Big Brother to Attend the 2012 ACC Meeting in Chicago

Last year, I became concerned about using RFID tags to track doctors at our annual scientific sessions for "planning" purposes. In return, the ACC explained why (really) this was necessary and how they will "take your concerns in consideration" for future meetings.

Suffice it to say, this year, RFID tags will be used again. From the ACC Scientific Session registration page:

RFID badge scanning technology will be utilized at ACC.12 to better understand attendee/delegate educational interests and preferences to assist with future planning. No personal information is stored in the RFID badge, only an ID number. Exhibiting companies that choose to rent RFID readers to analyze attendee movement in their booth will NOT be provided with attendee names or personal contact information. Only organizational affiliation, clinical focus, and city/state/country information will be provided.

So don't be concerned. After all, this year there's something more that's even better!

Big Brother will be watching.

Yes, doctor, please enter your Medicare NPI number at the time of registration so the government can track you, too.

Why does the government need to do this? We're told:

A provision (Editor: Caution - 323 pages!) within the 2010 federal Patient Protection and Affordable Care Act (PPACA) requires healthcare companies to disclose any transfer of value to a healthcare provider to the U.S. Department of Health & Human Services beginning in 2012. The ACC requests its U.S. healthcare provider attendees supply their publicly-available NPI number so that companies may comply with the above provision.

So companies will have your individually-identifiable Medicare NPI number anyway. You, dear doctor, will be tracked, courtesy of the US government, RFID tag or not.

We should ask ourselves some probing questions about this activity:

1. What in heaven's name is "affordable" to America's health care system about this action? Is it the development of a tracking database? Are our nation's doctors historically untrustworthy in their dealings with industry when attending educational scientific sessions?
2. Is this action required because patients will be harmed or placed at risk by this educational activity?
3. Will other professional and political conferences be similarly tracked?
4. How much does this tracking cost the American taxpayer? Will it cost more to collect the data and analyze it than is saved by tracking meal expenses? In other words, is it cost-effective?

Oh, and one last question:

Are US taxpayers aware they are funding this type of activity?

Well if they weren't, they certainly are now.

-Wes

A Variant of "Where's Waldo?"

For doctors, there's a new game they can play at their next professional society's scientific meeting: "Where's the RFID Scanner?"

See if you can find them in this picture from this year's earlier Heart Rhythm Society Scientific session:

Click to enlarge

-Wes

Toward More Transparent Physician RFID Tagging at Scientific Sessions

Heh. Gotta love physician activism.

-Wes

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

ACC Explains the Use of RFID Tags on Attendee's Name Badges

In response to my earlier post on the use of RFID tags at the ACC's Scientific Sessions, I left a message on the ACC's blog to inquire about this practice. My comment was not initially published, but today I noticed that traffic came from their blog and that my comment and a response to my inquiry was published on the 12th of April. Here's what they said:

Hi Dr. Fisher,

Thanks for your question and your feedback on the meeting. RFID is used by many large meetings -- the technology allows us to track which sessions an attendee attends, and also to track flow -- this will help us a lot to plan the education program next year, as we will be able to use data to determine co-location of pathways etc. to make for an ever better attendee experience on show site. Info that the ACC collected at ACC.11/i2 will help us better plan meeting rooms and expo entrances, adjust our conference programming & expo hall floor plan, and quantify to exhibitor prospects the value of investing in our event, among other things. We are not using the RFID to award CME.

Thank you again for your feedback. Please know we will certainly take your concerns into consideration as we plan for 2012.

All the best,

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

First, this was very nice of them to respond. I am concerned, however, that this company that tracks these RFID tags can identify the individual and their associated institution in real-time at these meetings (see their promotional video). As Calvin Powers from IBM notes on his blog:

Is it OK for the ACC to give the names, demographic information, contact info, etc of every individual that visited the booth?

At this point in the continuum we have moved into the realm of identified tracking and I suspect most people would feel like their privacy had been invaded if their individual movements were tracked and this level of detail was sold to the exhibitors. When the tracking becomes identifiable down to the individual, privacy practices regarding transparency, opt in/out policies, etf become very important.

We do not know if this practice occurred, but we do know that the capability was there.

My bet: there will be one heck on an "opt in" clause for this technology going forward for future meetings.

At least I hope so.

-Wes

The Potential of RFID Tag Readers to Interfere with Pacemakers and Defibrillators

RFID tags: they have become ubiquitous additions to our electronic and medical worlds, concealed in automatic automobile tolling systems, key fobs, store and drug packaging, pets and even humans.

No doubt the trend will continue to grow.

Recall that RFID tags are used to locate and tract objects and come in two varieties: passive and active. While active devices contain a small battery, passive devices require no battery since they get their energy from the reader that transmits a signal that is received by the RFID tag's antennae and returns a unique identifier signal to the reader.

Surpisingly, it seems some lower frequency readers have the potential to interfere with implantable pacemakers and cardiac defibrillators (ICDs) when they are held in fairly close proximity to the implanted devices.

Now before you blame and RFID reader for your last defibrillator shock, realize that the FDA has not received any clinical reports of this interference. But researchers from the FDA reported in this month's journal Heart Rhythm that bench testing has demonstrated the potential for interference from certain types of tag readers, particularly those working at the unrestricted lower frequencies (LF) of 125-135 kHz in close proximity to the medical devices. The authors of this bench research concluded:

Although there is in vitro testing evidence for concern for implantable pacemaker and ICD EMI at LF and HF (high frequency - 13.56 MHz), the FDA has not received any incident reports of pacemaker or ICD EMI caused by any RFID system. This could reflect a low clinical risk due to a number of factors: class III (minor) reactions are probably not clinically significant, close patient proximity to RFID readers may not commonly occur, and most reactions observed are transient. This could also be the result of underreporting; EMI issues are difficult to recognize as they are typically transient. If a patient is experiencing symptoms (e.g., lightheadedness) that they believe are the result of EMI effects from an identifiable source, the best advice is to move away from that source.

To effectively mitigate implantable pacemaker and ICD EMI (electromagnetic interference) from RFID readers will require work on the part of both implant manufacturers and the RFID industry. During testing, some implantable pacemakers and ICDs were more susceptible to EMI than others. Active implantable medical device manufacturers are currently working to understand these issues, to develop industry requirements, and to design future devices appropriately.

The RFID industry should also take note with regard to medical device EMC. With so many promising health care applications for RFID, it is inevitable that RFID and medical devices will increasingly function in close proximity. Modulated LF RFID is a near-perfect source to cause EMI for implantable pacemakers and ICDs. The low carrier frequency allows the signal to enter the implant, bypassing commonly used feed-through filters. Once inside the implant, the RFID signal is interpreted as a physiologic signal due to the slow pulse repetition rates. The pulse repetition rate of each RFID reader varies greatly as it is not limited by the Federal Communications Commission or defined by most RFID standards. Limitations for implantable pacemaker and ICD EMC do exist as these devices must sense in the physiological band. If it can be predicted that an RFID system will be near pacemaker or ICD patients, appropriate RFID technology should be selected. The RFID technologies that were most compatible with implantable pacemakers and ICDs in our testing were UHF RFID and continuous-wave RFID readers. Maintaining a reasonable separation distance between RFID readers and implantable pacemakers and ICDs will also help mitigate EMI.

Although this article suggests a particular risk in the use of sample RFID systems, this is not the sole intended message. The potential advantages of RFID in health care seem promising, and the FDA is promoting RFID as a technology to reduce counterfeit drugs in the supply chain. An important message from the results of this study should be that RFID implementation should take implantable pacemaker and ICD EMC into consideration. Additionally, both patients and their cardiologists should be aware of the possibility of adverse reactions from RFID.

We do not believe the current situation reveals an urgent public health risk.

Hey, but it's still good to know.

-Wes


References:

Seidman SJ, Brockman R, Lewis BM, Guag J, Shein MJ, Clement WJ, Kippola J, Digby D, Barber C, Huntwork D; "In vitro tests reveal sample radiofrequency identification readers inducing clinically significant electromagnetic interference to implantable pacemakers and implantable cardioverter-defibrillators," Heart Rhythm Jan 2010, 7(1), 99-107.

Heart Rhythm Society's press release.