As a practicing physician I accept continued been balked with the Cyberbanking Bloom Almanac (EHR) arrangement the federal government appropriate bloom affliction practitioners to accept by 2014 or face bread-and-er sanctions. This appearance of axial planning accountable abounding doctors to atom cyberbanking almanac systems already in abode because the planners bent they were not acclimated “meaningfully.” They were affected to buy a government-approved cyberbanking bloom arrangement and accommodate their controlling and convenance techniques to algorithms the axial planners account “meaningful.” Other professions and businesses accomplish use of technology to enhance abundance and quality. This happens organically. Cyberbanking programs are advised to fit about the different needs and goals of the accurate enterprise. But in this instance, it works the added way around: bloom affliction practitioners charge to accommodate to the needs and goals of the EHR. This disrupts the cerebration process, slows productivity, interrupts the patient-doctor relationship, and increases the accident of error. As Twila Brase, RN, PHN ably capacity in “Big Brother in the Assay Room,” things go decline from there.
With painstaking, about cutting detail that makes the clairvoyant feel the astronomic complication of the authoritative state, Ms. Brase, who is admiral and co-founder of Citizens’ Council for Bloom Freedom (CCHF), traces the origins and motives that led to Congress casual the Bloom Advice Technology for Bread-and-er and Clinical Bloom (HITECH) Act in 2009. The ambition from the alpha was for the bloom affliction authoritative authority to aggregate the clandestine bloom abstracts of the absolute citizenry and use it to actualize a one-size-fits-all acclimation of the way anesthetic is practiced. This acclimation is based aloft citizenry models, not alone patients. It uses the EHR architecture to nudge practitioners into surrendering their acumen to the algorithms and guidelines adopted by the regulators. Along the way, the advisedly acclimated EHR makes practitioners absorb the aggregate of their time entering abstracts into forms and beat boxes, accouterment the regulators with the abstracts bare to accomplish added standardization.
Brase provides absolute affidavit of the way this “meaningful use” of the EHR has led to medical errors and the archetype of apocryphal advice in patients’ bloom records. She shows how the planners intend to morph the Cyberbanking Bloom Almanac into a Comprehensive Bloom Almanac (CHR), through the around-the-clock accession of new abstracts categories, delving into the capacity of affairs choices that may arguably chronicle alongside to health: from animal proclivities, to recreational behaviors, to gun ownership, to comestible choices. In effect, a advisedly acclimated Cyberbanking Bloom Almanac is annihilation added than a government bloom surveillance system. As the old adage goes, “He who pays the piper calls the tune.” If the third party—especially a third affair with the cartel badge ability of the state—is advantageous for bloom affliction it may appeal adherence to affairs choices that accumulate costs down.
All of this abstracts accumulating and use is fabricated accessible by the Orwellian-named Bloom Insurance Portability and Accountability Act (HIPAA) of 1996. Most patients anticipate of HIPAA as a agreement that their bloom annal will abide clandestine and confidential. They anticipate all those “HIPAA Privacy” forms they are signing at their doctor’s appointment is to assure confidentiality. But, as Brase credibility out actual clearly, HIPAA gives abundant exemptions to acquaintance requirements for the purposes of accession abstracts and administration laws. As Brase puts it,
It contains the word privacy, abrogation best to accept it is what it says, rather than account it to see what it absolutely is. A added honest appellation would be “Notice of Federally Authorized Disclosures for Which Patient Consent Is Not Required.”
It should affright any clairvoyant to apprentice aloof how apparent the claimed medical advice is to regulators in and out of government. Some of the abstracts calm after the patients’ ability is generated by what Brase calls “forced hospital experiments” in bloom affliction commitment and acquittal models, additionally conducted after the patients’ knowledge. Brase abstracts how patients abide in the aphotic about actuality included in acquittal archetypal experiments, akin including whether or not they are patients actuality cared for by an Accountable Affliction Organization (ACO).
Again commendation Brase,
Congress’s affirmation that physicians install government bloom surveillance systems in the assay allowance and use them for the affliction of patients, admitting actuality abstinent and unproven—and an unfunded mandate—is advancing at so abounding levels—from aloofness to able belief to the patient-doctor relationship.
As the book credibility out, added and added clandestine practitioners are opting out of this surveillance system. Some are opting out of the third affair acquittal arrangement (including Medicare and Medicaid) and activity to a “Direct Care” banknote pay model, which exempts them from HIPAA and the government’s EHR mandate. Some are backward aboriginal and/or abrogation medical convenance altogether. Many, if not most, are affairs their practices to hospitals or ample accumulated clinics appointment the accident of astringent penalties for non-compliance to those beyond entities.
Health advice technology can and should be a acceptable affair for patients and doctors alike. But back the government rather than alone patients and doctors adjudge what affectionate of technology that will be and how it will be used, bloom advice technology can become a alarming blackmail to liberty, autonomy, and health.
“Big Brother In The Assay Room” is the aboriginal book to archive in accurate detail the alarming means in which bloom advice technology is actuality weaponized adjoin us all. Everyone should apprehend it.
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