Congressman Anthony Weiner announced that he is seeking treatment for sexual “addiction.” A private person would want to keep that mortifying information to himself. But soon it may be difficult to keep any sensitive medical information strictly between you and the doctor you consult. The stimulus legislation of 2009 and the Obama health law enacted the following year established a national electronic health database that will hold and display your lifelong medical history.
Government will oversee the network linking doctors and hospitals. Doctors will have to enter your treatments in the database, and your doctors’ decisions will be monitored for compliance with guidelines imposed by the Secretary of Health and Human Services.
The stimulus legislation allocated billions for incentive payments to doctors and hospitals to become part of the network. In 2015, incentives get replaced with penalties on the doctors and hospitals that have not complied.
And Sec.1311 of the Obama health law says private health plans can pay only doctors who implement whatever the federal government dictates to improve “quality.” That could cover everything in medicine.
Before the Obama health law, patients who voluntarily bought insurance shared information with their insurer. Now government regulators will have access.
The advantage of an electronic medical record is obvious. When you need emergency care, a doctor can access your past illnesses, tests, and treatments with the click of a mouse. It will reduce testing, save money, and sometimes save a life. But there are dangers.
Mark Rothstein, a bioethicist at the University of Louisville School of Medicine, worries that the system discloses information that is no longer relevant but could be embarrassing. Your oral surgeon extracting a tooth doesn’t need to know about your erectile dysfunction or your bout with depression twenty years earlier. Nevertheless, it will be visible.
Federal proposals to protect privacy have been half-hearted. On May 31, the Department of Health and Human Services proposed allowing patients to request a report on who has electronically viewed their information. After the fact is too late. Patients should have to give consent before their doctor links their record to a nationwide database.
The National Committee on Vital and Health Statistics, a federal advisory committee, proposed permitting patients to keep categories of information, such as mental or reproductive health, out of the national data base.
The Goldwater Institute, a free market think tank suing to overturn the Obama health law, argues that the law violates privacy rights by compelling Americans to share “with millions of strangers who are not physicians confidential private and personal medical history information they do not wish to share.”
The other issue is control of the patient’s care. In March, 2009 President Obama appointed David Blumenthal, a Harvard Medical School professor, to oversee the national electronic medical system. Blumenthal explained that his job was not about “just putting machinery into offices.” (New England Journal of Medicine, April 9. 2009) He said that if electronic technology is designed to save money, doctors will have to bow to a higher authority and use “clinical decision support,” medical lingo for computers telling doctors what to do.
Blumenthal, who has since resigned to return to academic medicine, predicted that many doctors would resist, resigning themselves to federal penalties or trying to get the law overturned.
Federal attempts to dictate how doctors treat patients will be challenged. In 2006, the United States Supreme Court struck down an attempt by the Bush administration to interfere in how doctors in Oregon treat terminally ill patients. The justices would not permit “a radical shift of authority from the States to the Federal Government to define general standards of medical practice in every locality.” That’s what the Obama health law does.
Meanwhile, the federal government is pushing ahead, and patients need to know that what occurs in their doctor’s office no longer stays there.