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Implementing EHR: Easier Said Than Done?

Dear Editor:

I would like to thank Dr. Steven Kraus for spending so much of his time in Washington, D.C., keeping up on proposed changes, especially the proposal for putting all health records in electronic media available online, and then taking the time to keep us apprised through his articles.

My observations and concerns regarding electronic health records are twofold. First, the equipment, software and clerk's time in making the changes will be very expensive, much more than the government's proposed reimbursement for an individual practitioner or small group practice. That means we doctors have a choice; join a larger group or retire. We already have a shortage of family-practice doctors, and many of these doctors will take the retirement option. Maybe the shortage won't be noticed so much in large urban areas, but it certainly will be noticed in rural areas and small towns.

My second concern is security. HIPAA and the "red flags rule"  have underscored the need for privacy of medical records. I recently talked to a person who was in charge of one of our federal intelligence agency's electronic security. When asked how secure any information could be if it were available to online hackers, this person said, "If it is known that certain information is available online, and the hackers think the information is worth the time and effort to broach the security, they will get in."

There are three reasons I can think of for a hacker to get medical information: for the general public, to steal identities and use them or sell them to unscrupulous people, and to blackmail high-profile people such as popular singers, actors and actresses, diplomats and politicians.

Bill Benton, DC
Centralia, wash.

The Paradigm Shift Is Inevitable

Dear Editor:

At long last chiropractic is mainstream. This is due in no small part to the cooperation of the ACA, ICA, COCSA and ACC. Our profession is the only profession that has entered into discussions with congressional leaders with tangible, affordable solutions to health care reform. Let me repeat that: Chiropractors are the only professional group entering discussions with solutions in hand. The rest, namely the AMA and other medically oriented professional groups, are entering these discussions in a highly agitated state, demanding monies and preferential treatment even before the discussions have started.

It may be noted that they are not equipped with solutions to the current dilemma and have admitted, rather heatedly, that they are not trained in wellness care and that time is needed for wellness training to be incorporated into the "medical" curriculum. Chiropractors have been equipped and trained in the wellness arena for the past 114 years.

What is happening is that the AMA and its backers are panicking. They are afraid of losing the monopoly they have created over the past 100 years. They are afraid of losing the prestige and money associated with being Earth-bound deities. The corporate side is afraid of losing a highly profitable distribution mechanism. Basically, what we are witnessing is the inevitable paradigm shift that was forestalled by 99 years of pharmaceutical domination of the medical profession and media.

Is the fight over? No, not by a long shot. The chiropractic profession will likely face even more harsh challenges before the paradigm shift is firmly ours, but like I said, the shift is inevitable. The key to ensuring that paradigm shift occurs is for our profession to continue working together while keeping our internal disagreements internal.

The AMA is currently suffering from its own internal splintering. There are the new-generation MDs who "get" chiropractic and are more than willing to work with chiropractors and step away from the pharmaceutical model, which they recognize as broken. Then you have the old guard or "white hairs" of the medical profession desperately trying to maintain the status quo under which they hold absolute, unquestioned authority, and who have held tightly to the pharmaceutical model that financed and upheld their image. Then there are groups riding the fence who do not want to step firmly into one paradigm or the other for fear of being left out if one side prevails.

It is this last crowd in which fear is most palpable. It is this crowd that attends weekend chiropractic courses with the idea that if they learn how to imitate chiropractic, they can "take" chiropractic over. Sadly, it is this last group that understands chiropractic the least. They believe that a 12-hour course will provide them with the proverbial sword of knowledge to defeat their perpetual foe, the dreaded chiropractor.  They have bought into the idea that chiropractors are a threat to their existence. What they have yet to learn is that they have hamstrung themselves with hate and prejudice directed at us.

Yes, I said hate. There is no other word for it because there has been no effort made to understand chiropractic or give chiropractic the benefit of the doubt. They have a loathing for our profession, scrupulously cultivated throughout their collective careers from college and continued on with continuing-education seminars in which we are vilified and made to look as if we are stealing their careers. Sadly, these poor souls are not at fault directly. They have simply taken what has been fed to them as truth, never questioning the source of the bile they have been so carefully fed.

Chiropractors will do well to reach out to this group, but we must do it carefully, for they are likely to bite and bite hard. But we should reach out only after we have the cattle prod firmly in our grip so that any untoward behavior from this badly misled crowd can be quickly and firmly addressed. The time has come for chiropractors to learn how to handle being on the top rung, and we must do so with authority, grace and above all, humility; a quality sadly lacking in the current medical paradigm.

Richard Bend, DC
Monterey, Calif.