Wednesday, June 28, 2006

Physican Prescribing Data (and your data) For Sale

Tomorrow's New England Journal of Medicine describes the phenomenon of selling physician pharmaceutical prescribing information and the efforts made by the American Medical Association to permit doctors to "opt out" of allowing their data to be released to pharmaceutical sales reps with the following caveat:

"The AMA has created a Prescribing Data Restriction Program. Physicians are now able to deny all sales representatives access to their individual prescribing data. The restriction is limited to sales representatives and their direct supervisors; physicians will not be able to deny access to other officials at pharmaceutical companies"
It's simple, really. I can opt out giving the pharmaceutical companies my data but the pharmaceutical companies can still get the data. That way, I can avoid being bugged by guys in suits much nicer than mine while I'm in clinic, and the AMA can continue receiving funds from the pharmaceutical industry. You see:
"In 2005, the AMA received $44.5 million in revenue — about 16 percent of its total revenue — from the sale of database products"
How can physicians carry an independent patient-centric and physician-centric political and healthcare policy voice when special interests are so critical to the funding of our own professional associations?

But the AMA is not the only organization with such ties: most professional medical organizations are similarly funded in tacit and not-so-tacit ways by Big Industry. Cash is the engine that keeps these organizations going. And Big Industry carries the cash (it certainly isn't doctors).

The simple truth: health care is a multi-gazillion dollar business enterprise. I assure you that every medical device manufacturer that sells product in the Chicago metro area knows precisely how many pacemakers and defibrillators I implant each year and whose product I use. (So far I have not been confronted with this data by the companies.)

But why stop there? The Health Insurance Portability and Accountabily Act (HIPAA), designed in 2003 to assure every patient's data is kept private, has an important word in it.... portability. Your medical data and my prescribing data are instantly available everywhere through the wonders of electronics. Just go to your local ER and watch: your healthcare data on your insurance card (and available online) is entered into a computer and verifies coverage. You are "registered" and amazingly a tremendous amount of information is already available (how did they get this data, anyway?) and they just need to "verify a few things." A doctor enters his evaluation and orders, all of which are available over the entire hospital information system and clinics to view by those with electronic access, and your bill after being sent home is automatically routed to your insurer (and a collection agent who uses a billing "scrubbing" agency to assure the bill is "clean" before it routes to Medicare and your insurer) before you leave the Emergency Room. I bet a few of those places you didn't realize. See what I mean?

And to think your medical data is not just as important to the government and Big Industry as my prescribing practices, think again.

And as we've seen (and outlined in Monday's LA Times article), the government's ability to keep sensitive electronic data private has met with obstacles recently. HIPAA, unfortunately, has become the smokescreen that permits the government and interested industries to garner tons of data about you and me electronically and under the guise of "privacy." Remember that HIPAA was really implemented to protect health insurance coverage for workers and their families when they change or lose their jobs. Only secondarily as part of the legislation was Title II of HIPAA developed, called the Administrative Simplification provisions, and requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. In reality, with the lack of enforcement of HIPAA privacy standards today, the privacy portion of this legislation is virtually meaningless.

While I applaud efforts of those privacy advocates to struggle to keep our medical information and prescribing information private, the reality is, with information flowing instantaneously as it does and business interests and government interests being what they are, I'm afraid real medical and prescribing privacy (whether drugs or medical devices) is a thing of the past.


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