03-08-2009, 07:05 PM
03-08-2009, 07:44 PM
Given the extent to which Obama has repeatedly described his plans to fund a program to capture medical records electronically, both in the campaign and in his remarks on the stimulus program, it's hard to say how this could be described as a change hidden in the bill. It is a reality that anything that captures such information electronically has the potential to be misused. However, most of that information is now in the possession of your insurance company.
I have reservations about the privacy aspects of this program. However, using the data to support analyses of treatment efficacy, which is the conspiracy claimed in the article and the linked columns, is a no brainer. Such analyses will be welcomed by health professionals. Hospitals now perform such medical audits on a routine basis using their own records, but suffer from a lack of more comprehensive information. Similar medical audits based on more complete data should benefit all of us.
Having said that, I should disclose that over a seven year period I designed and managed a database used as the foundation for a clinical prescription prior approval program that saved tens of millions of dollars per year while improving health care for recipients. I was also responsible for implementing Medicaid payment systems used to manage several billion dollars in payments. The medical audits we performed on those data made it possible to save several hundred million dollars per year while reducing both bad care and fraudulent billing.
The issue is often not problems with individual providers but with the fragmentation of the health care delivery system. A small number of patients will go to multiple doctors and do not tell their doctors about the other care they are receiving. Sometimes this is incidental. Other times it is part of a pattern of abuse to obtain excessive prescriptions. Frequently, this fragmentation results in patients receiving excessive treatment -- most often in the form of duplicated testing -- and even dangerous treatment (e.g. related to adverse drug interactions).
These are among the benefits often linked to single payer systems for health care financing. I would not favor implementing a single payer system. However, it would be beneficial to have medical information shared across payers to obtain some of these benefits on at least a limited basis such as test results and prescriptions issued and filled.
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