The American Medical Informatics Association opened its annual meeting in Chicago on Sunday, drawing 1,900 attendees from 52 countries.
William Stead, the physician who is chief information officer and associate vice chancellor at Vanderbilt University Medical Center, Nashville, was given the Morris E. Collen Award of Excellencenamed for the retired Kaiser Permanente pioneer in medical informatics. The award is given by AMIA to a person "whose personal commitment and dedication to medical informatics has made a lasting impression on the field."
Stead also presented with his colleague and mentor, W. Edward Hammond, a professor in biomedical engineering at Duke University and a past president of the AMIA, at a panel on what might be done to speed up adoption of electronic health records. The two agreed to disagree on whether a national patient identifier was the best approach to developing a system to link patient records in an interconnected network of healthcare records.
"Adding another number is not going to help," Stead said. "It's expensive, it's going to be a privacy third-rail and it's not necessary," Stead said, adding his experience with a health information exchange in Memphis, Tenn., using probabilistic matching software to identify patient records yielded a rate of 99.7% matches.
Hammond, however, argued for standardization across regional health information organizations, a uniformity that doesn't exist today. He also spoke in support of a national identifier. Hammond said when he goes to his doctor, he asks for the date of birth on the medical records the physician is using because his son's records have wound up in his files. "My son has the same name and my grandson has the same name," Hammond said. As to the expense of adding a national patient identifier, Hammond said the benefits gained from reuse of the data would justify the cost.
The topic of a patient identifier also came up during a panel discussion led by national privacy experts on the role of privacy in RHIO development. William Yasnoff, a physician and former senior adviser at HHS on the national health information infrastructure, led the panel. Yasnoff warned that public trust in healthcare IT is broken and will have to be repaired with privacy protections before health record exchange will succeed. Yasnoff noted that in 2000, when word got out about the national provider ID in HIPAA, the public outcry shut down implementation. Similarly, any attempt to mandate exchange of healthcare information risks a similar backlash.
"Once the public is aroused on this issue, your mandated healthcare infrastructure system will be shut down," Yasnoff said.
But giving patients total control over disclosure is a nonstarter as well, according to fellow panelist Mark Rothstein, chairman of the subcommittee on privacy and security for the National Committee on Vital and Health Statistics.
"The notion that we're going to control disclosure to insurance companies is a fantasy," Rothstein said, noting there are "at least 25 million compelled disclosures (of protected health information) in the U.S. each year." What needs to be done, according to Rothstein, who serves as director of the Institute for Bioethics, Health Policy and Law at the University of Louisville, is to undergo the painstakingly difficult process of determining just what an insurance company needs for its tasks and limiting disclosure to just that information.
"When a life insurance company wants information, they're only going to get mortality information," Rothstein said. "Limited disclosure is the only option we have. The only thing is how are we going to do it?"
Latanya Sweeney, an associate professor of computer science, technology and policy at Carnegie Mellon University, Pittsburgh, declared, for now, at least, "consent is dead" in part because of the ability of data-miners to re-identify patient data. But Sweeney argues that "privacy technology offers the best hope" for reversing that reality.
Today, Robert Kolodner, the head of the Office of the National Coordinator for Health Information Technology at HHS, will host a "town hall" meeting during a morning plenary session. His boss, HHS Secretary Mike Leavitt, will convene the American Health Information Community meeting at the conference Wednesday. Leavitt created the AHIC in 2005 to advise the federal government on healthcare IT policy.