>Privacy, politics, and medical records

>The editors and pseudoeditors of the American Journal of Bioethics blog are talking about all the people who accessed the hospital records of George Clooney after his motorcycle accident.

Somehow, according to the author of the post, it’s all President Bush’s fault.

In light of the news and comments on the latest iteration of SCHIP and Hillary Clinton’s health care plan, I’ve been doing a little research. We ought to learn and remember the history of the privacy laws, the push for electronic records. But we certainly can’t claim that the problem began in January 2001.

HIPAA began the whole electronic record push and originated in 1996. It’s about anything but “privacy.” See the records available on line, here.

The Privacy Rule, a later part of the Act (the Summary is 25 pages), specifically mandates full disclosure to the Secretary of Health and Human Services, or any agent of the Secretary, of all information in any facility that participates in any way (or ever hopes to do so) with Medicare. It also allowed those entities to make copies to take out of the office and to write their own subpoenas that need to be vetted by a judge after the fact. Attorney General Janet Reno advocated the use of the technology to track down Medicare fraud and abuse back in 2000.

The first big influences toward electronic medical records (EMR) and digital imaging are even older. Back in the late ’80’s, when I was in medical school, the Veterans Administration pioneered the EMR. (I used to practice diagnosing patients from their list of medications and procedures, the first elements of the record, before our notes could be entered.)In the early ’90’s, radiologists discovered the benefit of taking call from home while being able to read emergency head CT’s and other images.

The electronic medical record and digital storage of images is a good thing – but like all tools needs to be used properly.

The whole coding and reporting of medical care has grown into the usual government “leviathan” (to use Ira Magaziner’s defense to the lawsuit against him and Hillary Clinton for the unknown status of the consultants on their 1993 Health Care Task Force).

We still hope that the EMR will help us do better than we have in the past. Although I believe that most clinicians will disagree with the the “quality” markers used, see today’s NEJM article about child health care.

However, I don’t think that the incident involving Mr. Clooney’s records proved anything about electronic records other than the hospital had the ability to monitor who accessed the records – and that human beings are curious about celebrities.

In the meantime, Texas seems to be volunteering to be a lab for privacy issues with the correlation of drivers, insurance, and cars as well as photographing and surveying the people who use US IH 35. Car 54 can run your license plate at a red light or while you’re driving down the highway and then cite you if you’re uninsured. My taxes should definitely go down if these tactics can be used to generate revenue.