Good intentions, maybe, and despite the grief there are some advantages. I can see my patient's clinic charts in the hospital - before, I'd have to wait for Monday and a fax machine. I can see what happened to folks in the emergency department. I can figure out my obstetric patients' prior pregnancy history. I can send records to specialists directly, and send requests with an electronic copy of a chart note and pictures of moles and whatnot at no cost to a patient and sometimes save them a visit to another office.
It's not perfect, but it's not a total disaster either.
I like a conspiracy theory as much as anyone, but I really don't think the NSA convinced Congress to pass the not thoroughly thought out HITECH Act to amass statistics about the home addresses of people with pneumonia or which patients with high blood pressure are smoking. Being able to gather anonymized statistics on public health issues may help, however, to figure out how to improve immunization rates or best help diabetics get their blood sugar under control.
To the grandparent poster, our EMR company actually will pay their own way to have their engineers follow us around and see how we work, and our prior vendor was originally a nice internist who wrote his own code (who then sold the thing to a big conglomerate that also makes microwave ovens and jet engines and curling irons and stuff).
Our current EMR does a lot of stuff well, but I'm hopeful for the day it's more usable by clinicians. The basic process of writing progress notes (in some sense, the evidence of my life's work as a physician) is clunky and hard to correct and even less intuitive for my colleagues who don't happen to have fancy computer science degrees like me. Writing good software is hard, and maybe progress notes have had to wait in line behind revenue cycle and privacy and a bunch of compliance issues.
As a physician practicing in a US state (Oregon) where oral contraceptive pills are available behind the counter, I'm all for expanding access to contraception. Nothing quite has made otherwise young, promising women be overwhelmed in my practice than unplanned pregnancy (combined with flaky partners). OCP's are available here without a prescription, but require a consultation from a pharmacist. This isn't free, but where they make sure you don't have any of the various risk factors for having a stroke or blood clot on estrogen-containing contraceptives.
I'm also in favor of expanding access to more effective forms of contraception, like the subdermal implant (sold as Nexplanon in the US), and IUD. I'm pretty puzzled, however, about how one would implement an app to jab the implant in your arm. It's not hard to do (see this video), but clinicians have to get special certification from the manufacturer to do it. (This is to avoid the Norplant debacle of inadequately trained people putting the rods in a little too deep, making eventual removal challenging.) I do love the idea of having etonorgestrel rods and lidocaine hooked up to a smartphone app, however.
This story is exhibit A why I haven't been to the site in over a year. It's not only completely contentless, it's insulting, stupid, and not even funny.
Epic is a big suite of applications that run on top of a big iron server - typically Unix (ours is AIX, I think). There's fine-grained user permissions in the application itself. End users do not have shell access or filesystem access or MUMPS prompt access, and everything has an audit trail. A select group of IT nerds get access to a text-based system running as a (Unix) application (with audit trails), and, at least at our organization, next to no one gets MUMPS prompt access or shell access. We have hot swappable servers located on opposing coasts of North America. I can't speak to the implementation at your daughter's site.
There may be examples out of there of hackers breaking into Epic; I'm not aware of any. Since our implementation was modeled after Epic's recommendations my impression is they've got their heads screwed on straight, security-wise.
I have a very small mind and must live with it. -- E. Dijkstra