The privacy issues associated with the bungled Obamacare website roll out may bode ill for physicians and healthcare providers who participate in the expansion of the federal government's Electronic Medical Records (EMR) collection.
"Eventually the goal is to have all of these electronic systems connected. In that way, it's good because in theory, you could be anywhere and get someone's medical records," Dr. Jeffrey A. Singer, Arizona surgeon and adjunct scholar at Washington, D.C.'s Cato Institute, told Newsmax. "You could be traveling and somehow end up in an ER in a faraway place."
"But if all your information is kept up in a cloud, how safe is it?" Singer said.
Singer said he fears that personal data could be used politically, recalling breaches that have occurred with the Internal Revenue Service going after political opponents of the Obama administration.
"A lot of these agencies, which are supposed to be completely pristine and have nothing to do with politics…. You don't think it's possible for people who are politically motivated to get access to their political opponents very confidential and potentially damaging medical information? Why not," Singer said.
"It can be just some person working there who decides he now knows something about some judge, for example and he's going to blackmail that person," Singer said. "Or better yet, a conservative minister who is politically active treated for an STD. That is some juicy information. They've got potential that scares me. I don't think it's paranoid to worry about that."
In addition to privacy concerns, some doctors say the EMR expansion represents massive overreach and expansion of government control over their profession.
"From individual doctors who care about their patients, what I'm hearing is this is just a complete sellout to patient privacy. There is no more privacy," Dr. Jane Orient, an internal medicine physician and spokeswoman for Association of American Physicians and Surgeons, told Newsmax.
"The government is dangling incentives in front of you, saying we are not going to cut your fees as much if you use our record system," Orient said.
The EMR collection efforts began in 2009 under the federal stimulus bill program with a $19 billion provision to fund modernized information technology.
Obamacare expanded incentives to healthcare providers for participating in the EMR program and enacted penalties for Medicare providers who do not participate.
"One of the more significant changes" of the Affordable Care Act, according to the i
SALUS Healthcare website, was a provision to provide $27 billion toward the adoption of EMR technology "under which physicians are encouraged to make greater use of electronic medical records technology."
Doctors who do not participate by 2015 will be penalized 1 percent of their Medicare payments, which increases to 3 percent over 3 years.
Under the plan, doctors who convert to online records receive an incentive of up to $44,000 for five consecutive years of Medicare participation, or up to $63,750 over six years for Medicaid participation, provided they meet certain "meaningful use" requirements for online billing and patient records.
Incentives for institutions go further, with base payments for eligible institutions beginning at $2 million, iSALUS Health said.
Doctors who still take Medicare reimbursement payments "are demoralized," Orient said. "They are angry. Some are saying they are not going to do that, opting out of Medicare all together."
A growing number of doctors are leaving private practice all together over the burden of compliance.
"The tiny incentives are not nearly big enough to the maintenance of these [electronic records] systems, and with the loss of productivity, so many are opting out of Medicare and third-party payments," Orient said.
The goal of the EMR program was to make medical records "inter-operable," Heritage Foundation health policy analyst Chris Jacobs told Newsmax.
For example, if a patient went to one hospital for treatment of a condition, and then later transferred to a different hospital, the records for that person could be available online, thus saving time.
While that seems practical and a solid use of emerging technology, there is reason to be concerned, Jacobs noted.
"This is the federal government trying to dictate the practice of medicine by physicians by telling them they need to use these records and in certain ways the government would direct, or their payments would be lowered," he said. "That is the federal government trying to micromanage physicians across the country."
The Obamacare database collected for those signing up for the healthcare exchanges is separate from the EMR collection. The healthcare exchange program collects other vital personal data like Social Security numbers, employment and tax information and income, but it doesn’t track health conditions, Jacobs said.
Still, doctors' privacy concerns about the EMR system are not out of place, he noted.
"There is not one massive database [for health records] but certainly you can hack into a doctor's system or hospital's system," he said.
Singer described the nightmare scenario of having to implement the government's online records program.
It has cost his office, the largest and oldest group surgical practice in the state, about $400,000 thus far and wasted countless hours of patient time that he thinks could have been far better spent on listening and diagnosis, not checking boxes and tapping through a computer screen, he said.
The regulatory and paperwork burdens are slowly removing the doctoring from his profession and will likely force many physicians to leave after years of training and investment, he told Newsmax.
"It's a horrible burden," Singer said. "In many cases, it's the thing driving a lot of doctors to quit private practice and become hospital-based employees. They are becoming shift-working hospital employees and they have to follow orders. I would predict, after all this, that there will be only about 10 percent of doctors private."
The Electronic Medical Records system required by the federal government, which holds Medicare and other insurance reimbursement as a carrot for doctor compliance, will likely increase, not decrease errors, as its creators have suggested, Singer said.
"I would not be surprised that with the advent of EMR, not only is the doctor-patient relationship going to suffer, I think it's finally going to increase errors," Singer said. "The public policy is not evidence-based, it was anecdotal, the exact same thing they like to accuse doctors of."
Singer said he doesn't trust the system.
"I've seen too many instances where the information [added online on forms] is wrong," Singer said. "I have witnessed in the hospital doctors putting Control C and Control B – cut and paste – saving time by simply copying notes. And if you are running a half an hour behind, how easy is it to simply just click boxes, whether it's true or not, just to get to the same pages," he said.
The numbers of doctors and healthcare providers participating in the EMR mandate thus far remains fluid, but according to the federal government's CMS website, about 380,000 providers – half that are eligible – had received payments for participation through September.
The latest EMR figures more than doubled the participation since 2012, CMS said.
"We have reached a tipping point in adoption of electronic health records," Kathleen Sebelius, secretary of the Department of Health and Human Services, said in a statement. "More than half of eligible professionals and 80 percent of eligible hospitals have adopted these systems, which are critical to modernizing our healthcare system. Health IT helps providers better coordinate care, which can improve patients' health and save money at the same time."
Personal technology advisers note that many consumers don't seek out enough information about security, giving away too much information about themselves with little concern about it falling into the wrong hands.
"I know statistics show that Americans are concerned, but it's my experience that most people don't understand or don't care about privacy risks, period," says New York City-based consultant Jennifer Mendlowitz, who assists clients in setting up their technology needs and advises them on best practices on security.
"They're more than glad to share their information in return for potential gain – be it an increased Klout score, or free or reduced costs of goods and services, whether it's Groupon or a government-sponsored program," Mendlowitz told Newsmax.
Mendlowitz said the privacy fears gaining steam after the Healthcare.gov website crash are justified.
"Absolutely there is reason to be concerned by private health records being in government hands. Government couldn't even launch a functional site, so how secure can it be?" Mendlowitz said.
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