Patient Safety: National Health Care’s Trojan Horse

Published September 1, 2003

A Trojan horse comes dressed in attractive attire. It never announces its malicious intentions. Such is the case with the “patient safety” bills in Congress.

The Patient Safety and Quality Improvement Act of 2003 (S. 720 and H. 663) seeks to establish a national health information system. By so doing, it lays the foundation for a national health care system. But few objections are being raised to this dangerous measure masquerading as “patient safety.”

In the midst of a raging debate over Medicare reform, the patient safety measures are moving through Congress virtually unnoticed. H. 663 passed the House on March 12, 2003 with only six votes in opposition. S. 720 was approved by the Senate Health, Education, Labor and Pensions Committee on July 23, 2003. It could see action on the Senate floor before Christmas.

The following four concerns deserve the public’s immediate attention:

Creation of a national patient safety database. The U.S. Department of Health and Human Services (HHS) will be required by the measures to develop a single database (House) or network of databases (Senate) for the collection of non-identifiable patient data related to patient safety, medical errors, health outcomes, and quality of health care. This proposal raises several red flags.

The database is not intended to collect only reports of medical errors–a term that’s not even defined in the bills. It’s for everything under the sun: outcomes, errors, quality, and safety. This breadth of purpose makes it too easy to extend the government’s reach in the name of “data collection.”

More worrisome, non-identifiability of individual patients is promised but hardly guaranteed. And the government’s definition of “non-identifiable” patient data is likely to include information patients themselves would prefer not to share.

Development of a national electronic data system. The patient safety bills require HHS to promote interoperability and electronic exchange of health care information. The House bill provides $25 million a year for 2004 and 2005 toward the development of hospital and clinic data systems. The House bill also requires recipients of federal grants to assure HHS the data system will “be expanded to become comprehensive” with or without further federal dollars.

H. 663 establishes a new advisory board, the Medical Information Technology Advisory Board (MITAB), charged with developing proposals for creating a single electronic medical record for every individual patient.

Potential interference in medical decisions. In providing information technology grants, the House bill requires HHS to give special consideration to hospitals and clinics that seek to promote “improved clinical decisionmaking through acquisition and implementation of decision-support technologies.”

Whether such support systems will improve or detract from health care decision-making remains to be seen, but the proposal raises several serious questions. Who will have final decision-making authority? Will such decisions be monitored and tracked? Will financial penalties or other disincentives be levied against practitioners who treat outside guidelines suggested by the software? HMOs and the Medicare administration have a long history of medical micromanagement. Computerized tracking may increase their opportunities to meddle.

Development of a national patient identification card. On July 1, 2003, HHS Secretary Tommy Thompson announced plans to build a “national electronic health care system that will allow patients and their doctors to access their complete medical records anytime and anywhere they are needed.” He commissioned the Institute of Medicine to build a standardized electronic medical record and authorized $32.4 million for the purchase of a standardized medical coding system.

Implicit in Thompson’s proposal is a national patient identification card for tracking and linking every patient to a government database–an idea rejected by Americans at every turn.

A Trojan horse is a dangerous thing, no matter how benign a name it carries. While the media is focused on Medicare and the public is distracted with summer, the groundwork for a national health care system is rapidly being laid. It’s time the public realized the gift of “patient safety” is no gift at all.

Public health nurse Twila Brase is president of Citizens’ Council on Health Care. Her email address is [email protected]. CCHC can be found on the Internet at