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AMNEWS on "data minefields"
[AMNews] [American Medical News]
Technically Speaking, Jan. 4, 1999
Online insights for physicians.
By Sandra Guy, AMNews staff. No endorsement by
AMNews or the AMA is implied for Internet resources linked in
this column.
---------------------------------------------------------------------Tech
Speak Data minefields
While data mining has its upside, it is
important for physicians and health care workers to
beware its dark side.
Technology's evolution has always elicited the
forebodings of George Orwell. Data mining is no
exception.
Data mining uses advanced software programming and algorithm techniques to
identify patterns and draw correlations from huge volumes of data no human
would be expected to analyze.
Then there's the next step.
The analysis can be culled from far-flung databases to help identify
physicians' "best practices" and track patient groups' clinical profiles to
raise the overall level of care. However, the technology can reasonably
ignite fears about accuracy, liability, privacy and security.
Doctors do have reason to be cautious. The
information age is manifesting itself in health care well ahead of any
rules of behavior and ethical conduct.
For physicians, the potential pitfalls include being
tracked for the kinds of high-risk procedures they perform, the number of
abortions they provide or some other sensitive procedure that is both
controversial and confidential. And if the data get into lawyers' hands,
this could create new havoc in the area of malpractice liability.
Luckily, many patients and important patient advocacy groups are aware of
both the challenge and the opportunity.
Patient activism, for instance, is forcing hospitals
from Florida to California
to make patients aware of how their confidential
medical records are used,
processed and shared. It is becoming a standard
practice to alert patients when
these records are accessed and enable them to
challenge what they perceive as
breaches of privacy.
No groups are more aware of the negative consequences
in patient relations that
can result from poorly crafted records policies than
insurance, pharmaceutical
and managed care companies. They have had to deal
with consumer outrage about
unsolicited marketing mailings that clearly contain
intimate information about
the recipients' medical conditions.
Blue Cross/Blue Shield of Minnesota is shifting to a
more restricted policy
governing claims data. Clearly, the tightened policy
restricts data sharing,
which can be frustrating for many health care
providers. But given the
consequences of no policy at all, doctors should take
a deep breath before they
complain about the expense and bureaucratic red tape
required to keep data
private.
Get practical
The Internet is changing the way entire sectors of
industry do business. So it
is no surprise that it will introduce dramatic change
to the health care
industry.
Although the Internet remains largely ungoverned,
health-related data are
destined to course through this public network. The
federal government
consequently is mandating high levels of security to
mitigate catastrophes
(http://erm.aspe.hhs.gov/ora_web/plsql/erm_rule.rule_text?user_id=&rule_id=90).
It will no longer be OK for computer screens in physician
offices or hospital
hallways to remain logged on to a network, with the
password written on a
yellow sticky note in plain view. It will no longer
be OK to transmit sensitive
patient data without using encryption technology.
[....]
The proposed federal regulations requiring data security are designed to be
scaleable, that is, to grow as your practice grows,
and they specify no
particular technology, notes Bill Braithwaite, senior
adviser on health
information policy, Office of the Assistant
Secretary, Planning and Evaluation,
at the U.S. Dept. of Health and Human Services. "That
might mean locking the
computer at night [or] keeping the terminal away from
where the public can
access it. It's really common-sense stuff," he says.
Remember the upside
Despite the sticky issues that data mining poses, its
usefulness to the medical
profession is becoming apparent.
One obvious benefit is tracking patterns that
indicate fraudulent Medicare
claims. Data mining also is being used to analyze
clinical repositories of
patient records and encounters. The result will help
identify and prioritize
which patients are most likely to require immediate
help in the emergency
department, for example.
The Australian Health Insurance Commission used data
mining to identify 13
types of general physicians, such as a group of
"flying docs" who pilot Cessnas
and Piper Cubs to provide care to ranchers in the
outback, says Ramon Barquin,
founder of the Data Warehousing Institute in
Bethesda, Md.
Data mining also can hasten the way drugs are brought
to market, as well as
track the effects that specific procedures and
medicines have on various
illnesses, genders, weights and environmental situations.
And finally, one insurance industry official sees
managed care evolving into
what he calls "managerial epidemiology." In other
words, data mining will
eventually track variations in medical practice
across the country and identify
the ones with the most favorable outcomes, says Ray
Pyle, vice president and
division information officer for health care
management, Blue Cross/Blue Shield
of Michigan.
Physicians then will be encouraged to follow those
practices, which, it is no
accident, will be targeted at cutting health care costs.
[....]