I am responding to "Brailer's IT proposals draw fire," published in the Oct. 17 issue of MPStat.
Any attempt to make good on the promises made by President Bush and David Brailer, M.D., regarding the adoption of electronic health records will require extensive compromises. Interoperability will require substantial efforts and concessions by system vendors, their existing clients and the public to support the data interchange envisioned. Brailer's request that the standards proposals attempt to reconcile the differences between state and federal privacy laws will also likely require some compromises on the part of public (i.e. the privacy advocates) as well as local governments.
I disagree that this could "sap public support for electronic healthcare records overall." There is no question that privacy is a major concern, but I believe that safety, efficiency and quality are much greater issues for consumers of healthcare. I am commonly asked by my patients about the number of particular procedures I have performed, my success and complication rates, and the cost of the care. When patient privacy does occasionally come up, most are not worried about the security of their personal health information, but are frankly bothered by the nuisance the HIPAA rules have created.
Cerner Corp. and several other companies have done an admirable job of trying to interconnect communities where providers have purchased their products. The vendors are understandably reluctant to make data sharing between vendor applications simple and efficient, but it is disingenuous of Cerner President and Chief Operating Officer Neal Patterson to imply that government imperatives regarding interoperability are pandering to whatever ethereal entity a "beltway bandit" or "grant baby" is.
I do agree with one thing Patterson suggested, which is that interoperability will be enhanced and simplified if a national patient identifier (NPI) existed. Perhaps the privacy advocates could lobby for a mechanism to simultaneously protect the patient's data while allowing for the existence of an NPI.
Personally, I am no fan of "big government," but without requirements to interoperate, no one will ever be able to make a business case to perpetuate that kind of data sharing. The cost of medical care will continue to rise inexorably, with technology the great driver. Isn't it about time that we use technology to help reduce the long-term costs? Someday, economic realities will force us to ration medical care. It will be a waste, nay a travesty, if that day comes sooner due to either concerns about information security or barriers to data sharing.
Howard Landa, M.D., chief medical information officer and chief of urology, Hawaii Permanente Medical Group, Honolulu