In digitizing healthcare, patient privacy the battleground

The naifs below have totally missed the real problem: It won't work. The British have been trying to set up a similar computerized system for years but still have not got it to work properly.

The economic stimulus bill before Congress is certain to include billions of dollars to bring electronic record keeping to the healthcare industry, moving patients' records and doctors' prescriptions out of the era of carbon-paper triplicates and undecipherable handwriting. It's an efficiency that's expected to bring down healthcare costs and add jobs. But it's also a way for researchers and others working to improve overall healthcare outcomes to gain access to millions of patients' medical records – and therein lies the rub.

Lawmakers in the House and Senate are currently waging a battle over how to ensure that a patient's very private medical history is protected, even as they allot the money for an information technology (IT) system that makes widespread sharing of that history easier. "The two overarching goals … are to improve the privacy and security of health information, and at the same time, improve research using such information," says Bernard Lo, professor of medical ethics at the University of California at San Francisco at a press conference last week on the current medical privacy law.

For President Obama, the need to spend at least $20 billion over two years for an IT upgrade at clinics and hospitals is clear. "We're still using paper. We're still filing things in triplicate. Nurses can't read prescriptions that doctors have written out," he said Tuesday during a prime-time televised press conference. "Why wouldn't we want to put that on an electronic medical record that will reduce error rates, reduce our long-term costs of healthcare, and create jobs right now?"

Few in the healthcare industry would defend the status quo. In 2001, the Institutes of Medicine called for all healthcare records to be electronic by 2010. Today, only 14 percent of medical practices use electronic health records. The reasons are many: ranging from the high cost of computerizing thousands of offices to the need for staff training to the lack of standards that allow a computer in one office to talk to main frames in another. "Health IT is an important enabler to having a better health care system, but in and of itself it will do very little," says Gail Wilensky, a senior fellow at Project Hope, an international health education foundation. "We also have to be ready to take on some of the very difficult issues with regard to standards, terminology, and ... inter-operability."

The battle in Congress is over what kind of rules should guide that change – especially over ensuring privacy while striving for efficiency. A patient's medical history is vital to a healthcare provider's ability to provide high quality, efficient care. But privacy advocates contend that individuals should be able to control who can see their medical record and when. There is concern the information could be used by insurance companies or employers to discriminate, or that companies would mine the medical data for profit.

The need for patient confidentiality could conflict with the effort to improve overall outcomes. To understand which medical interventions work best, researchers need access to large databases that include the outcomes of particular treatments for various diagnoses. "The key depends in the long run on who owns and controls the patient record," says Marc Roberts, a professor of political economy and health policy at Harvard's School of Public Health. "Many healthcare systems are now intentionally building medical record systems that are nonstandardized and noncompatible so they can own and control the data." ....

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Australia: Private hospital emergency rooms soon to be covered by health insurance

Medical insurance in Australia normally covers hospitalization only -- with some ancillary benefits

THE nation's largest health insurer is planning to operate its own private emergency care centres, ending the up to 10-hour waits patients face for treatment in a public hospital, Medibank Private, which insures three million Australians, wants to set up the emergency centres staffed by specialised emergency doctors to serve its own members as well as other members of the public. Health insurers currently don't provide rebates for treatment in the 30 private hospital emergency centres operating around the country. And patients who use these private services often face bills of $200-$300. The situation has left health fund members with minor ailments such as broken bones with no option but to use a public hospital.

Medibank Private chief George Saviddes told The Daily Telegraph his fund was considering importing a system used in Ireland where private clinics have been set up to deal with the minor sprains, bone breaks and cuts that make up 80 per cent of public emergency work. All patients could use the centres but Medibank Private members would get most of their costs, estimated to average about $400 per patient, covered by their health fund. The fund is also looking at whether private hospitals would want to tender to provide the services.

The nation's choked public hospital emergency departments treated 6.7 million patients in 2007 but about 35 per cent of urgent and semi-urgent patients had to wait longer than recommended for care. It is estimated 40 per cent of emergency department beds are taken up by patients waiting for a bed in a hospital ward. The privately run and privately subsidised emergency care centres would help relieve some of the pressure on public hospitals.

Medibank will also later this year extend to NSW a program offering a free midwife to new mothers for the first month after the baby's birth. Health funds are also questioning why they cannot buy generic brands of hip and knee replacements that could help cut the cost of surgery for their members. These joints will cost one third less than newer branded prostheses and result in less complications and follow-up surgery.

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