Sunday, April 24, 2011

The Implications of Physician Tag and Release

Not everything that counts can be measured.
Not everything that can be measured counts.

-Albert Einstein
Recently, a disturbing trend of monitoring physician quality and accountability has taken another ominous turn: tracking physician's movements at scientific conferences (so called "tag and release") using RFID tags imbedded in attendees name badges at national scientific sessions. Having had personal experience with the recent American College of Cardiology meeting, this technology will also be imbedded in the name badges for attendees at the upcoming Heart Rhythm Society meeting to be held in San Francisco in May.

On first blush, it shouldn't be such a big deal, right? It was all just a great way for companies to obtain, for a fee, the names and institutions of people who visited their display booths and for the conference organizers to track the movements of attendees. (Heck, maybe they can partner with an industry sponsor to pick up our traffic tolls on the way to the conference hall or arrange other exciting activities for us! [Said tongue-in-cheek, of course])

Instead of "opting in" for tracking at scientific meetings, doctors must "opt out" from the use of tracking technology when registering for scientific meetings. At the upcoming Heart Rhythm Society meeting for instance, doctors had to "opt out" from the use of RFID technology tracking by checking a box that says:
Badge scanning technology will be utilized at this event in order to better understand attendee/delegate interests and preferences. The information collected will be used to improve future events to better address your preferences. No personal information is stored in the RFID badge, only an ID number. We encourage all participants to take part in this process to ensure the most accurate data is obtained. You may check this box to opt-out of the RFID data collection.
There's full disclosure, doctor.

But to me, the default tracking of doctors is disturbing on several levels.

First, tracking was approved by our professional society organizers upon their own members. It is no secret that these societies make a significant portion of their operating revenues from industry sponsors at these meetings. By instituting tracking, the value of their membership's privacy has taken a back seat to the income generated from tracking revenues. By NOT checking a box, we have implicitly "agreed" to this tracking. (Realize we MUST wear our badge to attend these conferences where we gain our REQUIRED continuing education credits.) Because we have "agreed" in this manner, the tracking data are now legally "discoverable." At the risk of sounding like a conspiracy theorist, it is not too hard to imagine one's credentials being called into question in court because a doctor did not demonstrate enough time in CME activities at the scientific sessions to quality for credit or because these data implicate a doctor in a purchasing agreement between a vendor and hospital system simply because a doctor visited a display booth.

Doctors have seen this sort of activity before when "only" our license and demographic information was sold by the American Medical Association (AMA). The AMA currently "licenses" physician state medical license numbers and demographic information to health care information organizations (HIOs), HIOs then collect and compile this information with prescribing data that contains the doctors' license numbers (no names, mind you) and then sell the lists to pharmaceutical companies. The AMA tells its members it does "not collect, license, sell or have access to physician prescribing data" and this is true. But the AMA facilitates an intermediary's ability to pair doctors' license information to a their prescribing habits via a third party. One can only speculate how out prescribing and practice profiles are being developed by other similar health information companies with the use of our RFID tracking data.

Behind all of this is a bigger issue: doctors are frustrated by the increasing intrusion into our day-to-day practice of medicine to measure things. Take, as one example, our "quality performance measures" that have done little to facilitate patients office visits, but rather add burdonsome documentation requirements in the interest of government payments. A number of hospital administrators have confided in me that it costs more to collect this data than they make in government payments. In fact, whether these programs are ultimately are found to be cost-effective or improve the quality of care has been brought into question in our literature. Yet we continue to collect these measures and expand them. We are now dispatching legions of people to collect and compile data to "prove" that Electronic Medical Records are used in a "meaningful" way. But an honest appraisal of this policy discloses the reality: these measures permit health care systems to collect another $40,000 per doctor from the government because they are using computers, not because it improves patients' care in any "meaningful" way. As proof of the overburdensome nature of all this data collection for the physician, doctors (or their health care systems) are increasingly employing "scribes" to relieve them of the data-entry burdens in the name of "efficiency." How much, exactly, do these scribes cost our health care system? Few dare to ask the question since no one wants to deny themselves of that juicy $40,000 pot of gold being paid per doctor.

Adding insult to injury, all doctors will soon be required to disclose if we receive anything over $100 from industry representatives. Like the public, most of us recognize the pernicious nature of industry influence upon our profession. Yet we now find we are being used. Should our professional organizations be any less forthright with their industry dealings and the use of our demographic data at national scientific sessions? How much is at stake?

Finally, we see more and more onerous licensure requirements and fees paid to the same tag-and-release operatives at considerable cost to ourselves. We now spend thousands of dollars to remain "credentialed." We wonder how much the RFID "return on investment" to industry sponsors adds to our annual membership fees. Could it reduces them? Who knows? Maybe, like other IT models, we should insist our membership fees be waived if we agree to being RFID tagged and released because most of us realize someone's making money on this deal.

In summary, doctors increasingly find the imperative to guard the privacy of our patients without regard to our own personal and professional privacy with the very same patients disturbing. Everything about doctors is being measured these days and it's taking its toll on patient care. We are frustrated with the governmental bureaucratic standards that threaten our time with patients. But time with patients does not pay bills. Meeting data-collection milestones do. Our government and employers have lost sight of the main issue here: improving and expanding our contact with (and the ability to do good for) our patients.

But as long as there is money to be made with our personal information, it is clear that there will be those that will try to capitalize upon it, whether we realize it or not. Only by demanding constant accountability and transparency from the collectors of this information be they government bureaucrats or our professional society appointees, can we hope to maintain any modicum of professionalism in our tenuous doctor-patient relationships of the future.

-Wes

20 comments:

Anonymous said...

As a member of the HRS, I'm equally infuriated. I just went and looked at my HRS badge, and indeed it does have an RFID tag on the back. While I fully intend to contact the organization to express my feelings, I suspect a 20 second procedure with a razor blade would safely remove the tag and solve the problem, at least on a personal level. I'll let you know how it goes.

Keith said...

What doctor-patient relationship? I thought we were all just desstined to become part of the seamless medical team with no ongoing relationship with our patients. One doc is interchangeable with another and we will use the wondorous EMR to bring each new physician face up to speed as to our ptaients (or customers) medical issues.

I do agree that we are entering the era of documentation hell. I think we just have to look what has been wrought on the educational professions to see what is coming. Lots of data collection and documentation, all with a big question mark as to whether it makes any difference or not. I, for one, do not plan to bite at the goverment carrots dangled in front of my nose. Not until they show that they actually matter or improve our delivery of care. That includes EMR.

Atul Salgaonkar said...

Dr. Wes, I am a technologist who ran an RFID company, exclusively focused on healthcare. Your note highlights the reason why I gave up on the industry’s ability to apply this technology and closed my shop.

RFID presents some powerful capabilities: if you have struggled to scan the bar code on the IV bag at patient bedside or wanted to check a sleeping patient’s id under the blanket, RFID can help. It also assists in counterfeit prevention and needle-in-the-haystack equipment detection. Making physicians, nurses accountable is different from turning them into objects in the healthcare supply chain!

The other point you make is also worth highlighting: How is the default set, with reference to opt-in vs opt-out. As a society, we don’t have a default opt-in for organ donation on our DMV licenses. I really hope that ACC/HRS conference organizers change RFID to opt-in and provide copious clarity about data use – and perhaps some conflict-free incentive to help them get information from willing (and informed) participants.

Abdul Abulbul Amir said...

Whats the big deal? Conferences used to scan a bar code on the attendee's badge. This just reduces labor cost.

BTW, conferences and trade shows tend to claim everyone that attended anyway.

DrWes said...

Abdul-

To my knowledge, medical conferences NEVER have required scanning of our badges - we just had to wear them. We could voluntarily give our contact information by having a trade show card swiped at the vendor's booth with whom we wanted to interact.

Now it's all invisible. If we don't opt-out of this tagging, off our data goes to places and parties unknown.

Docs have an unusual scruitiny applied to us in our dealings with pharma and med device companies in part because of the cost of health care today. The last thing we need is our data being used against us for marketing ploys.

ken in sc said...

I was recently on a county jury. We had a bar code on our name tags to prove we were in the jury pool and entitled to jury pay. An rfid would be even easier. What's the big deal?

Pogo said...
This comment has been removed by the author.
Pogo said...

Kill your RFID:
1) Put it in the microwave for 5 seconds. Some fire risk.

2) Pierce the chip with a knife or other sharp object.

3) Cut the antenna very close to the chip. The chip will then have no electricity and can't transmit its signal back to the reader.

5) Hit the RFID a few times with a hammer. This will destroy the chip.

jimbino said...

Someone could make a bundle selling metalized transparent mylar sleeves to put your badge into. This would make a Faraday cage that would impede RF access to the RFID chip.

Pogo said...

True, jimbino. A hammer ain't always nearby.

I expect the foot of a chair or the heel of a shoe would do though.

jimbino said...

Tag and Release are the two things that have been missing ever since physicians Neutered themselves when they started taking Insurance, Medicare and Medicaid.

I have found physicians and dentists who do not take those things and who do not have any need to share any of my medical information with anybody, anonymous or not.

jimbino said...

Tag and Release are the two things that have been missing ever since physicians Neutered themselves when they started taking Insurance, Medicare and Medicaid.

I have found physicians and dentists who do not take those things and who do not have any need to share any of my medical information with anybody, anonymous or not.

Fat Man said...

Anonymous and Pogo have it. I tend to go with Anon. Open the badge up and peel the sucker out of there. Make sure to dispose of it outside of their listening area.

Chris Hanebeck (Dallas, TX) said...

Dr. Wes: you make a number of excellent points. RFID does allow for the ability to track people, it can be read without your knowledge and you have no control whatsoever over how you data is used afterwards.

There are also important limitations in RFID systems. One of them is that you have to be in proximity of a reader. It is not possible to follow you along every step as that will require an impossibly expensive reader infrastructure. It is also, as has been pointed out, possible to kill the tag. However, you should not have to go to these extreme measures when all you want is privacy.

I work for a company called Revere Security and we have developed an encryption algorithm for RFID tags that secures your information and allows you to protect your privacy. The technology is available for any type of ID document or, if you wish, for the tag that car dealerships and car washes now attach to your vehicle. It is certainly not too late to begin the process of taking individual data and its ownership seriously. Hopefully, you will not have to beat your conference badge with a hammer or get your scalpel out in the near future!

Anonymous said...

Dear Dr. Wes:
Can you blame our medical societies for treating us as marketing puppets? ACC is actively 'diversifying revenue streams' (see Cardiosource). They are anticipating the day when membership drops off or can no longer afford the dues given the dramatic reductions in the past and future reimbursements from Medicare. Not to mention that the cardiologists will soon all be employees of hospitals who may refuse to pay dues to an organization which has competing lobbying interests.
Do you think that the AMA represents more than 20% of docs? It has evolved into something akin to the AARP. It is just a marketing/revenue machine that exists for its own purposes. If any so called medical society generates a significant portion of its revenue from any source other than its members, WHO does it really represent. Do you believe that industry is more concerned with patient care or shareholder value?

Tim said...

It's sad how much technology has eroded medicine. I'm a tech lover and can think of myriad ways to use it regarding patients. The problem is most of the erosion come from technology pushed on us by those who no longer or never did taake care of patients. In the OR, the circulating nurse is now the computer nurse! Instead of watching the case and anticipating needs, e nurse is scrambling to put in tens of pages of crap that no one will ever read. Ever try to go through a hard copy of what they put in? You can't find... Well, you cant find squat! You literally have to go through every page at least once. Nurses on Med/Surg floors spend more time treating the computer than treating patients. I'm not faulting the nurses. The hospitals force them into this practice. Trying to get traditional functions done, eg, getting a pre-op antibiotic given on time seems to be too much to hope for! Now they want to tag us like they do for biologic tracking of animals. I have emailed the ASPS regarding use of RFID at our meetings. I anxious to see what they say. I can sure cut it out. I'm a surgeon!

American Medical Association said...

The AMA’s role in sharing physician demographic data has real benefits for physicians. With the help of the AMA, physicians can exert control over pharmaceutical companies who want access to physician prescribing data.

Physicians can use the AMA’s Physician Data Restriction Program (PDRP) to designate their prescription data as off-limits to drug salespeople and register complaints against pharmaceutical companies that use the data inappropriately. The program is free and any physician can enroll in the service regardless of AMA membership.

The PDRP provides a balanced approach for addressing the diverse concerns surrounding the use of physician prescribing data. It gives the AMA the ability to intercede on behalf of physicians against unwanted use of prescribing data by pharmaceutical sales representatives, while preserving prescription data for public good purposes, such as medical research, quality improvement, drug diversion detection and drug recall notices.

The release of prescription data to pharmaceutical companies does not seem to be a significant issue for most physicians. A Gallup survey that found 84 percent of physicians either were not concerned about the release of individual prescribing data or felt that the ability to “opt-out” of the release of their data to pharmaceutical sales representatives would alleviate their concerns. The AMA’s PDRP accomplishes this "opt out" capability. A subsequent market research study indicated that 96 percent of physicians participating in the PDRP were either satisfied or very satisfied with the program.

Restricting access to prescribing data should be every physician's individual choice. Only the AMA can guarantee the nation’s physicians have that choice and control, while ensuring the data remains available for public good purposes. Without the AMA to protect physician interests, it’s likely that private companies would step-in and ignore the choice physicians deserve.

Cecil B. Wilson, M.D.
President. American Medical Association

Jay said...

I was able to peel my tag off the HRS ID pretty easily. I'm considering affixing it to my forehead for the duration of the meeting.

@EJSMD

Sue Sears Hamilton said...

ACC.11 Chair Michael Crawford, MD, FACC, has posted a blog addressing the topic here: http://blog.cardiosource.org/post/Using-Technology-to-Better-Understand-ACC-Meeting-Attendees.aspx. We hope you’ll leave feedback.

All the best,
Sue Sears Hamilton
Associate Vice President, Annual Scientific Session
American College of Cardiology

Tim said...

All due respect, AMA, if you help us out any more greasing the skids for for our socialist president, I'm not sure I'll be able to practice! I'm sure there will be someone from the "5 Minutes to Your MD Degree" program to take my place. All Obama cares about is being able to say, "Everyone's covered!" Treatment only comes, however, if the "panel of experts" approve. But you're covered!