Healthcare Reform

Dear Members,

I wanted to provide some healthcare information that I have come across while following the health care reform currently going on in the United States. I have tried to fact check and verify sources to the best of my abilities. Unfortunately, there is a great deal of misinformation available on both sides of the issue. While I wanted to present this argument in the form of a debate, I will soon be returning to my studies, a job, and other organizations and responsibilities (and will not have the time necessary to give this topic the attention that it deserves; it would also not be fair to the other party in a debate).

As a private American citizen, I am concerned about a variety of issues surrounding the healthcare reform (and the bill itself). I wanted to use this thread to voice both those concerns and to provide links to these sources. I encourage you to fact check both the sources that I have found, and any others that are submitted in this thread.

As a fellow INFJ member, I ask for civility and mature discussion of the issues presented in this thread at all times by all members. I do not have the authority to enforce what I am asking, but I am requesting it all the same.

I originally wanted to use a hybrid of online debate and classical debate (online for its fact checking and more complete response, and classical for its logic and real world discussion). This thread is an attempt to make that desire a reality.

http://en.wikipedia.org/wiki/Debate#Classical_debate (online is below it as well).

My purpose on this thread is twofold: to inform and persuade. I disclose this information to show my sincere desire for an honest discussion on the healthcare reform (and issues surrounding it) that is currently taking place.

Thank you,
Azure



For the first part of the discussion, I wanted to talk about electronic health records or electronic medical records (EHR and EMR). As far as I can tell, they are synonymous terms. I believe that the implementation of EHR will undermine patient privacy and expose patients to potential loss of patient health information (PHI) and medical identity theft.

The first link is a general description of medical identity theft:
http://www.worldprivacyforum.org/medicalidentitytheft.html

The second link addresses a growing concern among medical providers concerning EHR and identity theft.
http://www.naplesnews.com/news/2009/mar/27/health-record-identity-theft-growing-concern-among/

The third link talks about the financial and health implications of medical identity theft.
http://www.dallasnews.com/sharedcontent/dws/bus/stories/DN-perfi_02bus.ART0.State.Edition1.3a6ab43.html

The fourth link is an article about a claim made by several senior doctors from the Lismore Base Hospital (in Australia) that an EHR system in place will inevitably lead to patient deaths.
http://www.dailyexaminer.com.au/story/2009/07/23/doctors-issue-a-deadly-warning/

This link is a report by the National Research Council that examines computer technology in healthcare.
http://www.nlm.nih.gov/pubs/reports/comptech_prepub.pdf

Despite the problems that EHR exposes patients to, the government (according to the article) is setting aside $17 billion (or more) as incentives for physicians and hospitals to adopt EHR. I have provided the title and author of the article below: it can be found on medscape after completing a free registration.

Stimulus Package Could Convert More Physicians to EHRs
Robert Lowes

This is an article (on medscape) that talks about new problems that arise with EHR. The article below is also available on medscape.

EHR Meltdown: How to Protect Your Patient Data
T. Eric Schackow, MD, PhD; Todd Palmer, MD; Ted Epperly, MD



The government's protection of sensitive data is also an issue when it comes to EHR. I have found several links that reveal problems.

Sensitive Nuclear Data Leak
http://www.computerworld.com/s/article/9133921/U.S._mistakenly_posts_list_of_civilian_nuke_sites_
http://www.computerworld.com/s/article/340078/Open_Government_Could_Lead_to_Data_Leaks

VA Leak; 26 million are affected. While the data is believed to not have been accessed and a settlement has been reached, it brings up legitimate concern over government protection of sensitive data.
http://www.cnn.com/2006/US/06/08/vets.data/
http://www.cnn.com/2009/POLITICS/01/27/va.data.theft/index.html

Another VA laptop is stolen. It is recovered, and new policy/encryption of data protects the device. I include this link to be thorough in the VA story.
http://www.cnn.com/2009/POLITICS/01/27/va.data.theft/index.html


File sharing of sensitive government data. Please read this article in depth.
http://www.cbsnews.com/blogs/2009/07/29/politics/politicalhotsheet/entry5195953.shtml


I will also introduce a link to PolitiFact, a Pulitzer Prize winner of 2009.
http://www.politifact.com/truth-o-meter/. The site tracks campaign promises (and their status) made by Mr. Obama.

I wanted to introduce three links in particular here that are associated with healthcare.
http://www.politifact.com/truth-o-meter/promises/promise/517/health-care-reform-public-sessions-C-SPAN/
http://www.politifact.com/truth-o-meter/article/2009/aug/13/heath-care-fact-checks-greatest-hits-vol-1/
http://www.politifact.com/truth-o-meter/article/2009/aug/13/health-care-reform-simple-explanation/

Another website for consideration is www.factcheck.org.

 

I want others to have access to the information that I have found. It's up to each member whether they want to go through the links or not; the information is right in front of them. I've gone through the links, and I hope that others will as well. I wanted others to go through them (and to do some of their own research as well) to come up with their own informed decision. I spent days searching for all of the information; I hope the issue is important enough to others to warrant going through the links to see what they have to say.

I'm sure that there are stories out there that talk about what the government has done right. If you would like to search for them and post them, please do so. However, please make sure they are related to the current topic (government leaks of sensitive information, EHR, medical identity theft, computer technology in healthcare evaluations, etc.) You are also free to fact check the information that I have provided, or to agree/disagree with it. Though it may be premature, I wanted to ask you a question. Do you disagree with the claims that I have presented thus far? If so, what evidence do you have to contradict them?

I am not the media though; I can't choose what the media reports or writes about. That's their decision (and to make their work newsworthy to make a profit for their business).

I am posting news links on government security with sensitive information because EHR is being considered. I have found a link that talks about what the government did do right though (the VA link when the second laptop was stolen; it mentions encryption and other security measures). I mentioned it to provide some follow up. It is unfortunate though that a second laptop was stolen.

What I am focusing on are leaks of sensitive information; EHR will have sensitive personal health information (I believe the acronym is PHI) on them. While there has been legislation passed that protects PHI (such as HIPAA), converting PHI to a digital format creates new risks for the patient. Hacking and computer security become even more important when you consider EHR.

You are correct; humans will make mistakes. I disagree with you on the cost of mistakes though. If PHI is stolen and medical identity fraud is committed, it could ruin the patient's finances and health records (with diseases that the patient does not even have, or destroy insurance coverage) or it could even kill the patient. There are very important patient liabilities here, and the government is using stimulus money to provide incentives for physicians and hospitals to change to EHR! The taxpayer is providing money to fund a system implimentation which increases patient risk! The system of EHR is being shoved onto Americans (through physicians and hospitals that opt in) with their own money!

Let's also consider the case of P2P file sharing with sensitive data:

[Edited quote: too long, intellectual rights]


I would argue with you that the cost of having information like Secret Service safehouse locations, military rosters, IRS tax returns, and documents on Marine One should not be considered 'low'. It exposes this information to anyone who has a P2P client (from criminal organizations, to rogue states, to terrorists, etc.)

I hope for everyone's sake that a scenario of a large amount of PHI in EHR being hacked ends as you describe it. With the information being electronic though, thre is a possibility of it being put as a file on a popular P2P network under a different title (that would be appealing to download). Even if there is encryption, a dedicated team of hackers could probably break it eventually (and sell the information online). Are you willing to take a risk in having EHR with the scenarios, risks, and articles that I have described? I'm not.

 

There are stories of the US government doing well. My proof that the claim you made is false.

http://www.cnn.com/2008/WORLD/asiapcf/05/16/us.myanmar/index.html

How is my op conformation bias? It seems to me that you are raising doubts about me rather than my argument. You are also making an indirect attack on my motives for presentation of the OP (which I have already explained the purpose of: to inform and persuade). When I say persuade, I mean persuade my audience to another point of view than the one they may currently hold.

Alright, before we go on let's take a look the original claim. We'll go back to post #7.

You’re attacking a straw man of my argument based on your own faulty logic, and are also under false premises that you have proven something (see your last sentence). The logic breakdown [I have personally added material in brackets]:

1. Only media stories of what the government has done wrong are posted
[by Azure_Knight in the OP; 2nd VA story could be considered a partial success because new policies caught the stolen laptop faster]

2. Media stories of what the government has done right cannot be found by you [I assume the you to be Azure_Knight]

3. No one would read such stories if they existed [on what government has done right]

4. ambiguous statement followed by: the media only reports on what the government does wrong and seldom on what they do right

5. (conclusion) a barrage of media stories [posted by AK] paints a picture that is not representative of reality

... this line of reasoning to the conclusion doesn't make sense to me.

What exactly are you claiming (if anything) is a representative of reality with regards to media stories?

The settlement was for $20 million dollars in the VA case. I do not consider $20 million dollars to be a small sum of money (though I cannot speak for others). New security measures were put into place as a result of the theft as well.

While the mistake was caught, it risked exposure of more than 26 million patients' PHI. While there were new measures put into place, another laptop was stolen from the VA (this time it was a computer that did not contain sensitive information; I am unsure if the information was left off intentionally as a result of security measures, a matter of chance, or some other scenario). The theft still raises legitimate concerns over computer and IT safety in healthcare; how are you claiming that the system has been 'fixed'? If anything, it adds to a case of leaks of sensitive information by a governmental entity.

So my information is factually correct then? Please clarify this position since it’s ambiguous.

According to you, which claim do I have inadequate evidence for and why? Also, what logic are you disputing?

So far, I only see a circular claim that states it does not need evidence to contradict an unspecified claim that I am making (on the grounds of inadequate evidence). I’m disputing that the previous quoted section since it’s is based on nothing more than circular baseless logic.

Ok, where is your evidence that the media seldom writes stories of what the government does right? Or are you attacking my logic in some way?

Here is a link to privacyrights. According to the site description, it’s a nonprofit consumer information and advocacy organization (so there is now another source besides a media based one).

http://www.privacyrights.org/ar/ChronDataBreaches.htm
It will detail various data breaches of governmental departments. If you have evidence to the contrary, feel free to present it. Take special note to the first section of what Chronology of Data Breaches has in it. Note that these are only reported breaches; there may be more breaches that have yet to be reported.

Here's the case of Brandon Sharp.
http://www.nytimes.com/2009/06/13/health/13patient.html?_r=1

Here's the case of Anndorie Sachs (with a video as well).
http://www.cbsnews.com/stories/2006/10/09/earlyshow/living/ConsumerWatch/main2073225.shtml
http://www.youtube.com/watch?v=2NrLryd9o7I

More than 250,000 Americans are victims of identity theft according to a 2007 report on crime using federal data. Many have yet to find out that they are a victim of medical identity theft and “that number has almost certainly increased since then, because of the increased use of electronic medical records systems built without extensive safeguards, said Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft.”

These cases are not speculation.

I have provided evidence. Please read it.

The mistakes made by the government are related because they all deal with sensitive information (PHI and otherwise). Are you making a claim that this information is safe?

“Personal doomsday scenarios?” The computer system with EHR would be connected to an electrical system, wouldn’t it?

http://www.breitbart.com/article.php?id=D97EJPBG1&show_article=1


And yes, there is a very real possibility in hacker attacks. The FBI is investigating one such case as I write this:

http://www.foxnews.com/story/0,2933,519187,00.html

Feel free to make whatever claim you want, though it has nothing to do with my logic. I have already shown that the VA (which is a government run facility) has had a security violation that resulted in sensitive PHI physically leaving the hospital in a stolen laptop computer. In the case of the P2P network, sensitive government information was leaked through a computer program (and may still be on P2P networks). In the case of the nuclear sites, the sensitive data was leaked and circulated on the internet. All of these cases have a common theme: sensitive government information was leaked. In two of the cases, it was circulated. In the case of the VA, the information was not accessed (but it also wasn’t encrypted to my knowledge at the time). All of these stories raise questions (and concerns) as to how the government plans to protect sensitive PHI. Electronic health records are computer based and are not hack proof.

http://www.secpoint.com/electronic-health-records-not-hack-proof.html


I'll have to look up the weaknesses and who was supposed to be protecting the data.

It doesn’t make logical sense to trust the government with more sensitive health information when other sensitive information leaks are taking place in multiple locations. If anything, it invites the risk of medical identity theft and increased mortality to consumers because EHR has electronic and computer based vulnerabilities. It also raises legitimate privacy concerns for proper safeguard of PHI.

Yes, implementation is also a factor. These systems are expensive and raise legal liability concerns for hospitals and physicians. And what if the system does not save lives as you propose? Are you willing to personally compensate for the wrongful deaths and privacy violations that you are suggesting? The system won’t be of much use to those who died as a result of it.

Vaccines and computers are regulated differently, and they are not the same thing. You are erroneously attributing a perceived outcome to two unrelated things, and are suggesting that they are in some way alike in terms of benefits.

I have provided evidence. Please read it.

You’re using data from violent crime and a conclusion, but that does not provide evidence to support a claim about my OP. Again, you are only trying to raise doubts.

In summary, the implementation of EHR will undermine patient privacy through computer based security issues, expose patients to potential loss of PHI and medical identity theft. Leaks of sensitive government information reveal a glaring problem with a computer based ERH approach for a record keeping system.

 

You made a claim earlier and I disproved it. You are making a claim now as well that I am asking you to back up with evidence. I was fully aware of what you posted in your response.

I think I have disproven your points. Are you saying that I have taken you words out of context?

This entire thing sounds like sophistry. You are trying to raise doubts with your post, but if my persuasive pieces somehow raise doubts then I am a 'fear mongerer'. I think that's the kettle (you) calling the pot black. How are articles on government security not related to the security of healthcare? I've even provided the VA link: a government run hospital! If you have an 'objective interpretation' of the government's capabilities, go right ahead and post it.

So mistakes that the government made is the sum of my argument now?

 

Your second sentence is a stereotype, and is therefore invalid. With regards to your third sentence, please provide clarification in the original post in the future. Though you did say 'seldom' later, a literal interpretation of the previous claim (a claim being an assertion open to challenge) was what I was commenting on.

I apologize. I will respond to your posts as whole to avoid future mistakes.

The sources that I have picked both support my argument and inform the audience of specific instances that are relavent to my claims. I plan to provide an objective interpretation of government computer security in my next post. Depending on the department being examined, the government can be regarded as incompetent with regard to computer security.

With regards to sophistry, I was pointing out that the argument you were raising with regard to my sources was deceptive (and you linked it to fear mongering). You also made use of a popular idiom (of which I did as well in a later post) to accuse me of being marked guilty with a yet unspecified thing (perhaps raising doubts). I suggest that both of us refrain from this in future posts, as it has nothing to do with the argument at hand.

I have already addressed this. I hope we can continue to present sources and discuss healthcare reform without assigning blame to either party.

I apologize.

The topic is healthcare reform in the United States. Please stay on topic.