Touching a Raw Nerve: Medical Privacy Policy

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Not surprisingly, the Bush Administration’s recent ‘final ruling’ on medical information privacy did not satisfy everyone.

The debate among providers, consumers and insurers over medical information privacy is a decade old, and shows no signs of abating.
Patient privacy advocates have reservations that the U.S. Department of Health and Human Services' (HHS) latest medical privacy ruling, which is set to take effect next April, doesn't adequately protect the privacy of patient information, while health care providers and insurers are more favorable to the ruling.

Largely unnoticed in the ongoing debate is the basic need to bring America's medical information systems into the 21st century. The technology exists today to make medical information as accessible to consumers as their online bank accounts. The ruling looks to a day when patients will be empowered to access all their medical records, discuss them with their care providers, and arrive at informed decisions about treatment.

Moreover, health care providers will be able to exchange medical information to review a patient's entire medical history, rather than sift through incomplete records or wait weeks and even months to obtain records buried deep inside disparate paper, film and electronic databases.

As we work through the fine print of the ruling, which is lengthy and deserves careful attention, it is vital that the privacy debate not derail efforts to modernize health care information. America has the distinction of possessing the world's most advanced lifesaving medical technology, coupled with health care information systems that belong more to the 1950s than the new millennium.

Our hodge-podge of paper, film, text and handwritten health care records add substantially to the cost of health care delivery and contribute to an estimated 45,000 to 98,000 preventable deaths each year due to incomplete patient information, misread paper prescriptions and mistaken diagnoses and treatments. That's more than the fatality rate on our nation's roadways.

Setting priorities

Here are three priorities for implementing the HHS ruling over the months ahead:

First, health care providers, insurers and payers need to embrace medical information modernization as a solid business strategy - and not just as a regulatory requirement. Leading health care organizations have already started moving in this direction, and the results are impressive.

Atlanta-based National Account Service Company (NASCO) has modernized its claims processing for several Blue Cross and Blue Shield insurers, which has enabled it to nearly double its business and reduce its costs by over 40 percent.

Similarly, one of Houston's major health care providers has put its patient records online, and reduced costs by $300,000, at the same time it has increased its patients by 40 percent and kept its staffing at the same level. Moreover, by moving prescription drug fulfillment online, transcription and labor costs have been cut by more than 80 percent, and illegible handwritten prescriptions have become a thing of the past. Patients may be the biggest beneficiaries, because computerizing patient records prevents high levels of medication errors.

Second, government, health care and information technology professionals need to join together to agree on technology standards that will enable everyone to communicate with one another easily and flexibly. The goal must be to foster interoperability across today's diverse systems and data in a way that promotes access as it preserves patient privacy and security. This is possible with existing technology, but the health care community needs to catch up with other industry sectors that have moved toward common technology standards.

Achieving cooperation

Fortunately, efforts along these lines are well under way. The eHealth Initiative, a consortium of more than 100 information technology and health care companies, is working with federal and state public health agencies, health care providers and insurers to reach agreement on standardizing the format for communicating electronic data.

Finally, we all need to take a balanced perspective on preserving patient privacy as well as facilitating information access and exchange across the health care community. Privacy is not a zero-sum equation. It is a collaborative exercise between consumers and businesses, that agree to support and implement rules that are in everyone's interest.

We are at a turning point in creating the kind of modern health care system patients want and health care providers are prepared to deliver. The easy part is mustering the technology to get this job done. The hard part is giving up the ghost of past battles fought and settling down to build the new system. This is a very winnable endeavor - and worthy of everyone's cooperation.

Elizabeth J. Wood is health care national practice executive for IBM in Atlanta.


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