Whither Interoperability
An article in today’s Washington Post offers a hint at where healthcare IT is headed. In an effort to control costs, insurance companies have begun to rate physicians on how much money they spend taking care of patients. Those who generate large bills for insurers are dropped to a second tier to discourage patients from seeing them. On the surface, this seems like a perfectly reasonable approach. Problem is, sometimes the data are wrong, and there’s no opportunity to correct it. Like trying to get your name off the government’s no-fly list. (Take the train.)
Some of the questions are based on the NQF standards (beta blockers for heart attack patients), but insurance companies are interested in money, so the aim is to reduce their costs. Patients are discouraged from seeing lower doctors by higher co-pays. Nothing wrong with rating products and services for consumers. Consumer Reports has been doing this for years. However, the consumer is free to decide that “beta blockers aren’t important to me”, patients are not. They get punished for choosing a doctor other than one recommended by their insurance company. Back to the HMO concept of limiting choice to promote profits.
All of this is made possible by electronic medical records. The interoperability of these records enables insurance companies to peruse the records in your doctor’s office. Problem is, these records may be wrong or incomplete. Doctors have been dinged for not doing PAP smears in patients with hysterectomies or mammograms in patients who’ve had mastectomies. As more offices acquire electronic record systems, such scrutiny will become more pervasive--and invasive.
Again, patients have been left out. None of the ratings is of any interest to patients. For sites that do collect patient ratings, see HighlightHealth.com. As with other systems, it’s OK to collect data and perform measures. It’s the use of the resulting data that’s critical. Would you believe that some physicians are not overwhelmed with joy? Yep. Some have even sued.
The key discussion in Washington now is how to attribute healthcare costs among the various physicians taking care of a given patient. Who gets the blame for that unnecessary MRI?
Some of the questions are based on the NQF standards (beta blockers for heart attack patients), but insurance companies are interested in money, so the aim is to reduce their costs. Patients are discouraged from seeing lower doctors by higher co-pays. Nothing wrong with rating products and services for consumers. Consumer Reports has been doing this for years. However, the consumer is free to decide that “beta blockers aren’t important to me”, patients are not. They get punished for choosing a doctor other than one recommended by their insurance company. Back to the HMO concept of limiting choice to promote profits.
All of this is made possible by electronic medical records. The interoperability of these records enables insurance companies to peruse the records in your doctor’s office. Problem is, these records may be wrong or incomplete. Doctors have been dinged for not doing PAP smears in patients with hysterectomies or mammograms in patients who’ve had mastectomies. As more offices acquire electronic record systems, such scrutiny will become more pervasive--and invasive.
Again, patients have been left out. None of the ratings is of any interest to patients. For sites that do collect patient ratings, see HighlightHealth.com. As with other systems, it’s OK to collect data and perform measures. It’s the use of the resulting data that’s critical. Would you believe that some physicians are not overwhelmed with joy? Yep. Some have even sued.
The key discussion in Washington now is how to attribute healthcare costs among the various physicians taking care of a given patient. Who gets the blame for that unnecessary MRI?
Comments
I am not surprised with the examples that you cited. There will always be such insurers and other healthcare businesses who misuse data for their own advantage. I analyze data for healthcare purposes and know it is fairly easy to twist data to meet one's needs. To use data well there must be a strong positive ethical point of view--Data is used for the good of the patient and the provider.
Posted by: Donald Bryant | August 19, 2007 07:30 PM
Donald: These are not particularly evil insurance companies/HMOs. They are behaving the same way you or I would behave. The problem is that they are accepting data without examining it. Nothing wrong with collecting data--it's how you use it that matters.
RGB
Posted by: Robert Burney MD | August 26, 2007 07:29 PM