Electronic Medical Records - Pro or Con?
For this weeks blog I’m going to go back to my old life and put on my political hat to talk about electronic medical records.
If you’re one of the many looking for change between the Bush and Obama Administrations, you won’t find it when it comes to the government’s push to replace patient charts written and kept in a hospital or doctor’s office with Electronic Medical Records. The Bush presidency made it a high priority to convert the nation’s medical records to electronic databases, and President Obama plans to stay the course.
The justification given for the $825 billion estimated expense of converting medical record-keeping from paper files to electronic files is two-fold. Advocates claim that electronic records will reduce overall health care spending and eliminate medical errors which cause more than 100,000 deaths annually. So far, neither claim has been proven. In some communities electronic medical records have been universally implemented on a trial basis, but no evidence has yet been published to substantiate either the claim of reduced costs or fewer deadly errors.
The special interests who are pushing for the mandatory conversion to electronic medical records are technology firms like Microsoft, specialty-software companies, and medical suppliers including pharmaceutical firms. Collectively, these companies spend tens of millions of dollars annually lobbying Congress. Federal Election Commissions reports show that the Obama-Biden campaign raised more money from these special interests than the McCain-Palin ticket. Why do these companies care about our medical records? Because they stand to reap billions of dollars in profits if the medical records of all Americans are made easily searchable through data-mining.
Here’s an example of how the system works today. Aggregate data on the prescription drugs doctors prescribe to patients is gathered in a database by the American Medical Association and access to the database is sold to pharmaceutical firms. The firms use software to determine whether your doctor is prescribing their medication, or a competitors’ medication, for a particular medical condition. The data can also be mined to see if doctors are “underprescribing” their medication for certain conditions like high cholesterol or diabetes or asthma, based on patient demographics such as age. Armed with this data, pharmaceutical firm sales representatives fan out across the U.S. to individual doctors to encourage them to prescribe more of their firm’s medications to patients. Data collected by Senator Charles Grassley (R-IA) in a lengthy probe show that pharmaceutical firms spend an average of $10,000 on every physician – often in the form of free travel to exotic destinations – marketing them to prescribe their products to patients.
Imagine how much more efficient this gigantic marketing machine will be when every medical supplier in the country, from hospitals to drug makers to makers of surgical implants, can data mine the records of every American. Every visit you make to a doctor, dentist, psychiatrist, pharmacist, and hospital could, and I think will, be scrutinized in a nanosecond. By matching your medical data with other consumer, lifestyle, and personal details maintained by credit reporting agencies like Experian, sales teams will be able to use your personal medical records to push doctors to sell you more goods and services. Perhaps it will improve your health; it will certainly increase medical spending.
But, it will also mean the end of your privacy. Everything you say to your doctor and everything your doctor does for you will be accessible to anyone with the keys to the database. Does your soon to be ex-husband, who is battling with you over child custody, have a friend who works in a medical company? He’ll be able to give his lawyer details about why your doctor prescribed an anti-depressant for you that will help make his case that you’re an unfit mother. Your snoopy neighbor, an office assistant at a clinic, will be able to see whether or not you’ve ever been treated for herpes. Sure, those who advocate electronic medical records will say safeguards will be put in place to safeguard against such snooping. But, safeguards haven’t stopped government employees from infringing on privacy by snooping into the State Department’s passport or IRS files. Online medical records will be no different. Congressman Ed Markey (D-Mass.) warns that it will be “a nightmare for consumers” without enforceable safeguards.
President Obama’s plan, according to the New York Times (Page 2, Jan. 18, 2009) has special problems with privacy issues. Obama has added creation of the electronic medical record system as a job-creation measure in his economic stimulus proposal. He is asking Congress to pony up $20 billion to subsidize the conversion. Obama’s goal is to computerize every American’s private medical data by 2014.
Insurance and drug industry lobbyists are rallying to pass the Obama plan. Their goal is to water down privacy protections when Congress enacts legislation. They will lobby for weak “opt-out” provisions for the sale of patient medical data – a right that will become meaningless if a medical provider makes treatment conditional on a patient opting-in for an office visit or hospital admission. The only meaningful privacy safeguard Congress could enact would be to allow patients to opt-out of being included in industry-searchable databases, with extremely stiff financial penalties and a low burden of proof for plaintiffs whose medical privacy has been compromised.
What does the Obama plan mean for the IBD community? It means that insurers will be able to scrutinize our medical records as never before, to evaluate each of us as a risk, which means, in effect, expect your insurance premiums to rise and for more of us to be denied coverage under a broadening exclusion of pre-existing conditions that database mining can link to IBD. Also, expect your personal physician to be marketed by medical sales people to push more products and services onto you. Be prepared for employers to access your medical records before deciding on promotions, and who to keep on the job and who to lay off. Anticipate that prospective employers will have found a way to review your medical history before a final interview or making a job offer.
Advocates would argue that by linking up the medical records of every IBD patient in the country, practitioners might find the best combination of treatments to help us. Researchers might uncover previously-unknown linkages that would open new avenues for treatment, lifestyle recommendations, or genetic and environmental triggers. Yes, these things may happen, too, if patient records are easily searchable with data-mining software. But don’t be fooled that the potential upside of electronic medical records is all we will get. The downsides are plentiful, and without comprehensive medical reform, the immediate impact will be a loss of personal privacy, higher insurance costs, and increased job discrimination against those with Inflammatory Bowel Disease.