Payor foxes in the henhouse

As some of you may know, in my profession you simply don't let the advertising sales department determine what you write. Otherwise, you'll end up writing stories that nobody would want to read. While ad folks might try to let you do your thing, little by little, you'll begin to represent the interests of the people buying ad spots rather than the needs of the reader.

Of late, a debate over EMR design has raised some similar issues. A new proposal put forth in a federally-sponsored report, suggesting that EMR portals should contain "holes" allowing health plans to snoop around within the records.  We're talking a payor fox-in-the-henhouse situation here.

As I see it, giving payors access to EMRs is similar to putting FierceHealthIT's advertising department in control of our research and writing process. Both payors and ad sales reps have useful--and arguably beneficial--reasons for existing and guiding what their opposite numbers do. But it's also true that in both cases, the interests of the one party could conflict with the performance of the other.

Top government HIT officials say opening up provider EMRs on a limited basis is a good idea, primarily if the access is used to fight provider fraud. And sure, it's possible such an arrangement would catch provider wrongdoing (or mistakes) from time to time. But my question is, is it really worth the further chilling effect such openness would have on provider practices? 

Such a proposal suggests EMRs will catch providers who are committing billing fraud. But you know what? I don't buy that for a minute. Anyone who invests the kind of bucks it takes to mount a robust EMR isn't trying to trying to stay under the radar; by default if nothing else, they're joining a wider connected community and agreeing to broad disclosure.

Look, payors already have a tremendous load of data from providers, and the means to analyze it statistically to screen for abusive billing patterns. Given this reality, why tempt payors to further dictate the care process by tiptoeing through healthcare data?  Sounds like a really, really bad idea to me. - Anne