Medical records system is open to abuse by insurance companies, paper reports

Medical records system is open to abuse by insurance companies, paper reports
Federal health minister Maggie De Block © Belga

The system of keeping patient medical records electronically is being abused by doctors representing insurance companies battling damages claims, according to a report by De Morgen.

Federal health minister Maggie De Block has admitted the problem, and is calling for a tightening of restrictions on who can access medical records.

The paper details how patients who have insurance claims pending have discovered that their medical records were consulted by doctors representing the insurance companies who are able to access the records thanks to the rather lax controls in operation. In one case reported by the paper, the patient was surprised to find the insurance company knew a great deal about her medical history, and it was revealed that her own doctor had been retained by them and was able to fill them in on her condition.

The electronic records system has its benefits, by allowing access to medical information by medical professionals other than the patient’s own GP. The system makes it easier for specialists, for example, to be fully informed of a patient’s history without ever having treated the person before.

But the way doctors access the records is open to misuse, De Morgen claims. The system by which the chief medical officer of a hospital or hospital group is able to check on who is using their access correctly or otherwise should protect patient confidentiality, but is rarely enforced properly, simply because CMOs have so many other things to do. Meanwhile insurance companies with deep pockets engage the services of doctors to help them fight insurance claims, even when that represents a conflict of interests for the doctor.

Now Maggie De Block – herself a general practitioner -- has called for a review of the system. Her service is aware, De Morgen writes, that the system is not working as the theory says it should, and that the rules need to be adjusted.

If this [report by De Morgen] is true, we’re talking about fraud,” spokesperson Tijs Ruysschaert told the paper. “The minister is able to sketch out a policy, but it is up to the players on the field to apply the rules. And if they don’t, then some measures have to be taken.”

The entire system has to be reviewed and adapted where necessary, the ministry recognises. “It is clear that certain digital systems need to be brought up to speed. And there is also a need for more information about electronic patient files, because there is still a lot of ignorance and unclear information around.”

However the value of such a system is such that any change can only be minimal. “The digital files are not the origin of this sort of misuse, although they can make it easier,” the ministry says. “The guilty ones are the doctors who abuse the system.”

Alan Hope

The Brussels Times

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