The pundits still don't get it


Invoking the principle that any publicity is good publicity, it's safe to say that EMRs finally are officially part of the broad national debate on healthcare reform, now that some of the Fox News fear mongers have jumped into the deep end of the cesspool. However, we run the very real risk not that the public will run away from EMRs in a panic, but that the nation will replace an inadequate and unworkable mess of paper records with an equally inadequate and unworkable EMR mess, thanks to continued lack of understanding of the issues by The People Who Make The Rules.

Actually, I find myself agreeing with Fox News Channel windbag Bill O'Reilly that electronic records, as they exist today, do threaten personal privacy. "We don't have any privacy as it is in this country," O'Reilly said July 22 on his "The O'Reilly Factor," while chatting with Dr. Marc Lemont Hill, a frequent Fox contributor.

Hill argued that the public cares less about privacy than it does about the tens of millions of uninsured Americans. While it may be true that the twin problems of access and cost are at the center of the health reform debate, it's folly to think that people aren't worried about their medical data falling into the wrong hands.

On this point, liberal blog News Hounds ("We watch FOX so you don't have to") almost makes Hill out to be a hero, which he's not. Where the blog is right is on O'Reilly's main thesis, first stated in an earlier segment of the same program with pundit-for-hire Dick Morris. O'Reilly actually said that his medical records, once put in electronic form, are "gonna be in Washington, right, so every malady that I have is gonna be seen by people in Washington."

O'Reilly later said to Hill: "It worries me that my medical history and your medical history is now gonna be on a disk in Washington, DC....The data is going to go to a bank in Washington, DC." He presumably was talking about comparative effectiveness research, the bane of conservatives who fear that federal bureaucrats will start dictating health decisions--as if bureaucrats from insurance companies don't already occasionally do that." But nowhere in any law, regulation or proposal I have seen or read is there any mention of personally identifiable medical records being dropped into some sort of Big Brother database.

For one thing, most EMRs right now can't deliver interoperability, but I digress. The plans for a Nationwide Healthcare Information Network call for a series of regional health information exchanges. In most cases, the data would reside either in multiple locations--provider-based EMRs, insurance records, patient-controlled personal health records--or in a "health records bank," presumably a private, independent, not-for-profit third party. It couldn't be any other way, or the public won't ever consent to having their data moved around. Remember, the stimulus requires HHS to close the "treatment, payment or healthcare operations" loophole in HIPAA.

No matter where your political loyalties lie, misinformation about what EMRs can and will do is bad for everybody. Those of us who follow health IT understand this. If only we in the healthcare media had an audience as big as O'Reilly's. - Neil

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