AHA pushes for HHS review of data-gathering plan

The American Hospital Association called on HHS’ Office of Civil Rights to rule on the association’s position that a plan by the Joint Commission on Accreditation of Healthcare Organizations to gather certain hospital data violates patients’ privacy protections in the Health Insurance Portability and Accountability Act of 1996. AHA legal staff, outside legal counsel and the AHA’s chief liaison with the JCAHO met with the HHS office Wednesday.
The association has asked the JCAHO to abandon its plan to sell the data analyses through a for-profit subsidiary. AHA spokesman Richard Wade said the association would post a legal opinion supporting its position on its Web site today. “We could file a complaint, but we don’t want to be as confrontational as we could be here. But the Joint Commission is where it is and we’re going to keep our members apprised,” Wade said. JCAHO President Dennis O’Leary said the accrediting organization would never violate HIPAA privacy provisions and, in addition, has yet to decide whether to ask hospitals for patient-specific data. The JCAHO board will consider a policy on data collection and use at its board meeting mid-month, O’Leary said.

Press Release: Quality Advisory

In May, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced that it was selling analysis of accredited hospitals’ data to14 Blue Cross/Blue Shield health plans covering 29 states, and plans to expand its access to and use of hospitals’ patient-level data. For hospitals, this action raises three extremely serious issues and has triggered ongoing discussions between JCAHO and the American Hospital Association (AHA).

They are:

    • Health Insurance Portability and Accountability Act (HIPAA) compliance issues raised by JCAHO’s plans to seek patient-level data from accredited hospitals and its use unrelated to accreditation.
    • Necessity for JCAHO separately to collect patient-level performance data that duplicates the Hospital Quality Alliance’s efforts.
    • Apparent conflicts created when JCAHO, as an accrediting body, sells data analyses to insurance companies and other third parties.

During these discussions, significant differences in opinion have emerged over how the HIPAA requirements affect JCAHO’s proposed plans to access and use patient-level data from hospitals in its announced strategy to “over the long haul …[become] a purveyor of performance data analysis for a variety of purposes.”

States Want Congress to Act on Identity Theft, Data Security

Forty-six state Attorneys General are calling on Congress to help protect consumers from identity theft by enacting national security breach and credit freeze legislation. In the letter, the AGs point out that millions of consumers over the past year have been exposed to potential ID theft because of security breaches suffered by large financial and retail establishments.
The proposed laws would require businesses entrusted with personal financial data to notify consumers if their company’s data files are breached and allow consumers to put a credit freeze on their accounts.
In the letter, the AGs point out that millions of consumers over the past year have been exposed to potential ID theft because of security breaches suffered by large financial and retail establishments.
{We hope that these same state Attorneys General will fight for patient privacy protections and fight national legislation that will preempt stronger state privacy laws. ~ Dr. Deborah Peel, Patient Privacy Rights}

California HealthCare Foundation: National Consumer Health Privacy Survey 2005

In 1999, the California HealthCare Foundation (CHCF) released a groundbreaking study of Americans’ attitudes and behaviors concerning health privacy. The study found that nearly three out of four Americans had significant concerns about the privacy and confidentiality of their medical records. Six years later, following implementation of national privacy protections under the Health Insurance Portability and Accountability Act (HIPAA) and the President’s push to adopt electronic medical records, a CHCF survey plumbs consumers’ attitudes about the privacy of their health information.

Conducted by Forrester Research, the survey reveals that — despite federal protections under HIPAA — two in three Americans are concerned about the confidentiality of their personal health information and are largely unaware of their privacy rights.

In addition, one in eight patients reportedly engages in behavior to protect personal privacy, presenting a potential risk to their health. More than half (52%) of respondents are concerned that employers may use health information to limit job opportunities, highlighting the implications of the privacy issue.

Yet despite these concerns, consumers report a favorable view of new health technology, with a majority (59%) willing to share personal health information when it could result in better medical treatment.

As efforts to develop a nationwide health information network proceed, unaddressed concerns about personal privacy could have major implications.

Petition Demands Privacy for Electronic Health Records

Health information technology legislation is swirling around Capitol Hill this week, and there’s no shortage of recommendations of how it should be done.

Privacy advocacy groups began circulating a petition Thursday to bar employers from viewing patients’ health information and giving patients control over who can see what medical information.

The heads of the two advocacy groups who wrote the petition say that, designed properly, electronic health records can protect privacy better than their paper counterparts

That’s because, unlike paper files, electronic systems can show varying levels of information to different people as well as track who tries to access what information.

But such controls must be mandated from the start, said Deborah Peel, head of the Patient Privacy Rights Foundation.

Click here to read about how providers have come up short on HIPAA privacy compliance.

“If health IT is built without protections, then every American is exposed to the same kind of damaging practices that Wal-Mart is seeking to implement,” she said, referring to a recently leaked memo in which department store executives planned how to hire and retain employees likely to have the lowest health costs.

The petition being circulated by the Patient Privacy Rights Foundation and the Electronic Privacy Information Center states that patients should be able to choose who can view medical records, explicitly bars employers from viewing employees’ medical records and states that sharing private information should not be a precondition of receiving care.

Also this week, the Commission for Systemic Operability released 14 recommendations to ease the creation of systems that could instantly supply a patient’s health information when necessary.

The Commission, a bipartisan group created explicitly to advise Congress, recommended that anyone who knowingly attempts to obtain restricted information face criminal prosecution and that the Department of Health and Human Services figure out how to protect patients from the consequences of unauthorized access.

Though more explicit, these provisions are not so different from HIPAA, which states that employers will generally not be able to view information and lays out criminal sanctions and huge fees for harmful use of medical information.

Peel, however, said that the notion of who is authorized should be determined by patients. To avoid mountains of bureaucracy, the exchange of medical information for “routine use” need not be approved by or disclosed to patients. Peel said that this creates a loophole that thwarts HIPAA’s intentions.

Health IT could restore protections without crippling paperwork, she said. “Consent is a data field. People that design the system could easily put consent in.”

When he read the petition, Scott Wallace, head of the Commission, said that all the positions were reasonable and that none conflicted with the Commission’s recommendations, Ending the Document Game.

The Commission recommended that the government, employers, and health care payors should all offer providers incentives to connect information.

It also urged that policy makers and IT vendors stop squabbling about details and adopt national, consistent standards on issues like assuring patient identity.

However, Marc Rotenberg, head of the Electronic Privacy Information Center, took issue with the Commission’s recommendation that a national privacy policy should preempt state privacy laws.

“There’s a real risk that Washington can get it completely wrong. A bad bill that preempts the states could become an anti-privacy law.”

In that case, he said, individual states could provide a smorgasbord of possible solutions.

Wallace said that groups focusing on patient confidentiality can overlook the need to connect information, saying that actions required by some states are prohibited by others.

“Conflicting laws between those states stop my medical information from crossing the border. It is far more important that we have access to medical information than that we have states individually defining privacy needs.”

Rotenberg said information technology could be readily designed to adapt to different state policies. For example, appropriate codes and tags could be attached to data so that both data, and privacy protections, could travel with the patient.

But John Halamka, CIO and associate dean for educational technology at Harvard Medical School, said consistent privacy and security policies are essential to connect information, and such policies often extend beyond certain classes of data.

State laws that were reasonable before electronic systems now impede patient care, Halamka wrote in an opinion piece.

The ultimate privacy argument against RFID. Click here to read more.

“In Massachusetts, doctors can’t retrieve a complete electronic medical list from an insurance company, even with patient consent, if a medication related to mental health, substance abuse or HIV treatment is present.

“In Ohio, doctors must use a cryptographic electronic signature to prescribe medications electronically. In California, only paper forms are considered a valid patient consent.”

Peel did not see separate state privacy laws as essential, providing that current national privacy policies were strengthened. She warned that patients worried that their health information could be used to harm them would find ways to keep that information out of the system, even if it meant forgoing care.

In that sense, she said, the ability to protect information is a prerequisite for the ability to connect it.

“Information technology can bring us the best of both worlds. It’s not an either/or proposition, and it shouldn’t even be framed that way.”

Copyright (c) 2005 Ziff Davis Media Inc. All Rights Reserved.

Bill would lead to federal privacy standard for IT

HHS would recommend to Congress a single federal privacy standard to promote electronic medical records and e-prescribing, replacing state and federal laws, under legislation introduced by Rep. Nancy Johnson (R-Conn.). The bill also would set up a certification process to ensure health information technologies meet interoperability standards; direct HHS to revamp its 30-year-old diagnosis coding system; and require the HHS secretary to report to Congress within two years on the progress of the American Health Information Community initiative to develop a national strategic plan to implement a health IT infrastructure.

Earlier this month, the federal government proposed relaxing rules to allow hospitals and doctors to share IT hardware, software and training. Johnson’s bill would codify that effort.

Wal-Mart Memo Suggests Ways to Cut Employee Benefit Costs

An internal memo sent to Wal-Mart’s board of directors proposes numerous ways to hold down spending on health care and other benefits while seeking to minimize damage to the retailer’s reputation. Among the recommendations are hiring more part-time workers and discouraging unhealthy people from working at Wal-Mart.
In the memorandum, M. Susan Chambers, Wal-Mart’s executive vice president for benefits, also recommends reducing 401(k) contributions and wooing younger, and presumably healthier, workers by offering education benefits. The memo voices concern that workers with seven years’ seniority earn more than workers with one year’s seniority, but are no more productive.
To discourage unhealthy job applicants, Ms. Chambers suggests that Wal-Mart arrange for “all jobs to include some physical activity (e.g., all cashiers do some cart-gathering).”
The memo acknowledged that Wal-Mart, the world’s largest retailer, had to walk a fine line in restraining benefit costs because critics had attacked it for being stingy on wages and health coverage. Ms. Chambers acknowledged that 46 percent of the children of Wal-Mart’s 1.33 million United States employees were uninsured or on Medicaid.
Wal-Mart executives said the memo was part of an effort to rein in benefit costs, which to Wall Street’s dismay have soared by 15 percent a year on average since 2002. Like much of corporate America, Wal-Mart has been squeezed by soaring health costs. The proposed plan, if approved, would save the company more than $1 billion a year by 2011.
In an interview, Ms. Chambers said she was focusing not on cutting costs, but on serving employees better by giving them more choices on their benefits.
“We are investing in our benefits that will take even better care of our associates,” she said. “Our benefit plan is known today as being generous.”
Ms. Chambers also said that she made her recommendations after surveying employees about how they felt about the benefits plan. “This is not about cutting,” she said. “This is about redirecting savings to another part of their benefit plans.”
One proposal would reduce the amount of time, from two years to one, that part-time employees would have to wait before qualifying for health insurance. Another would put health clinics in stores, in part to reduce expensive employee visits to emergency rooms. Wal-Mart’s benefit costs jumped to $4.2 billion last year, from $2.8 billion three years earlier, causing concern within the company because benefits represented an increasing share of sales. Last year, Wal-Mart earned $10.5 billion on sales of $285 billion.
A draft memo to Wal-Mart’s board was obtained from Wal-Mart Watch, a nonprofit group, allied with labor unions, that asserts that Wal-Mart’s pay and benefits are too low. Tracy Sefl, a spokeswoman for Wal-Mart Watch, said someone mailed the document anonymously to her group last month. When asked about the memo, Wal-Mart officials made available the updated copy that actually went to the board.
Under fire because less than 45 percent of its workers receive company health insurance, Wal-Mart announced a new plan on Monday that seeks to increase participation by allowing some employees to pay just $11 a month in premiums. Some health experts praised the plan for making coverage more affordable, but others criticized it, noting that full-time Wal-Mart employees, who earn on average around $17,500 a year, could face out-of-pocket expenses of $2,500 a year or more.
Eager to burnish Wal-Mart’s image as it faces opposition in trying to expand into New York, Chicago and Los Angeles, Wal-Mart’s chief executive, H. Lee Scott Jr., also announced on Monday a sweeping plan to conserve energy. He also said that Wal-Mart supported raising the minimum wage to help Wal-Mart’s customers.
The theme throughout the memo was how to slow the increase in benefit costs without giving more ammunition to critics who contend that Wal-Mart’s wages and benefits are dragging down those of other American workers.
Ms. Chambers proposed that employees pay more for their spouses’ health insurance. She called for cutting 401(k) contributions to 3 percent of wages from 4 percent and cutting company-paid life insurance policies to $12,000 from the current level, equal to an employee’s annual earnings.
Life insurance, she said, was “a high-satisfaction, low-importance benefit, which suggests an opportunity to trim the offering without substantial impact on associate satisfaction.” Wal-Mart refers to its employees as associates.
Acknowledging that Wal-Mart has image problems, Ms. Chambers wrote: “Wal-Mart’s critics can easily exploit some aspects of our benefits offering to make their case; in other words, our critics are correct in some of their observations. Specifically, our coverage is expensive for low-income families, and Wal-Mart has a significant percentage of associates and their children on public assistance.”
Her memo stated that 5 percent of Wal-Mart’s workers were on Medicaid, compared with 4 percent for other national employers. She said that Wal-Mart spent $1.5 billion a year on health insurance, which amounts to $2,660 per insured worker.
The memo, prepared with the help of McKinsey & Company, said the board was to consider the recommendations in November. But the memo said that three top Wal-Mart officials – its chief financial officer, its top human relations executive and its executive vice president for legal and corporate affairs – had “received the recommendations enthusiastically.”
Ms. Chambers’s memo voiced concern that workers were staying with the company longer, pushing up wage costs, although she stopped short of calling for efforts to push out more senior workers.
She wrote that “the cost of an associate with seven years of tenure is almost 55 percent more than the cost of an associate with one year of tenure, yet there is no difference in his or her productivity. Moreover, because we pay an associate more in salary and benefits as his or her tenure increases, we are pricing that associate out of the labor market, increasing the likelihood that he or she will stay with Wal-Mart.”
The memo noted that Wal-Mart workers “are getting sicker than the national population, particularly in obesity-related diseases,” including diabetes and coronary artery disease. The memo said Wal-Mart workers tended to overuse emergency rooms and underuse prescriptions and doctor visits, perhaps from previous experience with Medicaid.
The memo noted, “The least healthy, least productive associates are more satisfied with their benefits than other segments and are interested in longer careers with Wal-Mart.”
The memo proposed incorporating physical activity in all jobs and promoting health savings accounts. Such accounts are financed with pretax dollars and allow workers to divert their contributions into retirement savings if they are not all spent on health care. Health experts say these accounts will be more attractive to younger, healthier workers.
“It will be far easier to attract and retain a healthier work force than it will be to change behavior in an existing one,” the memo said. “These moves would also dissuade unhealthy people from coming to work at Wal-Mart.”
Ron Pollack, executive director of Families U.S.A., a health care consumer-advocacy group, criticized the memo for recommending that more workers move into health plans with high deductibles.
“Their people are paying a very substantial portion of their earnings out of pocket for health care,” he said. “These plans will cause these workers and their families to defer or refrain from getting needed care.”
The memo noted that 38 percent of Wal-Mart workers spent more than one-sixth of their Wal-Mart income on health care last year.
By reducing the amount of time part-timers must work to qualify for health insurance, Wal-Mart is hoping to allay some of its critics.
One proposal under consideration would offer new employees “limited funding” so they could “gain access to the private insurance market” after 30 days of employment while waiting to join Wal-Mart’s plan.
Such assistance, the memo stated, “would give us a powerful set of messages to use in combating critics. (For instance, ‘Wal-Mart offers associates access to health insurance after they’ve worked with us for just 30 days.’)”
Steven Greenhouse reported from New York for this article, and Michael Barbaro from Bentonville, Ark.

Blues association launches hospital quality reports

The Blue Cross Blue Shield Association launched a hospital quality improvement program that stirred controversy among hospital leaders this spring over data-mining work performed by a subsidiary of the Joint Commission on Accreditation of Healthcare Organizations. The pilot program will provide quarterly performance reports to hospitals and employers on 18 quality measurements using publicly available data from the JCAHO, the CMS and the Agency for Healthcare Research and Quality.
Eighteen Blues plans, representing more than 80% of Blues subscribers, are participating. The JCAHO subsidiary, Joint Commission Resources, entered into a contract late last year to work on the pilot, merging data from the multiple sources and preparing hospital-specific reports. When the first reports reached hospitals in May, some hospitals criticized the JCAHO’s involvement without prior disclosure. JCAHO President Dennis O’Leary subsequently apologized.

Patrick J. Kennedy: A fresh start for Gulf Coast health care

PRESIDENT Bush and Congress have pledged to support the people of Louisiana, Mississippi, Alabama, and now Texas, as they embark on an unprecedented rebuilding of their communities on the Gulf Coast. But at least when it comes to health care, rebuilding should not necessarily mean replacing what was lost. Instead, we have the opportunity to give the Gulf Coast the first 21st Century health-care system in the country.

There are a number of Gulf Coast hospitals and countless doctor’s offices, nursing homes, clinics, labs, and pharmacies that are beyond repair. In the words of an official from the hospital-accrediting body, “Essentially the health infrastructure of New Orleans is gone — it no longer exists.” Because of the scope of the damage, the Gulf Coast communities have the opportunity to design their health-care systems from scratch.

A condition of federal assistance for the rebuilding of the health systems should be that they be designed for the information age.

Although technology has revolutionized nearly every corner of society, only 14 percent of physician practices have electronic medical records, according to a new survey by the Medical Group Management Association. Hospital numbers are not much better. One of the primary obstacles to investment has been the cost to providers, because much of the financial return on investments in health information technology — 89 percent, by one study — accrues to those who pay the bills.

But on the Gulf Coast the entire infrastructure is being rebuilt anyway, with the federal government largely paying the bills. There we can build a smarter, safer, more efficient system, and probably save money in the process. Out of the wreckage of Hurricanes Katrina and Rita would emerge a model for what health care can be.

We should begin by making a personal health record available to every citizen in the affected areas. Under the leadership of the national coordinator for Health Information Technology, Dr. David Brailer, there is already a crash program under way to make these patient-owned Web-based health records available to evacuees in shelters. That way, when they move to more permanent housing, their health information will not be lost.

We also need to rebuild our facilities for the information age. There is no reason that any doctor’s office should be rebuilt with big rooms for storing paper records, or without broadband-Internet access. Hospitals should be heavily wired and built with robust tele-medicine capabilities, so that rural populations can have better access to high-quality care. We should ensure that every provider in the new facilities who wants to switch to electronic medical records is assisted in doing so.

By integrally incorporating these technologies, we will be able to design health-care facilities differently. In an electronically enabled health system, for example, we may need fewer hospital beds, because length of stay is reduced and remote monitoring of patients from less intensive settings is available. Waiting rooms may become unnecessary as computers improve scheduling and reduce paperwork. With this sort of streamlining, building new, re-engineered facilities may actually prove cheaper than rebuilding what was lost.

The benefits of moving health care into the information age would be enormous for the Gulf Coast residents. It could mean the end of those infuriating clipboards, of photocopying health-insurance cards, of being sent for duplicate tests. It could mean that a doctor or nurse would always see emergency-room patients with critical information, instead of asking them what color the pills in their medicine cabinet are and how often they take them. Most poignantly, no Gulf Coast resident would ever have to worry again about his or her medical history’s being washed away.

Patients could communicate with their providers by e-mail and schedule appointments online, and their chances of being harmed by a mistake or of missing important preventive care would drop. Meanwhile, doctors could see the number of claims rejected by health plans fall, and the administrative burdens of coding and billing decrease, as electronic medical records automatically generated bills to electronically send to health plans.

This revolution could have particular benefit for those living in poverty — provided we are sure to include their health-care providers in these efforts. Low-income people move more often than others, are less likely to have stable relationships with care providers, and are more likely to have chronic diseases. There is no substitute for providing reliable health insurance, but at least with personal health records, these people could consolidate their information and make it available to any provider who was authorized — thus raising the quality of the health care received.

I do not minimize the challenges in realizing this vision. It will require speedy, collaborative action by a number of stakeholders to ensure that privacy and security are iron-clad, that the right data are available when needed and authorized, and that physicians have the necessary support to make implementation and maintenance smooth. It will involve changes that will take time to figure out. But these are not technological or even fiscal challenges; they are challenges of vision and leadership.

Here in Rhode Island, we know these challenges, and we are making great strides toward bringing our health-care system into the information age. On Oct. 20, Dr. Brailer, the Health Information Technology national coordinator, will make his second visit to see our progress and explore how the federal government can accelerate it. Still, as any of the dedicated Rhode Island stakeholders can attest, building this revolution into a complex existing system is difficult.

Nobody would ever ask for the tragedy that befell our neighbors on the Gulf Coast. But there is lemonade to be made of the lemons — if we can summon the initiative to build the future of health care, rather than rebuilding its past.

Patrick J. Kennedy represents Rhode Island’s First Congressional District.

CMS takes baby step toward national network

The grand plans of the Centers for Medicare & Medicaid Services to create a national health information network will soon be off to a humble start. CMS plans to recruit five to 10 small group practices to test what it hopes will become a widely used electronic medical record. However, if physicians were hoping to get a free system from the CMS, they’re out of luck. Even those participating in the test will have to pay.
The select group of practices will take a year-long test drive of the VistA-Office Electronic Health Record software, which is a modification of the EMR that U.S. Dept. of Veterans Affairs hospitals have used for 20 years. CMS says that after a post-test evaluation of undetermined length, it would release a full production version of the software.
The VistA-Office EHR software itself is only $37, but those test practices will be required to pay $2,740 in licensing and maintenance fees. For any practice with more than seven users for that software — a user being anybody, physician or otherwise, who uses the system — that price will go higher, though CMS didn’t say how much.
Those costs, while lower than most EMRs on the market, are giving some physicians pause.
“It’s going to be hard for someone to just volunteer and go ahead and implement this for evaluation if they have to spend this much just to get it up and running,” said Steven E. Waldren, MD, assistant director of the Center for Health Information Technology at the American Academy of Family Physicians.
The licensing and maintenance fees are costs “that CMS does not have the authority to pay for,” said Cynthia Wark, deputy director of the information systems group in the office of clinical standards at CMS.
The agency is not selling the system directly. Instead, it is licensing the VistA-Office system through private vendors.
Some believe that doctors who volunteer despite the cost could benefit by helping shape the final product. “If they are an early adopter, they may want to jump in on this to try it out and experiment. If they are more cautious, they should wait,” said AMA Secretary Joseph M. Heyman, MD.
Testing stage
VistA-Office is one of the pieces in a large puzzle that the federal government is assembling to realize the Bush administration’s 10-year goal of implementing a national health information network and electronic records for most Americans.
EMRs would be used by, or hooked into, localized regional health information networks — more than 100 of which are online or in planning stages — that can be linked to form a national network.
CMS’ EMR test system costs only $37 a year, but doctors need to pay $2,700 in licensing fees.
For its EMR test, CMS is looking for “small offices with one to five physicians that are committed to engaging in a meaningful beta test, which includes having the electronic health record installed, participating with the vendor in the configuration of that [system in] their particular office, staying current with [product] updates and providing us with feedback,” Wark said.
VistA-Office does not include a billing system, but doctors can pay vendors to develop interfaces to their practice-management software systems, CMS said.
The administration hopes that the eventual full-scale release of VistA-Office will encourage doctors in small practices to adopt electronic records by offering them a lower-cost alternative to other EMRs. Though costs vary widely depending on the vendor and the services offered, even a small practice can easily spend $50,000 per physician on hardware and software.
A money issue
Physicians interested in testing VistA-Office can contact an approved vendor through the Web site of WorldVistA, the official vendor qualifying organization. AAFP’s Dr. Waldren is not sure his members will sign up.
Before CMS announced the details of its VistA-Office program, six AAFP members had expressed interest in testing and reviewing the EMR for the medical society’s membership.
At the time, the would-be volunteers believed VistA-Office would be a finished or nearly finished software product that would be available for free, rather than as a beta version costing them at least $2,700, Dr. Waldren said. As a result, he is skeptical that those doctors will sign up for the test.
Doctors also would need to pay for hardware to install and run VistA-Office, Wark said. That cost will vary.
Based on a survey of EMR vendors that AAFP did earlier this year, a three-doctor office starting from scratch can expect to pay $20,590 for hardware for a stand-alone EMR, Dr. Waldren said.
In addition to the startup costs, any physician acquiring VistA-Office would have to pay at least $1,140 a year to a vendor for software support costs.
Although the cost associated with VistA-Office creates problems for some physicians, it is inexpensive compared with many EMRs sold today, Dr. Heyman said. He hopes the entry of CMS in the EMR market will drive vendors of EMRs to lower their prices.
“I don’t think that there’s ever any harm in adding a product to the market, especially if it’s an inexpensive one, [because it] becomes a goal for some of the private vendors to try to compete with that either on cost, value, function or something else,” he said. “I think that’s a good thing.”
So far, the program complies with AMA policy because use of the EMR is voluntary.
Also, to the extent that VistA-Office supports the government’s goal of creating a national health information network, the AMA supports the network “as long as patient privacy is protected and there aren’t any unfunded mandates for physicians,” Dr. Heyman said.