If you didn’t catch the National Governors Association meeting on Health Care & Information Technology, 7/22/2007, I strongly recommend that you watch it. It’s in the video archive on the C-Span. Watch it a couple of times so that you can absorb what they are saying. The discussion centered around a national Shared Health Information Technology (HIT) system.
The initiative shifts the focus of medical care from the doctor-patient relationship to one of information collection and exchange among the providers of services so that everybody can have access to your medical record. In the new paradigm of Health IT, you are a “consumer” not a patient.
There are several critical aspects of the planning for the HIT system that should be understood by all. The following is a brief discussion of each.
Cost Savings and Quality Improvement
The collected data will reside in networked systems at the community, state, and national (and international) levels. The initiatives are supposed improve the quality of care for the “consumers” and reduce costs system wide. In reality, it will simply shift health care dollars from the pockets of providers to the information technology industry. The savings will come from replacing qualified doctors with less qualified people using “Decision Support” systems and shifting the focus of medical care from caring for the sick to caring for the healthy. This new way of looking at health care is a set up to ‘blame the victim’ with built in incentives for the health care provider to dump sick people because sick people will affect their performance ratings and as a result, their compensation.
In order to implement this system – and I’m calling it a single system because multiple systems that are networked together are in effect a single system – requires changes in the following areas:
An electronic medical record that resides on a network connected to other networked systems will eliminate medical privacy altogether. Once implemented, there will be no such thing as medical record privacy. For all intents and purposes it will be public information there for the taking. Think of all the system break-ins and stolen data of recent years and you will understand how easy it will be to get your private information if somebody is of a mind to get it.
Gov. Phil Bredesen talked about how the health care licensing laws would have to be changed because the plan is to allow ‘remote’ medicine and ‘Decision Support’. When he talked about it, he said ‘health care providers in other states’ but the real idea is to have “Dr. Punjab” in Calcutta as the remote “doctor”. This is already being done with radiological reports. They are transmitted to India so that the radiology ‘call center’ doctors can interpret the x-rays.
Coincidently – and fortunately, I happened to be listening to C-Span2’s coverage of the Senate yesterday. Senator Jeff Sessions brought an amendment to floor S.AMDT.2374 to S.1642 calling for a lowering of the academic standards for entry into U.S. medical schools. His reason was supposedly the need for more medical providers and keeping medical education dollars in the U.S. rather than having them go offshore to the Brand-X alleged medical schools in the Caribbean. This is a classic example of how an issue is presented in one framework when the real goal is something quite different. The real reason for lowering standards is because IBM and the other Information Technology companies are selling “Decision Support” systems to replace highly qualified doctors.
If you’ve had to call a software company for technical support in the past few years, you’ve had the ‘Decision Support’ experience. The idea is that experts can be replaced with clerks when they have a ‘Decision Support’ system. In the development of the knowledge base, the expert provides the Question & Answer sets and the logic path that theoretically allows the clerk to go through the same “thinking” process as an expert and he would arrive at the correct answer to solve the problem. If that doesn’t scare the hell out of you, try calling one of the large software companies for technical support – you’ll soon see what the ‘Decision Support’ process is about. (Garbage in – Garbage Out). And that’s the real reason for the lowering of standards to get into medical school. They are anticipating not needing as many “expert” physicians in the future. Bubba from the football team will be good enough.
Electronic Medical Records
Without a doubt, this is the most disturbing aspect of the presentation: shared electronic medical records. They aren’t satisfied with simply making your medical information virtually public, they want your DNA so that they can apply IBM’s analysis of your ‘risk factors’ relative to your lifestyle, DNA and medical history. Listen carefully to what Dr. Douglas Woods of the Mayo Clinic and Ginny Wagner, IBM Project Manager have to say:
“The Health Metrics Network (HMN) is an innovative global partnership founded on the premise that better health information means better decision-making, which results in better health.”
The goal of HMN is to increase the availability, quality, value and use of timely and accurate health information by catalysing the joint funding and development of core country health information systems. In order to achieve this, HMN has three key objectives:
1. to elaborate a harmonized framework and standards for the development of country health information systems;
2. to support developing countries in adapting and applying the framework and standards to improve their health information systems; and to provide technical support and act as a catalyst to secure funding to this end;
3. to improve the quality, value and use of, and access to health information, by developing policies and offering incentives to enhance the dissemination and use of such information by all those concerned at the local, regional and global levels.
UN World Health Assembly - 2005
Recognizing the important role of State legislative and executive bodies in further reform of health-financing systems with a view to achieving universal coverage,
‘Nationalized – Shared network of Individualized medical records…
“Personalized genomic medicine… knowing genetics, background, behaviors and environmental factors which influence disease….individualized interventions to …..collectively improve the health of the population.
“We can create a genetic profile…By using the computerized health risk assessment, we can then combine the genetic information with an individual’s behaviors to understand their proclivities for actually developing disease…
IBM and the Holocaust
The four Nationwide Health Information Network Consortia consist of the following organizations:
Accenture, working with Apelon, Cisco, CGI-AMS, Creative Computing Solutions, eTech Security Pro, Intellithought, Lucent Glow, Oakland Consulting Group, Oracle, and Quovadx. This group will work with the following health market areas: Eastern Kentucky Regional Health Community (Kentucky); CareSpark (Tennessee); and West Virginia eHealth Initiative (West Virginia).
CSC, working with Browsersoft, Business Networks International, Center for Information Technology Leadership, Connecting for Health, DB Consulting Group, eHealth Initiative, Electronic Health Record Vendors Association, Microsoft, Regenstrief Institute, SiloSmashers, and Sun Microsystems. This group will work with the following health market areas: Indiana Health Information Exchange (Indiana); MA-SHARE (Massachusetts); and Mendocino HRE (California).
IBM, working with Argosy Omnimedia, Business Innovation, Cisco, HMS Technologies, IDL Solutions, Ingenium, and VICCS. This group will work with the following health market areas: Taconic Health Information Network and Community (New York); North Carolina Healthcare Information and Communications Alliance (Research Triangle, North Carolina); and North Carolina Healthcare Information and Communications Alliance (Rockingham County, North Carolina).
Northrop Grumman, working with Air Commander, Axolotl, Client/Server Software Solutions, First Consulting Group, SphereCom Enterprises, and WebMD. This group will work with the following health market areas: Santa Cruz RHIO (Santa Cruz, California); and HealthBridge (Cincinnati, Ohio); University Hospitals Health System (Cleveland, Ohio).
[How can we reduce costs with IT?] It is a new form of medicine. We prevent the progression of disease using IT prediction and prevention tools coupled with personalized genomic medicine. We’re doing a project at Mayo now with IBM which allows us to link the capabilities of knowing the genetics of each persons background along with their behavioral and environmental factors which in fact, influence the development of disease. In that fashion we can actually undertake individualized interventions that will make it less likely that any one person will suffer the ravages of a disease later on and collectively improve the health of the population – again as well as controlling costs. So this is the future of disease treatment. Very different than our current emphasis on acute care.
How might this work in reality from the perspective of prediction and prevention? With a simple buckle swab maybe even a simple blood test.. now even possible to do at home by obtaining a drop of dry blood and sending it to a laboratory, we can reconstitute it, we can create a genetic profile. By using the computerized health risk assessment, we can then combine the genetic information with an individual’s behaviors to understand their proclivities for actually developing disease that may not be evident. This allows us to do a physician-patient interaction that could occur with a computer – not in an office. The only way that I’m paid now to provide care is in the office. So this represents a substantial opportunity in terms of actually moving this capability forward.
In terms of acute episodes of care at Mayo Clinic, we are now using web-based protocols for our own employees to be able to access and guide their care for simple problems – upper respiratory infections, urinary track infections and the like can be managed just that way by individuals with the right guidance. Doesn’t require an office visit… doesn’t require coming into the clinic. But again, I don’t get paid for that as a physician. From an employer perspective, its a great advantage for us to do this because we manage to not only save the cost of the physician visit but improved the productivity of the employee – less time away from work.
Resistance likely to be “Consumers”
BE A RESISTER!
Ginny Wagner – “Identity Proofing”
Include all populations
Pay doctors for meeting performance goals
Using a computer system for ‘remote medicine’ will provide the opportunity for the population to be culled of “undesirables”.
The combination of “behavioral” information and “environmental” factors (i.e. location (ghetto), religion, ), plus DNA (genetic defects, race) will provide the selection criteria.
Populations of people can be selected for experimentation as well. Since the networked, shared medical information will be available on ALL citizens, the ‘selected’ population can be distributed in such a way that negative outcomes from the experimentation will be very hard – if not impossible to detect outside the research community.