Bob Gellman and me

[James Love <love@tap.org>]

Robert Gellman writes:
>I'm confused.  Insurance companies get records with consent.  
>Do you want them to revise their consent forms to request+
>permission to put data in computers?  If required, they will 
>do so and patients will sign the consents blindly just like they
>sign consents to disclose "any and all information" to their
>insurance company.  What will this accomplish?  If patients 
>had the ability to negotiate with their insurance companies,
>some would negotiate better terms today.  I am not aware that
>this is a  widespread event today.

My response:

The following language is what we want added to S. 1360, Sec.
202.

     Sec. 202 (e) Disclosure for Payment. -- A health
     information trustee that receives protected health care
     information for purposes of authorization of payment
     may only use information for this purpose, and may not
     redisseminate the information to any third parties,
     including persons who seek information under sections
     204, 205, 206, 207, 208, 209, 210, 211 or 212 of this
     act.  Protected information received for purposes of
     payment authorization shall be removed or destroyed at
     the earliest opportunity once payment has been
     authorized.
    
    
Bob Gellman writes
> So all of the other users (cost containers, auditors, fraud 
> investigators) have to go back to the doctor and hospital to
> collect the same records that were just disclosed to the
> insurance company.  But since all of these other uses are
> authorized by law and are going on today, your proposal will
> increase the demand on doctors and hospitals.  It will be less
> efficient, cost more, and not result in any few records being
> disclosed. An alternative is to just amend the old consent form
> so that the information can be passed around by the insurance
> company. 

Mr response:
   An alternative is for patients and doctors to decide, without
the coercion of insurance payments, if they want to enter the
records in databases.  Doctors and patients may decide that they
want to give Equifax, Travelers, or whoever the records, to
handle all these requests for data (gee, it sounds like there is
such a huge demand for records), but why not give them the
choice, instead of the insurer.  Are you afraid that people will
just say no?


Robert Gellman says
> If you object to cost containment and fraud control,
> then say so directly.  

My Response:
    Bob, this is a low blow, and you know it.  Why are indentifed
records necessary for cost containment?  And for fraud,
investigators will surely be allowed to investigate, but do they
need to know if a woman had an abortion 15 years ago, if I was
ever treated for VD, or what I told a mental health professional
about my family life.  Why is it so important to have these
massive cradle to grave databases, without any omissions except
for those who pay out of pocket?

Robert Gellman says:
> Why make an important process less
> efficient?  The real issue is use and not access because they
> have access today.

My Response:
   Let's see.  Are you saying that if someone has access today,
then its not a real issue?  Why would that be?  Why can't I make
an issue of current violations of privacy?  This isn't russia is
it?


> So who should be prohibited from maintaining computerized
> records? Doctors, labs, pharamcists, hospitals?  

My response:
   No one.  Anyone can put their records on computers.  What are
"their" records?  If an insurance company gets notes from my
sessions with my doctor, which I have paid for with insurance
that I have also paid for, does the record "belong" to the
insurance company?  If a hospital has a record of my visit, is it
theirs to sell or redisseminate?  This is about who has the right
to release and redisseminate information that is or should be
private. 

Robert Gellman:
> Can everyone
> have their own computer and print out information to pass on to
> the next person who then re keys it?  Do you want to ban
> computerized patient records?

My Response:
   I guess exaggeration seems like an effective polemic, Bob, but
its not really becoming someone as sophisticated as you.  Saying
the insurance company can't get my records without non-coercive
consent won't bring the world back to the stone ages, or
eliminate the use of computers.  But will give people more power
to control the redissemination of their records.  Don't be so
silly or alarmist.


> Computerized
> records will save billions.  

My response:
    Gee, look what they have done so far.  I can't believe how
much my medical bills are going down.  Isn't technology
wonderful.

Robert Gellman:
> Just how far do you want to carry
> this anti-computer position?  Should we all stop sending email
> because of the possibility of privacy violations and start
> sending snail mail? 

My response:
   Bob, I'm hardly a luddite.  We are discussing this on an
Internet discussion list that I set up.  We have a Web page on
this topic.  I have worked in the private sector to develop
private sector information products and services, including a
portfolio reporting system for IBM's pension fund real estate
portfolio, and a return attribution system for Digital.  I'm
getting a little tired of you, Janlori and Deirdre accusing
anyone who doesn't want all their medical records available to a
couple of million persons anti-computer.  Are you anti-privacy?



Robert Gellman:
> The Bennett and Condit bills provide NEW PROTECTIONS against
> law enforcement access.  Today, health fraud investigators 
> can obtain records without consent or notice and use the
> records against patients.  Under the bills, access is limited,
> notice is required for subpoenas, and USE OF INFORMATION
> AGAINST PATIENTS IS PROHIBITED except for health care fraud. 

My response.
Ok.  The Medical Records Confidentially Act does in fact contain
some modest, if cosmetic measures toward privacy.  Fraud
investigators can get records without consent and without notice,
but they can only use them against you if you committed fraud.

Mr Response:
Wow, what an improvement.  Law enforcement officals get access to
everything, on computer, without consent, but they need a warrant
from a judge -- any judge in America will do of course.  I feel
much better.

Robert Gellman:
> The bill impose greater restrictions on law enforcement access
> and use of records than exists today.  Do you dispute that?

My response:
    Well, I guess you can say that about some features, but I
can't imagine less of an improvement.  Don't we deserve a little
better, particularly as the technology is racing ahead?

Robert Gellman:
>Computers also make records more accessible, and they reduce the
>cost of health care.  A recent poll showed that the vast
>majority sees the trend toward computer based patient records 
>as either very beneficial (40%) or somewhat beneficial (45%). 
>People also think it is very important to use computerized
>patient records to identify bad doctors (79%), reduce fraud
>(76%), reduce cost (74%).  People are also very willing (40%) or
>somewhat willing (40%) to have their medical records in a
>computerized system if there is a privacy code.  Today, records
> are computerized and there is no code!!

My response:
Bob, isn't this the Equifax study that we have been hearing so
much about?  Why not ask the question: Who should decide if your
medical records are placed in a national (international) database
accessible to millions to persons -- you or your insurer?  

Robert Gellman:
>Railing against computers is barking up the wrong tree.
  
   Who is railing?


----------------------------------------------------------------------
James Love, love@tap.org
P.O. Box 19367, Washington, DC 20036; v. 202/387-8030; f. 202/234-5176
Consumer Project on Technology; http://www.essential.org/cpt/cpt.html
Taxpayer Assets Project; http://www.essential.org/tap/tap.html