Congress pursues electronic health records system

Critics say bill needs stronger safeguards

August 14, 2006|By LOS ANGELES TIMES

WASHINGTON -- After Hurricane Katrina devastated New Orleans and Mississippi, thousands of evacuees with health problems faced double jeopardy because their medical records had been lost - forcing doctors in evacuation centers to rely on educated guesswork in treating patients they'd never seen before.

One group was spared that risk: former members of the military whose records were available electronically from the Department of Veterans Affairs. For these patients, doctors in Texas, Arkansas and other states that took in Katrina evacuees could call up medical charts, prescriptions, lab results - even videos of medical imaging tests.

Congress is trying to bring the benefits of computerized medical records systems like the VA's to the whole country. By reducing reliance on paper records, lawmakers hope to save billions of dollars. And by tying computerized records systems together in networks, they hope to reduce medical errors by making information instantly available wherever it is needed.

But legislation to encourage a move to computerized records, now moving through the final stages of congressional approval, has provoked opposition from privacy advocates, consumer groups and civil libertarians who point to recent security breaches - including the much-publicized theft of a VA laptop containing personal information on millions of veterans.

These groups warn that the legislation wouldn't provide enough safeguards.

On one side of the debate is the issue of ensuring adequate protection for a person's most personal information. On the other side is the imperative from government, employers and insurers to curb the seemingly unsustainable growth of health care spending, as well as to improve medical treatment.

"We are not going to be able to get health care costs under control and improve quality without dramatic implementation of health [technology] over the next 10 years," said Robert Laszewski, a health policy consultant. "It's one of those things where choices are going to have to be made.

"That doesn't mean give the health care industry a blank check - we've got to have standards - but I'm afraid we're going to have to take some risks," he said.

Privacy advocates say the legislation needs stronger protections, such as provisions that would allow patients to control who sees their records or even to opt out of the electronic system. Agencies also should be required to notify patients of a security breach, and patients should have the right to sue over unauthorized disclosures, privacy advocates say.

"The main thing we are concerned about is that if this information leaks out to employers, it can destroy people's reputations and livelihoods," said Dr. Deborah Peel, a leading critic and a psychiatrist who heads the Patient Privacy Rights Foundation in Austin, Texas.

Under the legislation, patients would not "have the basic right to control who can see and use the most sensitive information on earth about you," Peel said.

Supporters of the legislation - known as the Health IT bill - say existing federal medical-privacy laws offer sufficient safeguards. Such laws "already provide absolute protection of our health information," said Rep. Nancy L. Johnson, a Connecticut Republican and a co-author of the legislation.

The Senate unanimously approved a version of the Health IT bill last year. The House version sparked partisan battles over complex technical and legal issues, as well as privacy. But House Republicans won passage over Democratic opposition last month.

A House-Senate conference to try to iron out differences promises to be contentious.

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