While policymakers and health care and legal analysts debate the constitutionality of U.S. healthcare reform, technology experts and medical doctors remain skeptical whether a nationwide data hub is desirable or even feasible.
One critical aspect of the Affordable Care Act is the establishment of state health insurance exchanges, which would begin operating in 2014. These exchanges would require the construction of a data system capable of handling everything from enrollment data of multiple private insurance providers that sell exchange plans to individual tax and citizenship information and state Medicaid enrollment forms.
Seton Motley, president of LessGovernment.org, which advocates a free-market, small-government approach to information technology and telecommunications policy, says current IT technology cannot handle the requirements called for in the Affordable Care Act. “I’ve had the same set of X-rays taken three different times in one 48-hour period recently,” he said. “Nobody can share this information because the files are too large to share. The technology simply cannot handle it.”
The ACA requires data-sharing between thousands of non-standardized computers and incumbent software systems, a complex task that may render such a system difficult if not impossible for most states to complete by 2014. Currently, less than 20 states are working to establish exchanges prior to the deadline. Of these few, it’s estimated fewer than 12 will be compliant with federal Department of Health and Human Services information technology standards by the deadline. Those that don’t have compliant systems in place will be required to partner directly with DHS rather than adopt state-based standards.
“Twenty states is not a coordinated effort,” Motley said. “Either a government-mandated system or a government-run edifice as required by the healthcare mandate would be a mess because the government cannot be depended upon to do anything efficiently.”
Dr. Richard Dolinar, M.D., a clinical endocrinologist based in Phoenix, Arizona, a consultant on the pharmaceutical industry policy, and a senior fellow with The Heartland Institute, says the state exchanges and the sharing of digital information “are all good ideas. . . . They just don’t work.”
Dolinar added, “Like Dick Gregory once said, ‘Anything good, you don’t have to force on people. They will steal it.’ Clearly, no one will try to steal this tangled mess of an idea called a state exchange. Trying to implement them before the necessary technology exists reveals how arrogant our legislative leaders are when it comes to passing laws.”
‘Hacking, Snooping, and Theft’
Dr. John Dale Dunn, M.D., J.D., a policy advisor for The Heartland Institute and the American Council on Science and Health, has been a civilian emergency medicine faculty physician at Carl R. Darnall Army Medical Center in Fort Hood, Texas since 2003 and an emergency room physician for 33 years. Dunn says he once worked for a Portuguese computer company that was “very successful in creating paperless hospitals. The company was unable to make inroads in the United States, however. I’ve witnessed firsthand many other, much larger companies that hit a wall when they tried to integrate systems from a wide variety of medical providers.”
Dunn says his experience as a doctor at Fort Hood has taught him that the emphasis on bedside computing by doctors and nurses results in a reduction of actual patient care by “10 percent to 20 percent.” Dunn explains, “Computerized information is great at creating data piles, which are great for tracking financial activity and creating reports, which could come in handy for resource allocation or rationing as we travel down the road of centralized planning of our nation’s healthcare.”
Additionally, Dunn says digital inputting of patient records presents “tremendous security and privacy problems. It may sound like I’m a Luddite, but sitting in front of a computer does nothing for patients except put their personal information at risk of hacking, snooping, and theft.”
Bruce Edward Walker ([email protected]) is managing editor of InfoTech & Telecom News.