Health IT: Fears and Opportunities

Response to health IT czar David Brailer’s request for feedback on his national health information network has been enthusiastic. The Office of the National Coordinator for Health Information Technology has received hundreds of responses. In addition, eight large technology companies have pledged support for nonproprietary standards that can serve as a common language. IBM, Intel, Microsoft, Oracle, Accenture, Cisco, Hewlett-Packard and Computer Sciences all decided that cooperation is a better bet than competition. They even recommended setting up a non-profit group, with board members appointed by HHS (Health and Human Services), to mediate any disputes.

Also last month, a report was published in Health Affairs estimating that a fully interoperable system of electronic medical records could generate $78 billion of health care savings annually by increasing efficiency and curbing duplicate procedures. The numbers do assume that the systems will be a breeze to interface and free of bugs. Still, the rosy scenario does not include savings from improved health care and fewer medical errors.

Even President Bush came back with renewed zeal, pledging to find $50 million in health IT funding for 2005 to replace a request that didn’t make it into the final budget passed last year, and to more than double the funding in 2006.

Brailer’s new boss, HHS Secretary Michael Levitt, spent part of his first day in office by his side, announcing upcoming electronic prescribing standards for Medicare. Fully implemented, electronic prescribing could cut errors caused by bad handwriting and make sure that a given prescription was in line with safety recommendations for a particular patient. It could alert doctors that a new drug could be dangerous if taken alongside other prescriptions or could remind a doctor to recommend a flu shot or other preventive care.

All this accessible information has a few people worried. In a joke circulating around the Internet, a middle-aged man calls to order an all-meat pizza, but is told that his cholesterol level is too high, so he will be sent a broccoli soy-cheese version instead. When he tries to use a coupon for free soda, he is informed that the offer only applies to households in which no one has diabetes.

Next Page: Appeal for Patient Privacy Foundation speaks out.

Deborah Peel, chairman of the Appeal for Patient Privacy Foundation, thinks a national health information network could very well marginalize patients who fear that their personal information could be shared without their consent or that their consent could be coerced. In an e-mail to, she said that as a psychiatrist she had seen banks and employers use patients’ medical records to make lending and hiring decisions. Insurance companies have used them to deny benefits and coverage.

In a statement sent to Brailer’s office, her organization stated, “Patients will avoid treatment, lie, omit information, use aliases, and seek totally private black-market health care” to avoid disclosure of sensitive conditions. The organization goes on to recommend against blanket consents for future content of medical records, and that even possession of a medical record without consent should be considered a crime.

Peel also said that HIPAA (Health Insurance Portability and Accountability Act) provided little protection, “The Bush administration flipped the HIPAA privacy rule into a disclosure rule, where patients cannot control any ‘routine’ uses of their medical records.”

Both Brailer and health information technology organizations maintain that patients should be able to view their medical records and have control over the information they contain. But the choice between having an inaccurate medical record and one that leaves a patient susceptible to discrimination is not one that a free and healthy society should force its citizens to make.

Instituting safeguards in how medical data is used is essential but insufficient. Patients must also believe that these safeguards are working and that they are safer with an electronic medical record than without one.

I welcome your thoughts on how to make sure that happens. Please e-mail me at

Check out’s Health Care Center for the latest news, views and analysis of technology’s impact on health care.

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