Just drop the identifiers and other letters

Regarding “Patients care what their electronic healthcare data are used for, survey shows”, to quote something a friend said when sharing this, “Hello, Captain Obvious.” Of course we care how and with whom our data is used, and that's as true with financial and phone records as it is with the info on our health history. I for one am happy to share any and all of my de-identified data with anyone who's researching any of my “issues,” but that de-identification has been problematic.

Data have value. In many instances, that value includes hard cash. I don't mind contributing to research, or to revenue gained from research that winds up as a product. However, I don't want my name attached to that data, my Social Security number or my insurance history. Making my data that secure shouldn't be a huge effort. My bank manages to do that with my financial records, even though they share that data with the FDIC, other banks, vendors I do business with, stores where I make purchases, etc.

Why is it so darn hard for healthcare to figure out how to do the same thing the global banking system does 24/7/365?

Casey Quinlan

Regarding “Patients care what their electronic healthcare data are used for, survey shows”, yes, I care very much who's using my data and where they go. I believe that for any and all uses, patients should be asked for consent to use healthcare data. If we look at data maps, it is clear that healthcare data go to approximately 200 users. Folks were so enraged over the federal government having access to e-mails. If they only knew where their conversations with healthcare providers are headed.

Mary Powell

Regarding your recent cover story “Critical debate”, the prospective payment system was designed for and tested only in three or four tertiary hospitals in New England; with its swift implementation, hundreds of rural hospitals closed over the span of just a few years, in less-challenging times than today.

Yes the critical-access hospital legislation was built on a model originally designed for remote locations. However, the “sense of the Congress” at the time was a recognition of the 20-year failure in trying to fit the round peg of rural into the square hole of PPS.

The funding for critical-access hospitals was intended to be an equivalent form of reimbursement to PPS, not a bonus or some form of public charity. In that light, I don’t see how a critical-access hospital being X or Y miles from another hospital can be wrong while it is OK that I can easily walk to four hospitals (one Veterans Affairs, one Catholic, one community and one academic) from my home in Madison, Wis.

We have to work much more effectively to support rural communities coming into the rapidly changing world to incent “value over volume” in a manner that helps preserve, where practical, local access to care and local jobs.

If we are pointing fingers, I am surprised that by now, the CMS has not worked to develop more robust models for rural hospitals in that regard. In any event, according to HHS’ National Advisory Committee on Rural Health and Human Services, spending per rural Medicare beneficiary is 3.7% less than urban. Maybe rural is a better model for the future rather than a scapegoat.

Tim Size