Beth Israel/Google Health Fiasco--Is Technology Really the Problem?
Recently the
Boston Globe has been reporting on problems arising when Beth Israel Deaconess Medical Center sent insurance claims data (i.e., billing codes) to Google Health PHR as a means of summarizing patients' medical condition. As it turned out, this practice resulted in at least one patient discovering that his personal health record contained wildly inaccurate or misleading information. These included diagnoses of cancer metastasizing to his brain or spine, chronic lung disease, an anxiety disorder, and an aortic aneurysm, none of which he had ever been told he had by any of his doctors.
The problem, according to Dr. David Kibbe, a senior technology adviser to the American Academy of Family Physicians as quoted by the Globe, is that "Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has." Adds Dr. Daniel Zands, the primary care physician for one of the affected patients, "The problem is that this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem.
On the other hand, the Globe quotes Dr. Roni Zieger, a product manager for Google Health, as acknowledging that billing information can sometimes be precise, but arguing that the overall benefit of having some information is better than no information, and that accuracy will improve over time.
Pardon me if I feel like Alice falling down the rabbit hole, or through the looking glass, or wherever the heck she went, but---
ARE YOU KIDDING ME??!!
I wonder if all this attention on health information technology is like making sure we use the most modern airplanes to deliver rotten food to a starving country. If our health care data is corrupt to begin with, streamlining methods of sharing that data just means we get more efficient at being wrong.
I know, I know. This kind of thing is old hat to folks who've made a career out of trying to wade through the morass that is our current medical coding/billing/reimbursement process, mandated by a system of health care delivery that rewards quantity over quality. But you'll have to excuse me while I look behind the curtain for Franz Kafka. Who else could have dreamed up a world where someone can say with a straight face that partially wrong medical information is better than no information, or that the data used to procure payment for medical care is "notoriously inaccurate and...incomplete with respect to an expression of the problems a person has?"
By no means am I the first to suggest that health information technology is, if not the least of our problems, certainly not the most important. I fear that HIT is being viewed as some kind of silver bullet that will drastically improve our health care system in and of itself. But no matter how advanced our technology becomes, there's no escaping this one fundamental truth:
Garbage In, Garbage Out.
One of the knocks against personal health records has been the potential for inaccuracies to creep into the medical record due to ignorance on the part of the patients who attempt to maintain their own PHR. All the more ironic, then, that in the case of the Beth Israel/Google Health brouhaha, the source of inaccurate information was not the patient, but the patient's health care provider!
Let me dial it back for a moment in order to say that I have a great deal of respect for Beth Israel and for its CIO, John Halamka, whose blog makes for great reading. Both Dr. Halamka and BIDMC have done the right thing by acknowledging that they made a mistake by using insurance claims information to populate Google Health PHR, and that practice has been discontinued. But this particular incident is, for me, simply a jumping-off point for a much broader discussion that needs to happen in this country. This really isn't about Beth Israel, or Google Health, or health care technology in general. The issue that needs to be addressed first is the way health care is procured, practiced, and paid for in the U.S. In the meantime, the proliferation of inaccurate and potentially dangerous information in the medical records of Americans is not going to be ameliorated simply by spending $19 billion dollars on modernizing HIT; if anything, things may very well get worse.
As patients, however, we're not without recourse. Take a few moments to read this blog post by Dave DeBronkart, the patient mentioned above, for some information and inspiration on how to go about finding out what's in YOUR medical record, and what to do with what you learn.