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Health Information Technology: Whose Voice is Being Heard, Whose Interests are Being Served?
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Fourth in a Series on Health Information Technology
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By Charley Richardson, April 30, 2009
Like many others, I have been writing about my concerns about the current rush to implement Electronic Medical Records (EMR) and other health information technologies (HIT). Business Week, in an in-depth story on April 23rd, calls this the “Mad Dash to Digitize Medical Records” and quotes the head of one large information technology vendor who compares it to the Oklahoma land rush – not exactly the kind of reasoned approach to policy that one would like to see with the nation’s health care at stake.
As part of the federal stimulus package, the HITECH Act directs $19 billion in federal funds toward promoting EMR and HIT. These funds are being committed prior to a full discussion of the many complex issues surrounding our health-care “system” and health-care reform. It seems that applying automation to a dysfunctional and deeply flawed health-care system is at best putting the cart before the horse and at worst setting the stage for inhibiting real and effective reform.
Three items recently crossing my electronic desktop have added intriguing details to this picture. The first of the three items was a list of 13 appointees to the HIT Policy Committee, established under the HITECH Act to oversee the activities of the Office of the National Coordinator for Health Information Technology (ONC) and federal HIT policy. I was frankly disappointed, although not surprised, to see that the list of appointees includes only one representative of the workforce but nine representatives from research institutions, IT vendors, health-care institutions and insurance companies.
The health-care workforce will be significantly impacted by the policies coming out of this committee and by the $19 billion worth of expenditures that will be overseen by the ONC. The workforce, for this reason, should have more representation. But beyond this, it seems that the voices of those who will actually use any new information technology systems should have a more prominent place in policy discussions. Time and again, the mistake has been made of excluding those who actually make the system work from discussions about new technologies. The result is often significant retrofitting and, in some cases, abandonment of the new technologies altogether.
The second item to cross my desktop was an article from the Sacramento Bee (April 24, 2009, page 1A) about how Wellpoint (the nation’s largest health insurer) has launched “what could be the start of a campaign for the hearts and minds of the American public as the country prepares for debates over reshaping its much-maligned health-care system.” The company, according to the Sacramento Bee “…made 3 million computer-generated phone calls last week to gauge the public's appetite for overhauling health care – and to enlist, critics say, a grass-roots army to voice concerns about the sweeping proposals developing on Capitol Hill.”
So, the largest health insurer in the country is not only planning to weigh in on the health-care reform debate (do you wonder how they feel about single payer or even about real competition from a public health insurance system?), but is also actively using its financial and data resources to build an army to oppose progressive health-care reform.
The story came full circle (at least I thought full circle) for me when I went back to the list of appointees to the Health Information Technology Policy Committee. Something was bothering me – one of those mind tics that pushes you to look where there may be nothing.
It turns out that Charles Kennedy, the Vice President for Health Information Technology of Wellpoint (the same Wellpoint), has been appointed to a three-year term on the HIT Policy Committee. Wellpoint will have its person in the middle of the discussion about Health Information Technology policy (government technology policy) and about how to spend the $19 billion plus that will flow from public coffers into promoting HIT. This at the same time that Wellpoint is moving to weigh in heavily against real health-care reform – using the electronic information that they have easy access to for their own political purposes and to serve their economic interests.
Is anyone else getting nervous here?
I thought that this might be the end of this string. I was, in fact, ready to send this piece out. But then the third bit of information arrived, which I had to add into this wonderful stew.
Wellpoint, according to FierceHealthcare, a daily electronic newsletter for health-care executives (April 28, 2009 edition), is now developing a program (the pilot is with a company called Serigraph) of Medical Tourism whereby non-emergency surgery patients will be shipped overseas to be operated on. I somehow can’t get out of my mind the image of scrap steel being shipped to Asia to be melted down and converted into new products to be shipped back to the US. According to the newsletter: “WellPoint execs say the cost of care is about 80 percent lower in India, primarily due to strikingly lower charges for labor, drugs and medical devices, but that the care itself still produces equally good results.” Results for whom? Equally good immediate results for individual patients, but what about the overall and longer term impact on our health as a nation?
So to recap, Wellpoint is organizing its customers to block significant health-care reform (and using its installed information technology systems to do so), it has a powerful place in the policy discussion around HIT and therefore in the discussion of the expenditure of billions of federal dollars, and it is moving to use overseas health-care services to cut costs.
HIT policy cannot be separated from health-care policy. The Office of the National Coordinator for Health Information Technology is working on health-care policy disguised as technology policy. The funding provided through the HITECH Act is health-care policy being implemented prior to the policy discussion.
Technology expenditures, particularly expenditures on systemic technologies like Electronic Medical Records, tend to lock organizations and even societies into particular pathways. Technology is never neutral and generally reflects the interests of those who design, develop and implement it. In the case of HIT the large players include the health insurance companies, the IT vendors, the purchasers of health insurance (companies, not patients) and major health-care organizations. All of these have representatives on the Health Information Technology Policy Committee. All of their voices have been heard and will continue to be heard.
At the same time, a robust HIT system is a critical enabler for a seamless system of medical tourism that allows patients to be shipped around the world to find the cheapest procedures. HIT makes Wellpoint’s medical tourism even easier to implement.
Now is definitely the time to take a step back and ask a lot more questions about where we are heading. Shouldn’t we be asking how to build a health-care system that cares for all of us, rather than how to automate a dysfunctional system or how to ship patients around the world? Now is definitely time to bring the real voices of those impacted by the health care system, including both patients (not customers) and health-care workers, into the conversation at all levels.
The health of the nation is at risk. Do we think that Wellpoint and others like them are watching out for us?
Charley Richardson is the former Director of the Labor Extension Program at UMass Lowell. He works with unions in all sectors of the economy, providing training, education and strategic support on issues of changing technology and work restructuring. He can be reached at charles_richardson@uml.edu .
Like many others, I have been writing about my concerns about the current rush to implement Electronic Medical Records (EMR) and other health information technologies (HIT). Business Week, in an in-depth story on April 23rd, calls this the “Mad Dash to Digitize Medical Records” and quotes the head of one large information technology vendor who compares it to the Oklahoma land rush – not exactly the kind of reasoned approach to policy that one would like to see with the nation’s health care at stake.
As part of the federal stimulus package, the HITECH Act directs $19 billion in federal funds toward promoting EMR and HIT. These funds are being committed prior to a full discussion of the many complex issues surrounding our health-care “system” and health-care reform. It seems that applying automation to a dysfunctional and deeply flawed health-care system is at best putting the cart before the horse and at worst setting the stage for inhibiting real and effective reform.
Three items recently crossing my electronic desktop have added intriguing details to this picture. The first of the three items was a list of 13 appointees to the HIT Policy Committee, established under the HITECH Act to oversee the activities of the Office of the National Coordinator for Health Information Technology (ONC) and federal HIT policy. I was frankly disappointed, although not surprised, to see that the list of appointees includes only one representative of the workforce but nine representatives from research institutions, IT vendors, health-care institutions and insurance companies.
The health-care workforce will be significantly impacted by the policies coming out of this committee and by the $19 billion worth of expenditures that will be overseen by the ONC. The workforce, for this reason, should have more representation. But beyond this, it seems that the voices of those who will actually use any new information technology systems should have a more prominent place in policy discussions. Time and again, the mistake has been made of excluding those who actually make the system work from discussions about new technologies. The result is often significant retrofitting and, in some cases, abandonment of the new technologies altogether.
The second item to cross my desktop was an article from the Sacramento Bee (April 24, 2009, page 1A) about how Wellpoint (the nation’s largest health insurer) has launched “what could be the start of a campaign for the hearts and minds of the American public as the country prepares for debates over reshaping its much-maligned health-care system.” The company, according to the Sacramento Bee “…made 3 million computer-generated phone calls last week to gauge the public's appetite for overhauling health care – and to enlist, critics say, a grass-roots army to voice concerns about the sweeping proposals developing on Capitol Hill.”
So, the largest health insurer in the country is not only planning to weigh in on the health-care reform debate (do you wonder how they feel about single payer or even about real competition from a public health insurance system?), but is also actively using its financial and data resources to build an army to oppose progressive health-care reform.
The story came full circle (at least I thought full circle) for me when I went back to the list of appointees to the Health Information Technology Policy Committee. Something was bothering me – one of those mind tics that pushes you to look where there may be nothing.
It turns out that Charles Kennedy, the Vice President for Health Information Technology of Wellpoint (the same Wellpoint), has been appointed to a three-year term on the HIT Policy Committee. Wellpoint will have its person in the middle of the discussion about Health Information Technology policy (government technology policy) and about how to spend the $19 billion plus that will flow from public coffers into promoting HIT. This at the same time that Wellpoint is moving to weigh in heavily against real health-care reform – using the electronic information that they have easy access to for their own political purposes and to serve their economic interests.
Is anyone else getting nervous here?
I thought that this might be the end of this string. I was, in fact, ready to send this piece out. But then the third bit of information arrived, which I had to add into this wonderful stew.
Wellpoint, according to FierceHealthcare, a daily electronic newsletter for health-care executives (April 28, 2009 edition), is now developing a program (the pilot is with a company called Serigraph) of Medical Tourism whereby non-emergency surgery patients will be shipped overseas to be operated on. I somehow can’t get out of my mind the image of scrap steel being shipped to Asia to be melted down and converted into new products to be shipped back to the US. According to the newsletter: “WellPoint execs say the cost of care is about 80 percent lower in India, primarily due to strikingly lower charges for labor, drugs and medical devices, but that the care itself still produces equally good results.” Results for whom? Equally good immediate results for individual patients, but what about the overall and longer term impact on our health as a nation?
So to recap, Wellpoint is organizing its customers to block significant health-care reform (and using its installed information technology systems to do so), it has a powerful place in the policy discussion around HIT and therefore in the discussion of the expenditure of billions of federal dollars, and it is moving to use overseas health-care services to cut costs.
HIT policy cannot be separated from health-care policy. The Office of the National Coordinator for Health Information Technology is working on health-care policy disguised as technology policy. The funding provided through the HITECH Act is health-care policy being implemented prior to the policy discussion.
Technology expenditures, particularly expenditures on systemic technologies like Electronic Medical Records, tend to lock organizations and even societies into particular pathways. Technology is never neutral and generally reflects the interests of those who design, develop and implement it. In the case of HIT the large players include the health insurance companies, the IT vendors, the purchasers of health insurance (companies, not patients) and major health-care organizations. All of these have representatives on the Health Information Technology Policy Committee. All of their voices have been heard and will continue to be heard.
At the same time, a robust HIT system is a critical enabler for a seamless system of medical tourism that allows patients to be shipped around the world to find the cheapest procedures. HIT makes Wellpoint’s medical tourism even easier to implement.
Now is definitely the time to take a step back and ask a lot more questions about where we are heading. Shouldn’t we be asking how to build a health-care system that cares for all of us, rather than how to automate a dysfunctional system or how to ship patients around the world? Now is definitely time to bring the real voices of those impacted by the health care system, including both patients (not customers) and health-care workers, into the conversation at all levels.
The health of the nation is at risk. Do we think that Wellpoint and others like them are watching out for us?
Charley Richardson is the former Director of the Labor Extension Program at UMass Lowell. He works with unions in all sectors of the economy, providing training, education and strategic support on issues of changing technology and work restructuring. He can be reached at charles_richardson@uml.edu .