Electronic health records systems definitely affect the willingness of patients to share medical information, sometimes in a negative way, says psychiatrist Scott Monteith, M.D.

He spoke during a session at the Health Privacy Summit in Washington. Monteith, medical informaticist at Michigan State University, uses an EHR in his practice. A recent patient, feeling stigmatized by past diagnoses, opted not to reveal private medical information, he said.

Two years ago, another of Monteith’s patients found an error in her electronic health records that indicated a history of inhalant abuse. It turned out that the EHR did not distinguish between four similar diagnostic codes, which included inhalant abuse, which the patient had not experienced, and caffeine addiction, which she had.

The EHR bundled the four diagnoses, and the viewing window had room to display one--the erroneous inhalant abuse. The patient was grateful for efforts to find and rectify the problem, but stopped coming in, Monteith said. Two years later, the problem--resulting from errors by the software vendor and implementation contractor--remains, in large part because the vendor has been unresponsive.

Now, a new version of the software is available that includes a fix of the bundled diagnoses problem, but the new version is an expensive upgrade, Monteith said. The practice is debating the pros and cons of buying the new version or an entirely different EHR.

Providers unhappy with their EHR vendor often find themselves “locked in” to that vendor because they spent so much on the EHR that they can’t afford to replace it, or even pay for a major upgrade, Monteith noted. And, most vendors are not good at responding to problems anyway, he asserted, making the decision to switch products more difficult.

Despite the problems, Monteith is an advocate of health information technology, but worries about a rapid move to EHRs that don’t appropriately protect patient information. “We’re doing the same thing--moving high-speed ahead with I.T., just like financial markets ran at high speed with little regard for protections before the 2008 crash.”

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