08 October 2013

Providers Label Patients as Second Class Citizens

I am glad someone is speaking out about what providers and the health information technologies (HIT) are doing to shut us out as patients. If doctors think that their pedestal is tarnished now, wait until patients really understand what they are doing and they may find that there may be some tar and feathers in the next round. Not only this, but also many doctor-patient relationships may come to an abrupt end.

Adrian Gropper, MD writes about Health IT Week – the Consumer Health IT Summit. He does not pull any punches and his blog should upset a few great doctors that understand the importance of communication. The rest probably are clapping their hands heartily and saying Amen.

Dr. Gropper says that the Health IT week demonstrated a double barrel strategy first to keep patient information segregated from provider information. Then by rebranding HIPAA as “Meaningful Consent” with no input from patients, this makes patients second-class citizens in Meaningful Use Stage 2 interoperability. Providers and regulators are working together to see that is stays that way.

Normally providers and IT people make comments, but they are strangely quiet after this blog. They seem to know that some patients read many of the blogs and they are careful not to disclose their opposition to Dr. Gropper telling all. Dr Gropper and several providers have laid out some of the background in a good discussion.

The segregation of patient information from “provider” information is the current federal regulatory strategy. It’s even more so in the states. By making patients into second-class citizens, the providers can avoid open scrutiny, transparent pricing, and independent decision support.”

Federal regulators then create a parallel system where information is delayed, diluted, and depreciated by lack of “authenticity”. This is promoted as “patient engagement”. For regulators, it’s a win-win solution: the providers support the regulation that enables their price fixing and many patient advocates get to swoon over patient engagement efforts.”

What is even more troubling is this. “The Model Notice of Privacy Practices legitimizes the practice of provider-to-provider health information exchange under the HIPAA Treatment, Payment and Operations (TPO) exemption. TPO is used by providers and health information exchanges to avoid patient authorization for sharing of private information.” This smacks of patient privacy being violated with no concern.

Another point made by Dr. Gropper is the intentions for emails between doctor and patient. Apparently, most providers, regulators, and HIT companies wish to keep emails out of the hands and use by patients. Dr. Gropper states that the regulators are making most emails an organization-to-organization system. This is part of the regulations for Meaningful Use Stage 2 certification.

This means that the original intent of Blue Button Plus, having secure communications between patient and provider, will be lost and transparency will be lost. This will also mean that hospitals and providers can avoid giving patients an independent decision support portal and a key independent communication channel.

Without transparency and independent decision support, the tools for reducing health care cost become limited. The market-based (as opposed to Medicare for all) foundation of ObamaCare cannot highlight unwarranted and overpriced services as long as the providers of those services maintain control of our personal information. This seems a merely politically expedient. If we accept an impotent Blue Button Plus and HIE exclusion via TPO we may be headed for a regulatory failure even larger than the sub-prime mortgage crisis.

Patients need to sharpen their skills and knives for the battle ahead. It won't be pleasant for all concerned.

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