is directing them to do. I would guess that about 85 percent of doctors and patients feel this way, if I were to start making up statistics.

 The result is that patients can become pushy and demanding or that doctors can become resentful of needy patients. And both conditions arise, I think, from a misunderstanding of the wishes of the other. I honestly don’t think either side wants to waste time or money on useless treatments. So, “communication is the key” to a better doctor-patient relationship, or so the shibboleth goes.

 But it is more complicated that that, of course. When I was quite a bit younger, a member of my family began having fairly vague complaints and discomfort that prompted her to see her doctor. She was overweight. She smoked. She rarely got exercise at all. The doctor told her to lose weight, stop smoking, and check back in a few months. Each time she went to the doctor, she received the same advice, even if the wording changed a little, but her symptoms became more pronounced and harder to ignore.

 Finally, the doctor ordered a biopsy, which was positive for colon cancer. She was then referred to an oncologist. On their first meeting, he said, “I wish you had come to me sooner before it had spread.” Perhaps he didn’t mean to blame her for her cancer or for her lack of treatment, but that is certainly how she heard it.  Too many of us who have experience with cancer in our families have heard, “I wish you would have come sooner,” even when the patient has been seeing a doctor regularly for months or years.

 So, patients are in a bind. If we go to the doctor at the first sign of a problem, we may be seen as hypochondriacs or as clingy whiners. If we wait till the symptoms manifest themselves more boldly, we may be blamed for neglecting our own health and causing our own deaths. Given this choice, most of us would rather be seen as frivolous. We say things like, “I’m sure it is nothing, but I watched my loved one suffer, and I won’t make the same mistake.”

 This is why healthcare providers need to show a little understanding. With the possible exception of a few individuals with some rare psychological conditions, people don’t go to the doctor for the fun of it. They trust their doctors to tell them whether their symptoms are serious enough to warrant further attention, and they aren’t looking to waste time, money, or resources. To be on the safe side, I try to tell my doctors that I only want treatments that are both necessary and effective. This takes, I hope, the burden off the doctor to “do something, anything” for me.