Eric Schmidt at HIMSS
Several comments and critiques as I watched Eric Schmidt, Google’s CEO, talk about Google Health:
- Please stop calling patients consumers. Patients are people with illnesses or injuries who need medical care; consumers are people who purchase goods or services and are informed about what they’re purchasing. (Most patients are not actively dictating what health care resources they’re consuming.) Note: there are certainly consumers of health information, but a person who comes to me seeking medical attention is not a consumer. He or she is a patient.
- The medical record is not the patient’s property. I believe the model we need to use for the medical record is “shared control,” that is, the patient controls who sees the information in their medical record, but the patient’s physician controls the actual information. A patient with HIV or a history of anaphylactic shock to penicillin should not be able to delete this from their medical record.
- Wow, it would be amazingly cool to have all XRays and CT scans from everyone in the country online. I would love that.
- Dr. Schmidt talks about young people, and how we already see the future of what will happen with society, what changes will occur and how quickly and says that the older people like him need to be ready to change and adapt. But I’d guess no one on their Health Advisory Board, with the exception of Matthew Zachary, is under 40 or 50; few if any likely have a Youtube account or Facebook profile. If young people are so in the know, get our opinions!
Please stop calling patients consumers
hear hear!! it is a frame which supports the for-profit health care model, which is part of the problem.
better public health improves the bottom line for everybody.
A patient’s record is his/her property.
There was an article in “The Technologist” section of March 3 Newsweek by Steven Levy.
http://www.newsweek.com/id/114712
Levy brings up important issues that everyone has been talking about. However, I didn’t realize that HIPAA rules, as they stand right now, do not offer legal protection to the likes of Googel Health/AOL’s RevolutionHealth/Microsoft’s counterpart. Sure, Microsoft has a good track record regarding “consumer” privacy.
These are good ideas and I can readily see a reduction in repeated exams and less delay while getting a second opionion/transfer of records. But the ease of record theft/privacy invasion lingers. Maybe healthcare providers will press congress to make HIPAA cover these online features. But, who funds these services? Advertisers? What do they (advertisers) get in return?
Many questions…
1. In our medical system, Patients are consumers. We have a for-profit, private system. Basic high-scholl economcs. In a for-profit system, where health care services and facilitiesare advertizid on television and physicians ROUTINELY peddle the drug dejour and ROUTINELY make tratment decisions based on reimbursements, patients are CONSUMERS. Now, under a nationalized single-payer system, patients are PATIENTS. But where healthcare is based on a for-profit model, to fit that model, patient care must be significantly based on a consumer model. That’s not rocket science.
2. A patient’s medical data belongs to the patient. That’s Black-Letter law. Ownership is not defined by physical possession, but by legal control; similar to the legal control afforded intellectual property rights owners. Why is that a hard concept for you to understand?
3. The Google Health Advisory Board’s role is not to advise on implmentation; that’s what Google’s programming teams do. Your point is specious. Are you trying to insinuate that Google is not consistantly on the leading edge of innovation in content delivery, and that includes every area of content delivery in enters? You can’t be serious.
You should really stick to informatics, Chuck.
At best we have a public-private system. (If you look at the spending, the government pays for almost 2/3 of health care spending.)
High school economic theory also requires that the consumer have an informed opinion about what they’re buying, and requires that they (the consumer) is doing the purchasing. But that’s not how it works. Patients don’t say, “Hey, let’s get a CT scan.” The doctor decides.
Perhaps I should have said, “The medical record *should* not be the patient’s property.”
Graham,
Obviously you’re not well versed in economic theory. LOL. There is no requirement in either macro or micro economic theory that a Consumer have an informed opinion, nor that they do the purchasing directly. A consumer is simply the end user of a product or service. Period.
From Econ 101: “A consumer is a person who uses any product or service . . . expressed in a buy/not-buy decision.” No doctor can force a patient to accept or reject treatment, and no doctor makes the final decision. Patients, as consumers of healthcare, are free, and often encouraged, to seek second opinions and alternative treatments. The doctor DOES NOT decide for the patient. No doctor can mandate a patient get a CAT scan. The doctor can say, I’m recommending that you get a CAT scan. However, the patient must make a conscious decision to accept any treatment. That’s a consumer choice. It has absolutely nothing to do with who is footing the bill. Your opinion that the doctor decides for the patient violates AMA doctrine, your oath as a physician, and probably patient protection laws in most States. I believe it would also be considered malpractice in some circumstances.
And further, any patient can elect to get a CAT scan on their own. My wife did it when she disagreed with her PCF on a diagnosis after a back injury. Also, elective imaging is quite common today, as evidenced by the increasing number of independant and mobile imaging services. So yes, a patient can say, “Hey, lets get a CAT scan” and many often do just that.See http://www.healthview.com/ocregister.htm
As for who owns the data in a patient record, applying any theory of intellectual property rights and privacy rights, the data in the medical record SHOULD be and IS the patient’s property. If the patient elects not to disclose certain information, that is the patients right and responsibility. Failure to disclose in appropiate circumstances carries consequences, such as ineligibility for many healthcare programs and a risk of inadequate or inappropriate treatment, and in some cases, criminal prosecution for fraud where the ommission constitutes a material basis for eligibility for a program or service. In any case, that information belongs to the patient, and the patient has the final say as to how that information is used and disseminated.
On what rational basis of sound public policy in a Democratic society do you see it any other way?
BTW Graham,
One of the most significant advances in healthcare delivery taking place today involves patient empowerment -the patient becoming ACTIVELY involved in treatment decisions. Further, if your patients are not making INFORMED decisions about their diagnosis and treatment because you are not informing them, then that is by any definition malpractice.
One more point Graham, to be clear. A patient can indeed say “Let’s get a CAT Scan” in most cases where the patient believes it is warranted even where the PCF does not. As my wife pointed out to me, it’s often done using what is called a “self-referral” and most health care policies provide for self-referrals (usually with higher copays) as my wife pointed out. I am at a complete loss in understanding how you believe that a patient could not say “Let’s get a CAT Scan” or that you would be the final decision maker for your patient on the issue. Legally and ethically you as a physician can recommend or discourage a course of treatment. You have absolutely no authority to unilaterally mandate or prohibit any course of treatment for any patient.
Sorry, public health trumps patient preference in several cases. A patient with a communicable disease doesn’t just get to strike that from his or her medical record just because he or she feels like it.
“Hey, let’s get a CAT scan” is bad medicine, whether your wife is an MD or not (my guess, not). Patients who believe that more testing is better are way off base. But since you don’t practice or understand medicine, I can understand why you believe this; it’s a common misunderstanding.
[...] One of the interesting differences between how Practice Fusion is marketing its product and how Google is marketing Google Health, is in how they view the ‘users’. Google CEO Eric Schmidt raised the ire of Practice Fusion’s management in a recent speech at HIMMS. Advisory board member Graham Walker scolded Dr Schmidt in a blog post: [...]
[...] One of the interesting differences between how Practice Fusion is marketing its product and how Google is marketing Google Health, is in how they view the ‘users’. Google CEO Eric Schmidt raised the ire of Practice Fusion’s management in a recent speech at HIMMS. Advisory board member Graham Walker scolded Dr Schmidt in a blog post: [...]