Wednesday, March 24, 2010

Healthcare Legislation to "Control the People?"

At "AMA And Almost 100 Physician Societies Sound Off To CMS On Health IT" I referred to concern held by AMA and ~94 other medical specialty societies about comments overheard from senior government officials that:

complex measures and high reporting thresholds are needed to discourage EP's - Eligible Professionals (i.e., eligible for government EHR subsidies) from switching back to the use of paper during this transition to EHRs.

Such reporting requirements could not only 'discourage' a switch back to paper even if these 'government-approved' EHR's turned out to be a clinical and/or operational nightmare (which I feel is likely if not unavoidable based on numerous writings at this blog and here), but also could force event those planning to stay with paper and endure the "penalty" for doing so to move to computer systems. The human resources required to satisfy truly ominous reporting requirements via paper records might simply be too burdensome.

This could be perceived as an ingenious and devious plan to establish control of healthcare providers via IT and data. (He who controls the data, controls the playing field.)

Privacy activist Dr. Deborah Peel shares related concerns as expressed in a Wall Street Journal article yesterday "Your Medical Records Aren't Secure."

Along the lines of control, now there's this, recently posted on the Drudge Report:

Shocking Audio: Rep. Dingell Says ObamaCare Will Eventually ‘Control the People’ (link)

I don't care which "people" Dingell's referring to - 300 [sic] Americans (he left out "million"), physicians, insurers, etc. Our government has no business discussing "controlling" anyone.

Ideology aside, the control mentality of government over medicine, facilitated by healthcare IT, is starting to rear an ugly head. I'm afraid this phenomenon might get really out of hand in the very near future.

-- SS

Addendum: there appears to be a healthcare IT industry sockpuppet writing in the comments thread at the aforementioned WSJ article by Dr. Peel, under the especially inappropriate nom de blog "Hank Dagny." The usual dismissal of physician concerns about HIT, unqualified statements, ad hominem attacks, and other games typical of an industry shill occur throughout that comment thread.

See my reply at this link. (It takes a moment to load the WSJ comment thread.)

Also see this summary of a Canadian analysis of electronic health record security at the blog of security technologist Bruce Schneier. Hat tip to Joseph Arpaia, MD.


Anonymous said...

Dr. Peel notes in her article that 12.5% of patients are not going to the doctor, refusing test, asking test results be changed, or paying out of pocket to protect privacy.

What happens in the future if:

Doctors are mandated electronic records only. No paper.

The IRS following its mandate to monthly review personal financial information finds medical expenses in person’s personal financial records.

Both of these situations could be devastating to a family. A couple of years ago my then doctor was going to an EMR. I asked if he was going to miss the sticky note in the front of the file, deer in the headlights. He would never withhold medical information from the insurance companies, and his records were open to all who had a reason for review.

All I could think about was the number of people who sought medical advice after an indiscretion and how this would destroy a family. This is only the tip of the iceberg of situations where discretion is paramount.

12.5% now, what will be the number in the future?

Steve Lucas

Joseph Arpaia, MD said...

Here is a link to a post on security issues in healthcare IT.

MedInformaticsMD said...


Thanks for that link.

Here is what might be described as a law of computing:

- If you want information to be secure, do not put in on a computer.

- If you must put it on a computer but you still want some level of security, do not put the computer on a network.

- If you put the computer on a network, the information is no longer secure.

I've also written about the IT security mayhem in medicine and in other industries at this blog, such as here: Networked, Interoperable, Secure National Medical Records a Castle in the Sky?

-- SS

Anonymous said...

I cannot be 100% certain what John Dingell actually meant by his statement, but I have an alternate take on it. It is a clumsily-worded statement (for example he refers to covering "300 people" (rather than 300 million)and surely is unfortunate phrasing, but what I think he was referring to was how difficult it would be to put all the apparatus in place to implement health reform. By "control the people" I believe he may have been referring to the administrative apparatus, not to controlling American citizens. Has anyone actually asked Rep. Dingell to explain his remark? I can't find a reference to any response by Dingell.

My transcription of his exact quote (in context) is:

"It takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people. ...Republicans have spent a long time not participating, not helping, carping and delaying, but at the same time, they have contributed nothing to this and made no offer whatsoever as to what it is that they want and what they stand for."

It is fascinating to see how this has been reported by the right-wing media. They have seized on the words "Control the People" and preceded it by whatever they felt like inserting (e.g. "Obamacare" or my favorite, "Commiecare"). There are thousands of examples, but I present just 6.

Shocking Audio: Rep. Dingell Says ObamaCare Will Eventually ‘Control the People’

"Obamacare will control the people"

"In Their Own Words: Rep. John Dingell on How Long it Took “To Control the People”

"Dingell: It will take some time for ObamaCare to control the people"

"Rep. John Dingell (D): Healthcare Law Will "Control the People ..."

"Dingell Says Commiecare Will Eventually “Control the People ..."