antidepressants in your personal electronic medical record

[QPublic]

I am a practicing psychologist and recently began working in a healthcare system with a comprehensive electronic medical record. I've been taking an antidepressant for a number of years and noticed that it now shows up in my medical record, apparently triggered by my filling the rx (was prescribed prior to my being in this position). I am really uncomfortable with this appearing in my EMR. I planned on finding a PCP out of the system so that it is not a colleague. Perhaps I'm overly concerned or even paranoid about this, but the idea of having this information easily accessible bugs me. What would you do?

Thanks

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[Doctor Bagel]

Maybe I'm naive, but I really don't worry about the information in my medical record, even though I'm treated at the facility I work at. I know our EMR system has a thing called "breaking the glass" that you have to do to look at other employees' records. Through that system, everyone who accesses your record is monitored. I'm assuming most people are respectful enough to not snoop in other people's records, but this breaking the glass thing certainly helps. I'm guessing most EMRs have similar mechanisms.

 

[psychattending]

Our EMR system tracks all users in all records. I personally do not think it is a big deal. Major depression is pretty frequent and I bet there are a large number of your colleagues undergoing treatment for it.

 

[whopper]

Are you saying that you work in a system where your healthcare records can be brought up?

 

[billypilgrim37]

I started to make a joke about you needing some risperidone to take care of your paranoia, but seemed like bad taste, and you aren't around enough to know that I'm a pretty benign-intending sorta guy.

I used to take my paxil during my first lecture M1 year in front of my friends, because otherwise I would forget it at home. My best friend bought me a pillbox for xmas M1 year because around tests I would be stressed, stop taking it, and go through ridiculous withdrawal pretty quickly.

I'm not much more shy about my Wellbutrin now.

I don't have data, but I'm guessing well over 50% of folks in mental health fields have had an MDE at one point and been in tx. You're perfectly entitled to your privacy, but understand that even if your info did get out (and the chance of this happening is low), the risk around mental health folks is low.

 

[DebDynamite]

My concerns about this sort of thing have always leaned more towards the potential problems with getting LT care policies in the future. I have never received a MH diagnosis, but do suffer from SAD. Thought about taking bupropion in the past, but now i live in a place with very sunny winters & really don't need it. I'm also getting myself a (full spectrum) lamp for my office next year, which has no windows.

My significant other suffers from MDD, and we don't file his rx with insurance. He actually pays out of pocket just to keep it from his EMR. Not that he cares about anyone knowing he gets depressed, but more from a concern about long-term care policies in the future.

The fact is that insurance companies will write out as much coverage as they can. He gets pretty depressed without medication, exercise, healthy diet etc. I would not want to have him denied treatment for TMS (IF it ever gets insurance backed in the future), ECT, and whatnot if he ever needed it in his older years. That is one if the real potential problems I am paranoid about with EMR. I know Obama Care will (supposedly) "take care of" the concerns surrounding pre-existing conditions. But I don't think it's ever really going to transpire.

 

[Doctor Bagel]

My concerns about this sort of thing have always leaned more towards the potential problems with getting LT care policies in the future. I have never received a MH diagnosis, but do suffer from SAD. Thought about taking bupropion in the past, but now i live in a place with very sunny winters & really don't need it. I'm also getting myself a (full spectrum) lamp for my office next year, which has no windows.

My significant other suffers from MDD, and we don't file his rx with insurance. He actually pays out of pocket just to keep it from his EMR. Not that he cares about anyone knowing he gets depressed, but more from a concern about long-term care policies in the future.

The fact is that insurance companies will write out as much coverage as they can. He gets pretty depressed without medication, exercise, healthy diet etc. I would not want to have him denied treatment for TMS (IF it ever gets insurance backed in the future), ECT, and whatnot if he ever needed it in his older years. That is one if the real potential problems I am paranoid about with EMR. I know Obama Care will (supposedly) "take care of" the concerns surrounding pre-existing conditions. But I don't think it's ever really going to transpire.

Yeah, this might be the more significant concern. I've heard our resident wellness program even directs people to certain pharmacies that don't report this stuff for insurance purposes. Our resident wellness records are apparently also not part of EMR for this reason.

If you work for a big enough place to offer insurance, it won't an issue for health insurance, though, since group plans generally don't exclude based on preexisting stuff. I guess life insurance and disability insurance are the bigger factors for physicians. Also if you work for yourself, hmm, that could be a problem, since it's the people getting individual insurance who get screwed.

I'm not getting why people opposed health insurance reform.

 

[sunlioness]

I was told when I started working at this job that I could get in a mountain of trouble for even looking up my own chart.

I agree with the insurance pre-existing stuff though. Though you might be damned if you do and damned if you don't. If you pay for tx on your own and don't disclose to your insurer and they find out about it, they could still probably cancel a policy based on not disclosing a pre-existing condition.

 

[QPublic]

Thanks for the input, folks. Yes, I know I can be a bit overly concerned about this. I am very private about taking ADs ("not that there's anything wrong with that"). That's interesting, being told that you can get in trouble for checking your own medical record... I read recently that EMR snooping of coworkers' medical records occurs with some frequency. I definitely understand the concern about the implications vis-a-vis obtaining health insurance but I've had the rx in my insurance records for years. I've been getting health insurance through employers as long as I've been out in the real world. Purchasing individual health insurance is definitely one of the drawbacks of private practice.

 

[whopper]

I wouldn't say to not be worried. All things being equal don't worry, but depending on the specific institution, the culture there, and your specific position, while I would say it's unlikely it's anything to worry about, I could see some situations where concern would be prudent.

It's not common, but I've seen situations where some of my patients told me their privacy was violated in the past in places I haven't worked. E.g. one patient needed time off due to a psychiatric reason, had to report to her place of work what was going on to get the time off, and when she returned everyone knew what was going on because the idiots at HR that had to approve it leaked it out.

Like I said, not common, actually on the order of rare but I've seen it.

 

[sunlioness]

I really hope there were consequences for those HR idiots.

 

[BobA]

Thanks for the input, folks. Yes, I know I can be a bit overly concerned about this. I am very private about taking ADs ("not that there's anything wrong with that"). That's interesting, being told that you can get in trouble for checking your own medical record... I read recently that EMR snooping of coworkers' medical records occurs with some frequency. I definitely understand the concern about the implications vis-a-vis obtaining health insurance but I've had the rx in my insurance records for years. I've been getting health insurance through employers as long as I've been out in the real world. Purchasing individual health insurance is definitely one of the drawbacks of private practice.

I know of one nurse who lost her nursing license for looking into a co-workers chart. EMR privacy is taken very seriously where I work. Also, FWIW, At most places with EMR you are entitled to request a list of people who have accessed your medical record so you could see for yourself.

Be the change you want to see in the world. If we don't counteract stigma, who will?

 

[whopper]

I have a patient on Suboxone, got hurt at work, his boss brought him to the ER, and he told the ER nurse he was on Suboxone. Per him, the first thing she did was go to the boss and tell him that my patient was a drug addicted Suboxone user.

Yes, perhaps the story isn't true, after all its from the patient and I didn't see the incident, but his boss called me up and asked me what was going on and if this guy was on Suboxone. I responded I wasn't allowed to talk about it.

Now the guy is getting dirty looks from his boss. I informed him that if he loses his job as a result of that event, he definitely would have a potentially winnable malpractice case because all of the criteria for it would have occurred (but he'd really have to talk to a lawyer about it), otherwise, if this is the type of thing where his boss is just going to be ticked off with him for a few days to weeks and it'll blow over, and he'd have no case, but he should call the hospital, find out the name of the nurse, and report the event to the state nursing board.

I'm ticked off because since this guy's been on Suboxone, he's really cleaned up his life and has been on the straight and narrow for months, he's rebuilding his marriage and he's getting a lot things in order that weren't for several months.

 

[kugel]

I am really uncomfortable with this appearing in my EMR.

Be concerned, but don't be obsessed.
It does happen sometimes, and some of the peeking happens at HR, billing, employee health. I doubt all EMR systems log who sees your record at these non-provider departments. I think most people in your health system and most co-workers would find gossip about this to be disgusting and would be unlikely to continue it. However, if the gossip got more juicy (like if Seroquel was added as an adjunct), then chances of disclosure and gossip spreading would go up. So it might be more worth pursuing care outside the system if something changed.

Personally, I'm pretty private.
My house and car are not in my own name.
Once out of residency, I always opted to get all medical care outside my own system. If the only insurance offered by my employer was within the healthcare system where I work, I would be getting any care related to mental health outside that system - on a cash basis. But I would not withhold that info from applications for Long-term Care (LTC), Life Insurance, Long-term Disability (LTD).

BTW, VERY smart of you to be thinking about this. LTC and LTD health issues often bankrupt families, even doctors. Imagine your family living on the $ you would get from SSDI after you get a TBI. LTC, LTD rates are, of course, lowest when you are young and healthy.

Also, you are right that certain insurances can be significantly adversely affected by some health problems and medications, insurance like Life and Long-Term Care (nursing home, home health, hospice) and Long-Term Disability can all be negatively affected by certain conditions. However, if you hide the info from insurers and they figure it out - you may be blacklisted among insurance companies forever. If one insurance company rejects you, they can (and do) share that info with other companies - not your medical info, but that you were rejected, and probably that you were rejected for lying on your application. Also, if you lie to the insurance company and they don't catch it, but then 40 years later you submit a claim, they may review your application very thoroughly and could reject you at that time (40 years and a fortune of premiums later) for having lied on your application. That's right. Now that have MS, you are uninsured and cannot get insurance. You can't even get Medicaid until you sell your house and empty your bank accounts paying for medical care.

On the issue of long-term insurance, talk to someone who knows. Go talk to a reputable broker of LTC/LTD insurance and life insurance and discuss the issue - without filing an application. Ask how often in his/her experience this condition and these medications cause a rejection. Ask if the reason for the prescription changes anything about acceptance/rejection rates. For instance, does getting a Rx for and AD for depression look different to underwriters than getting it for anxiety, or for smoking cessation, or for attention problems. Then, of course, go talk to another broker for a second opinion.