Big Doctor is Watching

Rodney Warner
Rodney Warner

When I first learned about electronic medical records I feared hackers could break through security measures and snoop around our medical histories for fun and profit. According to a Businessweek article it looks I was fearing the wrong thing. Maybe I should fear my medical providers snooping around my financial records for fun and profit. According to the article,

Carolinas HealthCare, which runs more than 900 care centers, including hospitals, nursing homes, doctors’ offices, and surgical centers, has begun plugging consumer data on 2 million people into algorithms designed to identify high-risk patients so that doctors can intervene before they get sick. The company purchases the data from brokers who cull public records, store loyalty program transactions, and credit card purchases.”

At the next check up, one of their patients may not only be asked about aches and pains, but about their buying habits at the grocery store or why they eat at restaurants so often.

For a patient with asthma, the hospital would be able to assess how likely he is to arrive at the emergency room by looking at whether he’s refilled his asthma medication at the pharmacy, has been buying cigarettes at the grocery store, and lives in an area with a high pollen count, (Michael) Dulin (chief clinical officer for analytics and outcomes research at Carolinas HealthCare) says. The system may also look at the probability of someone having a heart attack by considering factors such as the type of foods she buys and if she has a gym membership.

You read that right. In the future, your doctor may know the types of foods you buy or whether you have a gym membership without telling him or even if you don’t want your doctor to know. Is it just me or is this really creepy?

One of the things driving this more aggressive approach is the Patient Protection and Affordable Care Act (Obamacare) under which hospital reimbursement is being linked to quality metrics, not the traditional fee-for-service model in which hospitals are paid based on the number of tests or procedures they perform. The goal is to have patients be healthy with the least amount of medical intervention so armed with all this Big Data health care providers may be shepherding us like so many sheep to better health, whether we want them to or not.

Though the reasons for these efforts are well intended (improving the health of patients and lowering medical costs) this is incredibly intrusive. As the article points out, the information this hospital system is purchasing is publically available by data brokers, but just because it’s out there doesn’t mean health care providers should use it. If my doctor wants to ask me about my personal habits, he’s more than welcome to ask, but I only want my doctor to be aware of and as involved in my life as I want him to be.

If a hospital system wants to take this approach, the best way to go is to have them explain what kinds of information they have, how they get it, how they use it, the benefits of their program and allow patients to “opt in” or “opt out” of this system.

This has the potential to becoming the ultimate “nanny state” in which you’re being supervised by your insurance company or health care provider in real time. They could constantly monitor your credit and debit card purchases and send you reminders on your smart phone of what you should or shouldn’t be doing or buying. You could get updates warning you that you shouldn’t have purchased that second margarita if you’re driving or that you’re not buying enough fresh vegetables. Maybe by obeying, or failing to obey, your premiums and treatment costs would go up or down. Do what we say, save money, ignore us, pay more at your next doctor’s visit.

It will be all in the name of improving your health and lowering health care costs. But will we be willing to pay the price in lost privacy and freedom?