November 16, 2005: In the wake of polls
showing most Americans have privacy worries as their
personal health data goes electronic, consumer groups want
lawmakers to ensure that the ultimate control over medical
records remains in the hands of the patient. Congress is
considering a proposal to build a national Health
Information Network, but two patient groups -- the
Electronic Privacy Information Center in Washington and the
Austin, Texas-based Patient Privacy Rights Foundation --
told United Press International that the measure is still
weak on privacy safeguards.
The groups say that the following
protections should be included in the nascent health
information network: The patient should determine who can
see and use his or her medical records. The patient should
not have his or her medical records seen or used by an
employer. The patient should not be forced to give up
privacy to get medical treatment.
The 21st Century Health Information
Act, sponsored by Rep. Patrick Kennedy, D-R.I., is the only
bill currently under consideration in Congress that allows
people to opt out of being part of a national health
database.Patients have the option of allowing only
designated healthcare providers to access their individually
identifiable information concerning diagnosis and treatment
of sexually transmitted diseases, addiction and mental
illnesses. REp. Kennedy said that Health IT is the
inevitable wave of the future, but reassuring a nervous
public is a cornerstone to its success.
Despite their concerns, consumers
generally had a favorable view of new health technology --
59 percent were willing to share personal health information
when it could result in better medical treatment.
May 7, 2005: An article in the Lancet
(The Lancet 2005; 365:1610-1611) states that the USA's
electronic medical records system is "a muddled collection
of disjointed parts". Mark Leavitt, medical director for the
Healthcare Information and Management Systems Society (HIMSS)
considers “There has been no incentive for [providers] to
share data and really no incentive for vendors to build
interoperability into their products because the customers
weren't asking for it”. David Brailer was appointed by
President Bush last May as the country's first National
Coordinator for Health Information Technology and has set
out a framework for Electronic Health Records (EHR)
development and is now assimilating 500 suggestions from
stakeholders into a complete strategic plan for a national
health information network. A Presidential Commission on
Systemic Interoperability is slated to produce its own
comprehensive strategy by October.Brailer considers that EHR
technology is "prohibitively expensive for small physician
practices. While hospitals and larger practices have the
capital to invest in EHR-supporting technology, physicians
in smaller practices are reluctant to spend the up to US$36
000 per physician necessary to purchase a system, and are
receiving little help from payers which view these
investments as business overheads rather than part of
patient care". Brailer is working on ways to encourage
payers to contribute to EHR purchases. Leavitt chairs the
Certification Commission for Health Information Technology
that is sorting through the vast array of available EHR
software to certify which systems meet specific standards,
including interoperability. Current EHR systems are not only
expensive, but also require a major change in the way
practitioners work, resulting in "a marked increase in
physician work load as they convert from paper to screen".
Dave Garets, CEO of the research arm of HIMSS, comments that
widespread adoption of EHRs in the USA will occur when
system prices drop to a level individual physicians can
afford. Robert Tennant of the Medical Group Management
Association, argues that the Bush Administration needs to
invest more money in EHR and says that “The primary
beneficiaries [of EHR cost savings] are going to be the
health plans”, in the form of reduced procedure redundancy
and improvements in chronic-care management. Patient privacy
is not receiving high enough priority according to Janlori
Goldman, director of the Health Privacy Project. Proponents
argue that well-designed EHRs are safer than paper records
because they can be encrypted, will require passwords, and
provide an audit trail. Goldman counters that the magnitude
of harm with a paper record passing through the hands of a
few individuals is small compared with the potential injury
associated with private medical information moving through
cyberspace and that HIPAA rules should be strengthened.
Privacy concerns derailed earlier efforts in the USA to
establish unique patient identifiers, making it more
difficult to use EHRs to develop a national database for
clinical research. Nonetheless HIMSS' Leavitt says the
current regional approach to patient data collection and
storage still holds huge promise for research improvement as
EHRs expand. Large collections of anonymous data could
simplify the process of feasibility studies for clinical
trials by identifying populations with specific conditions,
Leavitt says. Countries that are farthest along are those
with more centralised health systems, comprehensive
strategic plans, and the willingness to make the necessary
investment. Leaders include many European countries, Canada,
Australia, China, South Korea, and Japan. US health
technology advocacy group eHealth Initiative calls the UK
EHR campaign “the largest-scale initiative underway in any
country worldwide”. The goal is to have online records for
50 million citizens, with connections between all physicians
and hospitals by 2010.
