Posted by Metamorphoses Healthcare 11/27/11
Summary of previous blogs
In blog # 1 entitled, “Electronic Medical Record, National Disease Registry & Master Patient Index”, on Friday, October 28, 2011, we discussed a central design feature of a national disease registry, the master patient index. In blog #2 entitled, “Is Healthcare a Right or an Individual Responsibility?” on Wednesday, November 16, 2011, we discussed the two healthcare models that presently define the American healthcare delivery system: healthcare as a right under Medicare and Medicaid (~48% of all insured) compared to healthcare as an individual responsibility under private insurance company plans (~52% of all insured).
In this article (blog # 3), we will discuss how the proprietary nature of medical information impacts the ability for hospitals and physician offices to share medical information.
In Canada, the private sector of medicine has worked out arrangements to share medical information. In India and Korea, similar legislation was proposed but was resisted by various groups. We will present interview excerpts from our documentary, “EMR and Healthcare Reform”, with Dr. James Frame, MD, JD, who discusses the implications that the proprietary nature of medical information has on the sharing of medical information in the USA.
In the USA, that issue is not actively being assessed by the various political and medical groups that would normally create such a plan. During the Clinton administration, in the early 1990s, Hilary Clinton tried to pass healthcare legislation that would have assigned unique medical numbers to all patients, the equivalent of the master patient index discussed in blog #1. Privacy and proprietary medical information interest groups successfully opposed this proposal.
In Canada, although there is a private and public sector of medicine, they are planning to launch an IT platform “to link private labs with the public system, and to connect patient records in private doctor's offices with hospitals. Plans are also afoot to link prescription information between private pharmacies and hospitals”. Healthcare officials related to the project expect that this database will “dramatically reduce the number of medication errors”. (Derfel 2011)
The Korean government attempted to standardize terminology across all patient hospital records which had been different between hospitals. In addition, the government enacted a law protecting a patient’s medical information while allowing patients to request their medical records, in a streamlined process, from a previous hospital to facilitate their treatment at another hospital. But medical organizations and civic groups complained that this process would increase the risk of a patient’s medical information also being viewed by unintended parties. Various medical groups accused the government of using the law as a cover for the purpose of legalizing and commercializing the leakage of a patient’s medical information. The government denied this charge and maintains that it has set up ways to block the leak of medical information to unintended parties. (Chung 2006)
India recently passed a law that has wide ranging influence on all data related to business including medical information. Business leaders in India and the USA both fear that this law will add layers of cumbersome disclosures “such as obtaining written consent from each customer before collecting and using personal data. “ Google has protested the part of the law that makes internet intermediaries responsible for the transmission of any “any objectionable content, which is defined as "harassing," "grossly harmful" or "ethnically objectionable." All other countries that have data privacy laws have “exempted the service provider or vendors from these obligations." “These restrictions on the use of data have been described as “far more restrictive than American and European data privacy laws”. Experts state that this law will “radically alter India's outsourcing business” and that companies will “take their business elsewhere, to China or Philippines”. India’s outsourcing business is valued at $41 billion and these companies share the concerns of clients and experts. India's deputy minister for information technology Sachin Pilot said that the law was created to respond to the IT industry’s desire to have a legal framework for data protection. In a recent survey 60% of banking customers “said that information security is a significant concern”. Russell Smith of SDD Global Solutions, a New York law firm that runs a legal-process-outsourcing business in India said that "The law will end the last remaining arguments people have against outsourcing to India”.(Lakshmi 2011)
In the following excerpts from an interview with James Frame, MD, JD, Emergency Medicine, from the documentary, “Electronic Medical Records and Health Reform”, Dr. Frame discusses how the proprietary nature of medical information impacts the sharing of medical information between hospitals.
Interviewer: Why don’t hospitals share data with hospitals outside their systems?
James Frame: An often cited example compares hospitals with other businesses such as Home Depot (HD). HD has a customer base, i.e., regular customers with credit cards. Does anyone expect HD to share its customer list with its competitor, Lowes? Similarly, investment managers do not share their list of investors with competitors.
Hospitals, too, have a need to protect and maintain their patient or customer base in order to survive financially. As I have said, the hospital industry is over-regulated in some areas and under regulated in others. Information sharing is one area where improved regulation is needed. Right now, we have no financial incentives (actually we have many disincentives) to share patient (customer) lists with competitor hospitals.
In the healthcare industry, information sharing could result in patient stealing. Although it is considered inappropriate to refer to patients as customers in our industry because people’s lives are at stake, objectively, that is what we are talking about.
To encourage medical practitioners to share data, some type of financial incentives is needed, perhaps, on a limited basis.
My sixth Corpus Christi hospital system has a completely integrated EMR system. If patients enter the CHRISTUS hospital and stay within the CHRISTUS system, all their medical history and visits for the past 20 years are in the system. We can access every patient’s progression of disease and treatment. Unfortunately, when systems do not talk to other systems across local communities, regions and states, medical practitioners cannot effectively integrate patient care. (End of excerpt)
The business world and hospitals are still struggling with balancing privacy and proprietary medical information concerns with the desire to share medical information to benefit the quality of patient care, improve patient outcomes and, thereby, decrease the costs of healthcare.
In future articles, we will discuss what the differences are between the private and public medical sectors in Canada, India, Korea and the USA to better understand the specific factors in each country’s economy that allows or prevents the sharing of medical information.
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Metamorphoses Healthcare is a non-profit organization that advocates for the establishment of a national disease registry and healthcare reform that focuses on how to optimize the quality of patient care in the most cost effective way. The views presented in this organization’s documentary, “Electronic Medical Records and Health Reform”, focus on physicians' opinions about these issues. These physicians represent a diverse group. They are from different backgrounds in regards to race, ethnic ancestry,religion, regions of the country, medical specialities, and political views (from conservative to liberal viewpoints).
The goal of this organization is to identify reforms that benefit patients taking into account the political realities that exist in the USA without advocating a particular political point of view.
The excerpts from the interview with JAMES FRAME, MD can be viewed on the documentary website, http://www.emr-ndr.net/index.html
A transcript of the full interview will be sent with the purchase of DVD of the documentary, ELECTRONIC MEDICAL RECORDS AND HEALTH REFORM.
Links to Facebook, twitter and our blog can be found on the website.
Words: actual article 997; total words that include summary, article, references and notes about organization: 1312
Chung, P. (2006). Medical Information Law Faces Backlash. The Korea Times.
Derfel, A. (2011). Digitization of medical records proceeding one step at a time; Full computerization five years away, but some institutions already paperless. The Gazette Montreal, Canada, CanWest Media Works Publication Inc.
Lakshmi, R. (2011). The long reach of India data privacy. The Washington Post: G04.
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