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By Vikram Khanna

The medical world’s pursuit of the right to self-defense, the most fundamental of all human rights, is heading underground. When responsible gun owners and their advocacy groups ground down the nomination of Vivek Murthy to become Surgeon General, they won a significant political victory. Setting aside that the position itself is an anachronism worthy of elimination, the victory inflamed bureaucrats, politicians, academics, and other master manipulators who, 223 years after ratification of the Second Amendment, still want to pretend it never happened . . .

The struggle by anti-self-defense advocates to learn who owns what kind of gun and what they are doing with it will, I predict, soon head to a very different and much murkier place: the federally mandated, three-layered, electronic medical records swamp. Most Americans are unaware that a critical plank in the Titanic that is Obamacare is the transition from a paper-based medical records system (flawed in its own right) to an electronic one that is, already, deeply troubled. The federally contrived system is a mess that is angering physicians and could actually lead to user-alert fatigue that causes more problems than it solves, especially in places like emergency departments where speed and accuracy are crucial.

But that’s not what should give gun owners pause. It’s this: we have little idea what’s in those electronic records, who sees the data, where it goes, and what they do with it. While the debate over whether physicians should routinely question patients about firearm ownership is quiet for now, that does not mean that healthcare professionals cannot or would not be encouraged, with a wink and a nod, to record gun ownership information in an electronic health record as it emerges in the course of routine conversation with a patient.

Gun owners need to know that there are three kinds of electronic records in play. The first is the electronic medical record (EMR), which replaces the paper chart in a specific clinical setting. Then comes the electronic health record (EHR), which is the granddaddy record; it is supposed to be transportable and contain all the clinical information about you from any medical professional who has interacted with you. Finally, there is the personal health record (PHR), which is the record that the individual patient is supposed to see and manage. Of course, by federal decree, all this information is secure, private, and confidential.

The electronic records systems emerging in the marketplace are all built and sold by private vendors. They are frequently modified by purchasers to meet specific needs and interests. The major incentive for providers to use these tools is federal money: the feds will reward providers who can show that their use of these electronic records improves patient care, a doctrine called Meaningful Use.

Among other things to watch, there are Clinical Quality Measures within Meaningful Use, and two of them, population and public health and patient safety, are potentially areas that providers could be told are appropriate landing grounds for recording even unintentionally disclosed (and medically irrelevant) gun ownership information. Then there is the issue of Syndromic Surveillance, which is a brand new mechanism for reporting clinical data to state and federal agencies. I am all for reporting infectious diseases, which is the historical basis for this process, because viruses and bacteria don’t respect boundaries or laws and frequently behave irresponsibly. But, this process is as yet so ill-defined that there are no boundaries. What will state or federal agencies deem collectable? Will their decisions be open and accessible for comment? How will they communicate their surveillance interests to providers in their jurisdiction?

The lack of transparency about the evolution of EMRs and EHRs has been appalling. Why is that patients are encouraged to access primarily their PHR? Why can’t they easily see their EMR and EHR, despite the government’s chest thumping over their Blue Button initiative? Even more to the point, why don’t I, as a citizen, have the right to see who has looked at my EHR data or the entities to which it has been sold or transmitted (in a de-identified manner, we are assured)? I can log on to my credit report any time and see who has requested it. Why can’t I do the same for my EHR and EMR? Why don’t I have the right to correct the records by removing information that is not medically relevant or opt-out of having my data shipped to federal agencies or academic institutions?

The obsession with big data as the solution to all that ails us is shattering privacy and responsibility walls. As physicians increasingly become employees of large health systems including gigantic health insurer-hospital alliances, their loss of professional independence will imperil their ability to resist calls that emanate from central planners and filter through their employers about what kind of “data” is needed to keep people “safe.” As Florida legislators demonstrated, and a federal appeals court agreed, it is possible to segregate medically legitimate firearms ownership inquiries from intrusive and unwarranted fishing expeditions.

Sadly, people who disavow the very concept of responsible gun ownership are missing the point of why this matters so much. In our very modern era, all fundamental rights are under assault. The medical care bureaucracy has no more legitimate need for routinely gathering information about gun ownership than it does about where you worship, whether you vote, or if you peacefully participated in a political rally.

Vik Khanna is a healthcare consultant and writer in St. Louis, who is author of the forthcoming ebook, Your Personal Affordable Care Act: How to Avoid Obamacare.

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    • Ralph: thanks for pointing to that section of the ACA, which reads as follows: ‘‘(b) WELLNESS AND PREVENTION PROGRAMS.—For purposes of subsection (a)(1)(D), wellness and health promotion activities may include personalized wellness and prevention services, which are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants, and which may include the following wellness and prevention efforts:
      ‘‘(1) Smoking cessation.
      ‘‘(2) Weight management.
      ‘‘(3) Stress management.
      ‘‘(4) Physical fitness.
      ‘‘(5) Nutrition.
      ‘‘(6) Heart disease prevention.
      ‘‘(7) Healthy lifestyle support.
      ‘‘(8) Diabetes prevention.

      My reading of this and subsequent text is that it is intended to prevent data collection by plans and providers engaged in organized prevention and wellness programs. It will probably take a court case to determine whether it applies to EMRs/EHRs used in the episodic care of patients.

  1. I agree that Med Records are possibly a critical upcoming gun rights battleground, but without transparency including a review/correction option, the public will never know what is in their records at all.

    I believe state-level initiatives to make each person’s record open to review and correction by the person might be the best first stop. Notifications for each viewing and/or transmission of the data would also be a good thing, although it’s probably impossible to do anything about it after-the-fact.

  2. I could see how this could all be a problem… That said, it’d sure be nice not to wait months for my county to get my medical records. It’s the loophole in NC’s statutes that lets them drag their feet as long as they want. I’m supposed to call them at 60 days to see if they’ve gotten my records in the mail yet? C’mon.

    • Request a hard copy of your latest medical records. Always insist on a hard copy of any medical records, lab results, etc. Buy a bound notebook and tape them into it. Add to that notebook your own narrative of what happens at doctor visits, clinic or hospitalizations. Record what medicines and supplements you regularly take. Add anything else you think might help another doctor or medical professional help you.

      Make any corrections necessary, and demand that your next provider READ your records as you have preserved them.

      Do NOT depend on any records kept by the doctor or other providers. Those records are being kept for their own use, protection and to satisfy their payers… you are dead last on the list of priorities.

      Take care of it yourself. I spent 30 years as a registered nurse and advanced practice nurse. My own personal medical records are the only ones I trust.

  3. The Second Amendment is the freedom canary in the tyrannical coal mine. The reason the enormously fraudulent push by a few moneyed elitists to remove 2A is once it is gone whatever freedoms remain will fall in short order. We are approaching an America without any rule of law.

    • The 2nd Amendment is hardly the canary… fact that’s so false that while much of the rest of the Bill of Rights has been shredded, the 2A remains alive but in serious distress as it has become clearly a privilege and no longer a Right. But at least it still survives, unlike much of the rest of the Bill of Rights.

      • I think the 2nd Amendment is more like a guard dog. The 10th and 4th amendments are the canaries in the coal mine.

        The guard dog is still barking, so maybe we haven’t lost everything yet, but I think the canaries are comatose by now; maybe they’re not dead, but if we don’t turn this mine cart around soon, they will be.

  4. Yep we’re all screwed. Keep your powder dry…and never ever go get anything like mental health treatment.

  5. It is actually much worse than that.
    Case in point. It is illegal for any IRS employee to disclose private taxpayer information. But we all know that the IRS under Bummer released tax records for thousands of political enemies for personal and political gain.
    So you can expect that once all medical records are on a single federal database, that an illegal donor match matrix will be put in place to match the wealthy donors and ruling class to have pre-identified organ donor matches. When they need an organ, the donor determined to be of least value to government will have a fatal head injury.
    Look for HHS to follow through with declaring that all organs belong to the government when someone dies. recall that several democrats have already taken this position publicly.
    If gun owners are listed, that information could also be sold so that criminals know what homes are safe to break into. This happened when a news paper published a map of gun permit owners. The criminals thanks the paper for making their jobs safer.

  6. I’m not terribly concerned with someone knowing I’m a gun owner. In today’s electronic “google everything” age, I think we all need to accept that any two bit hacker, let alone the federal government, can know pretty easily if we own firearms. What we need to avoid at all costs is a registration, where the government knows exactly WHAT we have. That would be the beginning of the end for this little freedom experiment our founders created.

    • Sadly, this is entirely correct. They can data mine and get a pretty damn good idea of what you may have. I agree, if it comes to registration, then that’s precisely the time to resist in earnest.

      Of course, it helps to resist every step leading up to that as well.

  7. As someone who works in IT in the Healthcare field EMR is terribly implemented far too often. While there are a lot of benefits to doing EMR, healthcare is a bad on following IT security and best practices. Far to often doctors have more sway over IT on policies and procedures and security suffers for it. Not ever hospital and clinic is like this, but more often than not, IT is ruled by the doctors.
    There are so many ways mistakes can be made and your data can be sent to the wrong person or company. Someone I knew had their entire medical history and personal information including SSN set to the wrong doctors office as the nurse put in the name of the clinic wrong. This was a major HIPPA violation, but stuff like this can happen accidentally, let alone malevolently.

    • Happens with paper records, too. Lab results faxed to the wrong doc, chart notes mailed to the wrong referring doc, etc. EMRs solve nothing, are cumbersome and inefficient expensive messes, but *DO* allow much easier gov’t access than a paper chart.

      And, btw, it’s spelled “HIPAA.”

  8. When applying for CHL completed the forms, signed and in except one: authorization to access my medical records. I did not sign & send in that one. Received my CHL 30 days later. My medical history is between me, my doctor & private health insurance company.
    If I can pass NICs background check to purchase a gun, and have many times. That should good enough in and of itself to get a CHL.
    Don’t need unelected pencil pushers to know my business. If the right to privacy is in the Bill of Rights, on which abortion legalization was based then to violate my gun owning rights would make abortions again illegal. How do you think liberals would like that? Guessing about as much as I like their infringement of my 2nd. amendment rights.

    • Wise move. I’m a Registered Nurse. My health records get the same confidentiality as yours. But when I renew my license I must answer several health related questions, and that information becomes a public record. The board of nurses needs to protect patients, but if I get treatment for depression after my parents died, that is a permanent and public record once I renew, and follows if I move to another state.

  9. There is a much greater danger lurking here. Almost anyone could obtain a copy of our records and use them for nefarious purposes. The perpetrator could be a disgruntled employee (with nominally legitimate employee access) who wants to create havoc. It could be a corrupt employee (with nominally legitimate employee access) who seeks to profit handsomely from the sale of the information. It could be a healthcare, insurance, or government lackey (with nominally legitimate employee or government access) who seeks to use the information to attack their political enemies. Of course the perpetrator could also be a hacker working for another nation, organized crime, or who knows what else without nominally legitimate access who uses the information to harm us. And, the perpetrator could be an employee of the records management company who uses “backdoor” access to use the information for any number of illegal or unethical reasons.

    We all should demand an end to these massive electronic databases. Multiple pillars of capitalism with both a profit motive and legal repercussions for failure (mega retailers and banks) have failed miserably. Why does anyone think other private enterprises (medical practitioners and medical records companies) or government would do better?

  10. The thing that I am spring-loaded about are all the questions about my mental state. I have been seeing the doctor lately for my arthritis. When I fill out the questionnaires there are always questions such as, “does this illness make you feel depressed?” Or “have you considered getting counseling about your feelings?” I always answer no or leave the entire section blank.

  11. Well so long as your doc doesn’t know your a gun owner,,,,,, Hell if asked I would lie to any doc asking. It’s none pf their business. IMHO

  12. Why would Uncle Sam delve into ones medical records, when a subpoena’d copy of the targets debit card transaction statement will suffice?

  13. Bravo. Excellent article. And as the writer correctly points out — this isn’t just about guns at the end of the day.

  14. The most important concern is the violation of our fourth amendment that will lead to the violation of our second. Isn’t it sad that most people are accepting to give up their rights and just assume that is how it works. The Art of War teaches not to be prepared for if the enemy comes, but instead to be prepared for when they eventually do. The Army combat troop book also says if your enemy opens a door rush in with extreme prejudice. This is such a dangerous situation because Americans are going to get killed by the state sanctioned thugs for trying to get help with a problem they may have had. An individual assuming personal responsibility to fix a shitty situation will now be an American that has had a green light put on them to be murdered in the wee hours in their own home, that is not the american way. The irony is that they payed for their own execution, while they thought they were paying for a solution to a problem. I have a chosen Brother with PTSD which he acquired being an American Warrior and killing over two hundred enemy combatants with intimate close contact not drones, and of course he is a little messed up but he can compartmentalize very well. He is a very successful man and he would sacrifice all of that and his life, if the country he fought for as highly decorated special ops warrior would do exactly this to him for seeking help. There is nothing wrong with him except for the occasional full on operator mode when undesirable folks try to come around us. One small story I’ll share with yall. In Gulf War one my buddy has a picture of a Russian Hind chopper bearing in on his men and the next picture is him with his pants soaked in urine standing in front of the burning chopper. The Iraqis obviously didn’t see the Apache behind a tent, and only knew it was there after the pilot’s 100 yard dash to it and dropped them with 20mm nose gun while it was still on the ground. You know but this guy could be deemed too dangerous to exercise the rights he fought and killed for because he had issues as a Christian who is responsible for killing more humans than some diseases have. I helped him understand and history has shown that we Christians can kill and still kneel before God, we just can’t murder. He never killed innocent people and had every right to kill the evil scum he has. God forbid though that he wanted to talk to someone for some guidance and ends up getting left behind. If any of you think that is right you need to get to the nearest border and cross it, because you are not our countrymen.

  15. After a few years of travel nursing I’ve seen many variations of EMR’s in emergency medicine. My experience is that the various and incompatible EMR’s are so highly structured that they actually impede sharing of information. Too many mandatory check lists that don’t allow for something not listed. I also felt like the records were neutered to become useless if the hospitals were sued and records subpoenaed. They’re a flipping mess!

  16. If they ask me if I own a gun I will refuse to answer and if they refuse me medical treatment I will sue and take the case as far as I can.

    • Sue for what? You do not have a right to health care. Like any other business, they can refuse to serve you for any reason (except inability to pay, lulz).

  17. Bottom line is if your physician asks if you are a gun owner, it’s time to inform him/her that you are seeking another provider. It’s really that simple.

  18. 27words.
    So you think the government doesn’t already keep track of every NICS check?

    All of you are part of mega data. Me too. Ever buy a firearm or use a cc to buy hunting accessories(scopes etc)? Or better yet, ammo?

    You are already there. I see many boating accidents in our future.

  19. The last time I was asked about firearms by the medical assistant I refused to answer the question. I suspect my doctor knows anyway since I have been going to her for 30 years and she knows where I worked all that time. My dentist knows for sure and always asks me what I am carrying today when I come for an exam.

  20. What I would keep an eye on is not so much doctors asking
    if you have guns but whether someone in government will
    slip in a provision that will allow doctors to view ATF and State
    records regarding purchases or CCWs.

  21. I have heard that soon your doctor will be required to ask you (his patients) if they own any guns or not because of Sheik-O care, but I’ll be damded if I have to be truthfull about it. I have been preaching for decades that this country is a changing, and not for the better either. But I always get the last laugh unfortuneatly. My son for instance thought nothing old dumb ass dad said could possibly come true when I had been telling him for years that he had better stock-up on some ammo but naaaw he knew better. Never seen someone like him have 50+ guns and not a box of ammo but for probably 2 of them that he was going to go shoot the next day. I said many times “there is a second amendment alright but show me where it says that someone had to make available ammo for them as per our constitution & bill of rights”. But after “the scare” came he got wind of what I was talking about, and that was just the first round, whats gonna be next? Oh he is still standing firm about me warning him that he is gonna regret using that stupid plastic to buy ‘certain things’ that its just no ones bunnus to know how much you have or know at all that you have it reguardless of our rights or laws considering our so-called leaders have little or no reguard or respect for “that piece of paper that those old men wrote so long ago that has little to do with todays world” as they call it not my words because they run over it like a lawn mower over grass when it suits their agenda. How many people know that when Sheik-O was a junior senator one of the very few things he tried to get through was a bill to raise the price of ammo 500% per-round? So I hope my doctors can get over me being less than truthfull with them when it concerenes anything but my health matters.

  22. It’s times like this that I wonder if we’d be better off if the United States went bankrupt and fell apart. There’s so much awful stuff that’s been screwed up by the federal government over the last century that I don’t know how it would ever be possible to undo it all.

    health insurance laws drug laws gun laws unconstitutional search laws eminent domain laws civil forfeiture laws environmental laws repeated wars militarized police financial bailouts federal reserve retirement laws income tax laws labor laws campaign finance laws federal education laws etc. etc. etc.

    A giant, unfixable mess.

  23. An awful lot of misinformation in this article. Virtually all of the rights you imply you do not have (“Why don’t I have a right to…?), are actually guaranteed rights under HIPAA. You should actually read your doctor’s Notice of Privacy Practices for more info. I will be the last to claim that there are not problems with medical records – paper and electronic – but you actually now have many more rights regarding those records than you used to have. PS: I don’t answer the guns question either.

    • HIPAA does provide for consumers to see and correct their medical records, but it is not a seamless process and it requires people to be very proactive. For example, after you see a provider you have to ASK to see the electronic version of the record. Even after HIPAA updates in 2013, there is still no restriction on health information being used by government agencies “To protect the public’s health,” which has generally applied to tracking of infectious diseases but could be construed much more broadly. Personal health data cannot be sold for marketing purposes or transmitted to employers, but those restrictions would not, at least to my eyes, keep data out of the hands of academic institutions and even private consultancies that buy federal databases for their projects. Finally, I did not say people did not already have the right to see this information; my beef is with the ease and tranparency of the process.

  24. As a career security professional, I would be extremely concerned about ANY medical information being held by the Feds in electronic form. Can you name ANY government data store that has NOT been hacked into?

    Take your time…

  25. Your personal medical information is ALREADY available to law enforcement at federal level, which means sharinfg at local level via fusion centers. NSA and DEA have provided information to federal and local cops from information collected under the Patriot Act that would normally have required a warrant, so the cops could use it, while devising “parallel construction” to cover their tracks later in court to use as evidence.

    Now, understand who is building the EMR data collection for ObamaCare. And be warned.

  26. If you can forgive my religious diversion, let me warn those out there who are Christians and look at things from a Biblical end time perspective. The Mark of the Beast, the increase of knowledge in those times, and the ability of the Anti-Christ to target those who will not worship him all tie in nicely to the databases used against us, as EHRs will surely do. Don’t willingly submit to any type of registration.

    As mentioned above, please name a governmental database that has not been hacked or misused…
    So assume that whatever gets put down in a database can come back to bite you later.
    Be a gray man, be unobtrusive, be unremarkable (too late for me with this posting).

    My advice is to not answer (or lie) about firearm ownership to protect yourself from the medical inquisitors (and this is coming from someone who works in healthcare and health informatics).

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