When it comes to privacy and medical data, the issues seldom are black and white. That makes a data-gathering venture between the American Medical Group Association and pharmaceutical giant Aventis a cause for both interest and concern.
On the surface, the effort to gather data on the treatment provided to millions of patients by thousands of physicians who are AMGA members seems fairly benign. Improving the quality of patient outcomes certainly will require the gathering of detailed information about how care is delivered. The ability of medical practices to benchmark their practices and outcomes is likely to be a major quality measurement and improvement tool.
But the database that AMGA and Aventis are creating will contain sensitive health and insurance information on as many as 35 million patients and 67,000 doctors. The database will track everything from lab tests and prescription drug use to physician productivity. Although the sponsors say that individual patients are not identified, the compilation of so much information in one place sends up red flags.
Only a few months ago, doctors at the AMA's House of Delegates meeting in Orlando, Fla., saw the trend to aggregate drug and treatment data and warned of the need for privacy controls on prescribing pattern data.
AMGA President and CEO Donald Fisher is convincing when he insists the proposed data warehouse and the AMA resolution are not at odds. Individual patients will not be identified, he vows. As a safeguard, the AMGA will own and license its data to the warehouse company, he says. "That license will have a lot of teeth in it, and (the data) could only be used according to the uses prescribed by members," he adds.
Still, call us skeptical. Information, once gathered, cries out to be used. And as masters of marketing, pharmaceutical companies live and die by how well they can develop tools for selling more of the products they produce.
Rep. Fortney "Pete" Stark (D-Calif.) spoke for many critics of the drug companies recently when he noted that when a drug company gets involved with doctors, somehow that company's sales increase.
Stark knows whereof he speaks. He has worked to highlight abuses by many of the powerful drug companies. Around the country, prosecutors are pursuing several Medicare cases involving kickbacks and bribes offered to doctors to prescribe certain drugs such as Lupron, which is used to treat prostate cancer.
If drug companies are bold enough to flout existing drug pricing laws to get doctors to prescribe their products, it's hard to believe they would be more cautious in treating data that isn't fully protected under now-developing HIPAA laws.
As an organization pledged to serve the best interests of its doctor members, AMGA needs to be extremely sensitive about the murky water into which it is now wading. Strong firewalls must be created and guarded to protect the patient and the physician from being steered toward drugs of Aventis or any other future sponsors.
It's going to take a lot of convincing that this time drug companies will behave differently.