Another Thought on Electronic Records

>> Monday, June 22, 2009

Alright, I'm going to say this and then I'll finally shut up (for at least a little while) on healthcare.

I think electronic records are very important.

Now there are two impediments to widespread electronic records, and they're related. The first is privacy - people want to make extra extra sure no one can take a look at their medical records, that the privacy is maintained. Largely because of very strict privacy regulations, electronic records are much more expensive to implement than they ought to be.

I don't quite understand the privacy thing. Sure, the records should be private, but the harm of that information getting out is...what? Aside from the fact that most people are almost too ready to tell you about their medical travails in excruciating and unsolicited detail, what's the motivation? And what can they do with it?

Sure, teenagers may not want their parents to know they had an abortion or someone may not want their employer to know they have aids, but most employers and parents are supremely underqualified to hack into even the least guarded systems. The odds of someone who could hurt me with my medical information having the skills (and motivation) to look at the results of my pap smear are infinitesimally small as opposed to, say, the benefits to getting all of my bank account and credit card information, which they can do by hacking into my bank - and, what do you know, all banks manage to use electronic records. The only real motivation I can see is to try to sell you tailored medical supplies, but I fail to see how that's more irksome that the omnipresent "increase your manhood" and "drive the girls crazy" and cialis spam. (I have no interest in increasing my manhood, thank you).

Ironically, the folks that can do you the most harm with your medical information are the ones we give it to: health insurance companies. They DO use that information to up premiums and refuse coverage.

I've mentioned reasons why I think it's important on an individual basis for us to have electronic records, but there's another potential use that we could use to our advantage (instead of for the health insurance company's advantage as it is currently being used): real statistical data.

Right now, effectivity of a drug is determined by clinical trials, usually run by the drug company. Ideally, they'd have a large base and run double blind controls, etc. etc. But there have been many instances where the tests were not as extensive or as objective as they could be - which shouldn't be a surprise. Big pharma is a multi-billion dollar industry and a promising new drug can make billions by itself.

But, statistical (anonymous) data were automatically captured and sent into medical databases that anyone could use, we could see real trends rather than arrange for a group of people to test theories. We could see if a drug wasn't working as planned or if it caused a statistically significant jump in some other condition as a side effect much more quicky and more objectively than anecdotal evidence sent in to the FDA or drumming up a class action suit that may or may not have any real merit.

In fact, that might be a fine way to screen class action suits (as part of tort reform) before they cost the accused a dime - if they don't meet a certain statistically significant threshold, the class action suit is thrown out. No more settling for millions to avoid the publicity whether there is merit in the accusation or not. But the suit is also much easier to prove with the objective evidence to hand.

But it's bigger than big pharma. We can check the efficacy in real world conditions of different treatments and diets and regimens. We might be able to find other factors that lead to heart disease and autism, that trigger cancer or obesity. We might change what we know about our tools and tests. Because that information is already there - we just don't have a comprehensive way of accessing it for our good.

Believe me, that information has been accessed to our detriment by those most likey to profit by it. Wouldn't it be nice to have it collected for our good?

And that's why I think electronic records are worth the trouble, worth the risk, worth even subsidization to have.

Now, the Mother can step in and explain why I'm all wet.


  • The Mother

    Not all wet. I agree with the significant advantages of e records.

    As I have pointed out several times, the govt itself is responsible for failure of implementation, because of the massively misguided and terribly difficult HIPAA rules.

    Nonetheless, there are significant privacy concerns.

    First: yes, your current insurance carrier can already get aspects of your medical record. But it isn't blasted all over cyberspace, and so it's not quite so easy for a prospective carrier to notice that you have the BCR-2 gene, and therefore deny you coverage.

    Second: there is a potential for misuse of the information. One of the concerns is with employers, who could, theoretically, check your record to decide whether they want to hire you. Not a problem? Well, what if you've been on antidepressants or antipsychotics? What if you have that BCR-2 gene, and they decide they don't want to take the risk of training someone only to have them face life-threatening illness at a young age?

    These are only some of the concerns. In a perfect world, everyone's records would be available to every doctor and no one else.

    But this isn't a perfect world, and bad things happen in cyberspace. Thus the serious concern over privacy issues.

    And the massive expense of implementing e records, coupled with the liability should there be a hijacking, are the reasons that most docs haven't done it.

  • flit

    So much of people's info is already available one place or another - it seems a shame to allow fear to prevent an actual POSITIVE use of information

    I'm reminded of the case of a woman whose search engine queries were released publicly - amazing how much one could tell about a person just through that

  • Relax Max

    A potential employer doesn't have know how to hack into other computers. People already do that for a living and then sell the information. And employers use them everyday, don't think they don't. Especially for executive background checks.

    But the main reason is simple privacy, which you keep blowing off as really unimportant. If I don't put the government in charge of everything in my life, then they don't need to know much about me.

    What was the advantage again? The ability to run accurate medical experiments and conduct new product surveys? Sorry, not worth it. The only advantage I see is to avoid duplicate treatments and to make sure there are no conflicts in the medicines that are prescribed. And that can be accomplished simply by giving the patient records to the patient. Since most patients would lose them, my second choice would be to establish a central medi-data bank that authorized care-givers could access on the computer. Not separately in every hospital and clinic in the world. All the patient has to do is give the password for his records in that database to his new physician.

    I know, I know. They would soon forget their password too.

    Why do you think this is something else the government should be in charge of? Just because they are big enough to make us do it? Like handicapped parking spaces? I forgot.

  • Relax Max

    Well, now you are going to think I don't believe the government is the ultimate answer for everything.

    I mean, what is wrong with you and I and 100 other investors saying, "This needs to be done. Let's not wait for the government to screw it up." And the construct such a data base and start building it until it is large enough to be a useful tool and people (Hospitals, etc.) would start buying memberships to use it.

    Don't scoff, that's what the 3 credit bureaus did. And now they know all about you and sell your information every day. Is there anything worse than that?

    Yes, the government being the credit bureau would be worse. :)

  • Relax Max

    I KNOW a central data base is what you advocated. Don't yell at me.

  • Stephanie B

    Yes, yes, I'm always abusing YOU, Relax Max.

    I don't know that it has to be government but I absolutely don't want anyone with a profit motive involved. One could do it with an FFRDC, but you probably wouldn't see that as different than the government where I think this whole making-money-from-people's-suffering-without-actually-helping-medically is a nightmare.

    And government-run healthcare WORKS. Check the stats on WHO.

  • Relax Max

    What do you have against capitalism and competition? Why does it always have to be a monopoly with a subsidy? Anything government can do, the private sector can do better. Let the government do it's jog: regulate the greedy part of capitalism. And stop trying to decide what I need.

  • Stephanie B

    Now, why is it that people who don't want something want to keep me from having what I need? And millions of people just like me?

    What I have against competition is that people are doing things for the wrong reasons. When greed is the motivator, well, look at the mess right now. See what happens?

  • Stephanie B

    And I have no problem with competition/capitalism for things that aren't life and death, with things that aren't necessary for life. But when people die because someone else is greedy and the argument is not to take away their profits or it's unfair, it pisses me off.

    If competition is so damn good, it should be able to compare favorably with a public option. If it can't, I guess it won't be missed.

  • Relax Max

    I'm all for Universal Health Care. I am all for you having what you want. I just don't think the government is the answer. And the more "life and death" a thing is, usually that is a sign to leave the government out of it. Whether you like it or not, excellence most frequently springs from the possibility of personal gain, not from bureaucrats writing procedural manuals. The real question is, do you want health care for everyone or do you want EXCELLENT health care for everyone? Let government do what it does best: regulate the cheaters and the price fixers and the gougers and the bean counters; then watch the private health industry soar - super service at prices lower than the government could ever imagine. The name of the game is TRUE and HONEST competition - ensured by the government watchdogs and Department of Justice. And I don't mean like the banks and the oil companies and the current insurance companies. Don't let your government be as lazy as you have let them become. Their laziness and unwillingness to do their job caused the current financial crisis. "The fix is in" can no longer be our corporate motto. This country was founded on Capitalism and competition. Don't settle for government mediocrity. You can have your cake and eat it too.

    You donate your time right? I mean, you work for free?

  • Stephanie B

    I've seen how much government agencies that can be effective can be corrupted by private contractors. However, that's just my opinion. I won't tell you yours is wrong, but I feel there is ample evidence that it isn't. Implementation is the key, and I don't disagree the record is, at best, spotty. But then I know a number of government agencies which quietly do a superlative job under the radar of regular people.

    And I do make a salary, a fine one - I get paid for the work I do, but I gave up another job because of conflicting interests. I was willing to take a salary cut to work in a job where I was not conflicted, where I did not feel penalized for telling the truth.

    I'm very fortunate I didn't have to.

    Oh, and I work for a not-for-profit company.

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