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Can We Find a Balance Between Privacy and Meaningful Use?

Posted on Tue, May 05, 2015 @ 04:01 PM

You’ve probably noticed that there is a lot of conversation about meaningful use lately. It’s not a new concept insmartphonechart-744642-edited health IT, but these days, it’s timely.

The reason is that CMS and ONC released a proposed rule for Stage 3 of meaningful use on March 30, and the comment period closes on May 29. That isn’t very far in the future, and people still have a lot questions about this next stage, which is set to kick off in 2016, and many others are still grappling with Stage 2. 

Briefly, meaningful use is, using certified EHR technology to improve healthcare and healthcare services. Eligible professionals and hospitals must meet objectives put forth by CMS to qualify for financial incentives. If you want to get down into the weeds, a more detailed definition is available here.

The goal of this upcoming phase is Improved Outcomes, at least in part because the first two stages should have covered data capture and sharing, followed by more efficient clinical processes. The objectives are laudable and, despite bumps along the way, achievable; but this piece in the New York Times by Austin Frakt gave me pause.

In 2013, researchers who study drug and alcohol abuse and the illnesses that are often linked to them found that they had been locked out of Medicare and Medicaid data connected to substance abuse. Officials at HHS closed the door on this kind of research quietly, citing concern for patients’ privacy. 

And of course, privacy is a reasonable concern, perhaps most especially for people seeking treatment for addiction because it still relatively little understood and still highly stigmatized. To use the data, researchers would have to obtain consent from individual patients.

In his Times piece, Austin Frakt points out how onerous that would be. He also points out that physicians whose patients’ abuse histories are tied to their Medicare or Medicaid records would be in the dark without patients disclosing their histories. 

If that’s the case, interoperability between EHRs (part the proposed rule for Stage 3 meaningful use) would be meaningless for millions of people because neither they nor their doctors would think to ask for what isn’t in their health record.

Frakt proposes a chilling scenario:

“Imagine that a doctor sees a patient who does not disclose a history of opioid addiction, which was diagnosed at another doctor’s office. If that physician prescribes a narcotic painkiller, he could fuel the patient’s addiction, with potentially lethal results. But today, the prescribing physician couldn’t be told about the condition absent patient consent — even if the two physicians are working together to coordinate that very patient’s care.”

While there is certainly a lot of criticism regarding EHRs — even on this blog! — there is also so much promise for them to play a significant role in improving healthcare outcomes. Let’s hope we can strike a reasonable balance.


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