Comments on: Why there needs to be a national healthcare information database

By: Edward Pullen MD

Edward Pullen MD — Wed, 03 Feb 2010 03:02:50 +0000

-Tom. We just disagree on the issue of confidentiality. I think this could be overcome, you I guess do not. It sounds like you are not alone in comments on fear of misuse or loss of the database information.
-One system for all simply applies to the data base, not to EMRs. All EMRs would simply have one place to interface with, not to all try to interface with each other or multiple places.
-HIPPA concern, the information could be used in an extracted, deidentified way, this is done in lots of systems already for research.
-The issues Emma B brings up are more challenging. I would not suggest that all parts of a medical record be in the database. If it excluded information on STDs, pregnacy information, possibly some mental health information, it could still be extremenly helpful.
-The issue of insurability is a huge problem of its own, and it impact on many Americans is immense. It needs a solution, a database or not.

By: Paul Weiss

Paul Weiss — Mon, 01 Feb 2010 21:35:18 +0000

I for one think the basic premise is a great idea. It is truly unfortunate that some people are in a circumstance whereby their complete medical history could be held against them/make them un-insurable. Perhaps it is better to say that our current system is unfortunate because such a problem could arise. I believe that Taiwan has a system where people are given magnetic stripe cards with a microchip. The chip contains their medical records, and people keep their cards. The card is given to a health care provider to review their history and update it accordingly.

It is not something that has to be mandated for the masses. If people want to opt in, let them, and if people choose not to they can have that choice.

By: IVF-MD

IVF-MD — Mon, 25 Jan 2010 21:16:48 +0000

In my field, all patients are with me temporarily and eventually go on to a general OB when they get pregnant. Not only do I encourage patients to keep a summary of their record which I am more than glad to provide them, I try to EXPLAIN to patients as much as they care to know about their condition, so they can understand and have a better conversation with their next doctor. (Yes, I know that some patients don’t want to try and understand their condition, but most do, and many want to know it in great detail).

Why does an unreliable third party have to be involved? If I give my patient a folder with their labs and their sequence of events, they can take that with them when the travel. I have patients who do treatment and then travel to Europe while pregnant. They will meticulously carry with them all their info.

Anyway, when the patient has the information, it is safely in their hands. No prying eyes of a low level government worker can see it. This is especially desired if the patient themselves works in the hospital. If you think the government should be 100% trusted to not allow nosy insiders to invade your privacy, you might want to think again.

By: Kelly

Kelly — Mon, 25 Jan 2010 16:22:44 +0000

I agree with Dr. Pullen. I also understand the concerns of those who posted comments. What we need is a common sense compromise. The privacy issues, both legal and fear-based, can be alleviated if we use the data without linking it to the individual’s I.D. Of course, this isn’t exactly what we want, but in the meantime, there are many advantages to using data without the identity of the patient. The persons gender and age, diagnosis, procedure codes, frequency of visits combined with some basic algorithms, provides a wealth of information. All of this is available in standard claims data. We need to merge the pharmacy data and the lab results. We have the technology to do this. As a health information analyst for more than 20 years, I have always wondered why the insurance companies don’t use the data to study outcomes, etc. If you assume they do, you’re wrong. The details are in the data that we are not using- we need to move beyond this nonsense and utilize the technology and brain power we have available to us, rather than continuing to stumble, bicker and argue. I recently did some analysis on pharmacy data, specifically mental health drugs. Over 75% of those who had filled prescriptions for anti-depressants or other mental health diagnoses, did not have any E/M claims for consultations or visits to mental health providers.
And consider this: pre-diabetes, borderline hypertension could be addressed before they deteriorate to full blown diabetes and high blood pressure (or worse), if we had a system in place that was intended to be ‘meaningful’. As it stands now, the insurance companies have all of the data, the doctors have the medical records (that contain the lab results). The disparity between information, systems, payers and other third party entities is the problem and we need to fix it.

By: Robby

Robby — Mon, 25 Jan 2010 16:03:22 +0000

How in god’s name can our personal, medical information being misused be overblown?

It is one of the most personal, private peaces of information we have….

And us being concerned about its privacy is something we need to just get over?

What part of that do you actually think will fly with anyone in the country besides yourself and your friends?

By: Emma B

Emma B — Mon, 25 Jan 2010 03:59:34 +0000

The problem with a single global database of this sort is that it contains a great deal of information which is not necessarily relevant to the medical problem at hand, some of which is potentially quite sensitive. For example, I might not necessarily want my orthopedic surgeon (or more specifically, the nurse in his office who is a casual acquaintance of mine) to know that I went through infertility treatment. I might also not want anyone to know that I had an eating disorder as a teenager, or to be aware of hypothetical STDs, abortions, or psychiatric diagnoses. However, any doctor who could access my medication list and previous bloodwork would also be necessarily aware of such conditions, even though it would rarely if ever be relevant in your car-wreck scenario.

Even Google has not managed to satisfactorily solve the granularity problem inherent with sensitive health information, because it’s a behavioral problem rather than a technical one. The vast, vast majority of users will not adjust their privacy settings or manage their information in any way, so the default settings you choose for any new piece of data will govern the system’s behavior, and you will always be trading privacy for clinical usefulness. When a piece of data (say, bloodwork results) enters the system, it has to be defaulted to public or private access. If it’s public, most users won’t choose to make it private, and the ER doc knows that you’re being treated for infertility. If it’s private, the ER doctor won’t know that you’re newly pregnant with multiples. Which one would you prefer?

As someone who actually has some potentially-sensitive health information in my background, I’m willing to accept the car-wreck scenario rather than have my orthopod’s nurse know about my pregnancy history.

By: kullervo

kullervo — Mon, 25 Jan 2010 00:54:27 +0000

You left out a big fear: if my lifetime medical records were all available, I would be uninsurable.

By: BladeDoc

BladeDoc — Sun, 24 Jan 2010 23:43:36 +0000

Which concern is overblown? Do you not believe that the government would lose this data? If that is the case I can think of multiple episodes of loss of personal information both in the public and private sector. Identity theft is rising exponentially as a problem (see GAO report For examples of government data loss see VA data loss or how about in the British NHS Unlike if someone in my office did something like this, in none of these instances was anybody held personally responsible. In none of these instances could the patients sue for damages or HIPAA recompense ($50K per incident I believe).If you mean that you personally don't care if your medical information is disseminated to the public then good for you. That's a decision each person should make for themselves. As far as I'm concerned, I would prefer to risk the marginal possibility for improvement in my medical care for the possibility of my medical records being public knowledge.

By: Fray

Fray — Sun, 24 Jan 2010 23:35:09 +0000

“We just need to get over this concern. The benefits are just too big, and these concerns overblown.”

You’re fired from you job, denied health care, etc…is not a concern. When you get in that accident, there won’t be any medical records because you can’t afford to go to the doctor.

By: Bob

Bob — Sun, 24 Jan 2010 17:50:31 +0000

Having a “system” is somewhat overemphasized in that we have many more systems thane we need. Factually we have all the data for those who have been treated in the past several decades for most of the population; it just isn’t very retrievable.

Most of the population have stayed in the same general geographical location and have used the same Docs, hospitals and testing facilities, and the jargon and claims processing have been computerized for years. The biggest data banks are the Government ones and none of them are able to be “standardized into a single system”.

And so if all these records are somehow brought to single data base form, will the attending physicians take them as being something other than historical markers and the tests as all being correct? As for the patients there are large barriers in place for them for few would understand their own records since few “read medicalize” the real purpose of this exercise is exactly what?

Computerizing existing records in physician’s offices and matching this with the data available from hospitals and insurers would more quickly get to usable medical data and would replace the current system that is mainly paper duplication in these offices. The number of people replaced would be extremely large savings until the cost of unemployment in the record keeping functions is calculated in.