Wednesday, February 03, 2016

How Sure Are You This Sort Of Stuff Will Not Start Happening As The Usage Of The PCEHR Rises?

This appeared in the UK last week:

'State snooping' fears as civil servants are handed new power to examine detail in every sick note given out by GPs

·         Government can view data in sick notes and only the name will be hidden

·         GPs say it's snooping because before the data was completely anonymised

·         Civil servants say the new power will help them deal with work sickness  

A new power allowing civil servants to see the detail in all sick notes handed out by GPs has been branded 'state snooping' today.
Critics fear that now the Department for Work and Pensions have access to the data from next month it will be used to name and shame surgeries who issue the most 'fit notes'.
Data on the number of people GPs signed off as 'unfit' or 'maybe fit' used to be completely anonymised.
Now it will include their gender, health problem, location and how long they are off sick for.
GPs will need to inform patients their data is being taken, but cannot withhold information unless their patient has a good reason to object.
Family Doctor Association chairman Dr Peter Swinyard said: 'I think that is state snooping.
'Although I am sure some civil servant thought it was a terrific idea somewhere, I am not entirely sure I agree. I don't know if patients understand that when I write a fit note, some bureaucrat is going to be able to have a look at it.'
GP and data sharing campaigner Dr Neil Bhatia said he was 'not sure why' practice-level data was required, 'other than to compare practices, create league tables, name and shame'.
The data will also say what type of health condition the person has and the location of where the note was issued.
More here:
If people allow all this PCEHR nonsense to proceed - see just what my happen with the DoH having vast fun mining all the data they are collecting.
You can bet this is the sort of stuff they have in mind. I am sure I am going to opt-out of this nonsense before it gets to cause humongous trouble.
If you trust your detailed health information to the Government you deserve all they then do with it!
David.

7 comments:

Bernard Robertson-Dunn said...

David,

IMHO, the thin edge of the wedge is already in place. The PCEHR was supposed to be part of a health system infrastructure project that improved health outcomes.

The general opinion, as evidenced by the lack of interest by patients and health professionals since it went live, is that the PCEHR is worse than useless when it comes to delivering health care.

However, the real infrastructure is in place. The patient identifiers, provider IDs, communications capabilities and a large searchable database are all there along with legislation that permits secret snooping by law enforcement and revenue protection agencies.

All that is missing is the data. Medicare, PBS and immunisation registry data is available for populating new health records. Initiatives already in place to force everyone to have a health record and to put pressure on GPs to upload health summaries will gradually increase the amount of data and the value of the database as a surveillance tool. It won't do much for health outcomes, that's what real Health Record systems run by the states and other health organisations will do.

From the government's perspective, the data will be of most use to monitor the population and the activities of health professionals. The fact that much of the data in the system is inaccurate, irrelevant and of little use medically is not important when it comes to snooping.

And don't think the government isn't into using technology to snoop. Read this:
http://www.theguardian.com/australia-news/2016/feb/03/government-monitoring-social-media-accounts-to-hunt-down-welfare

Is it likely that the government wouldn't use a fully populated health data system looking for fraud, for evidence of criminal behaviour that results in health related issues and for poor (as judged by the government) health care practices? Especially when it is legal.

At least monitoring social media accounts is an example of people stupidly giving themselves away. They can choose to stop being stupid.

With a mandated national health record system there's no choice and most people are unaware of it. Even those who are aware only have the option of not using the health system. And what will that probably lead to? Bad health outcomes because of a lack of health care.

And the government is not even using the fear tactics of terrorism or xenophobia.

It's all too easy.

Terry Hannan said...


Bernard, I like this posting. Of course your text has opened up a whole range of topics that are in addition to the one introduced by David in the blog.
• “thin edge of the wedge is already in place”-a component of the imposed system.
• “the lack of interest by patients and health professionals since it went live, is that the PCEHR is worse than useless”-the introduction of new technologies into social structures (man-machine interactions) is complex and the history of human developments is littered with more failures than successes e.g. “The design of everyday things” by Don Norman (and many others). If humans do not find the implementations as useful they will discard them.
• “It won't do much for health outcomes, that's what real Health Record systems run by the states and other health organisations will do”- you are correct in the first part of this sentence. The second part seems to imply that the States know how to do it. I am not sure about this and I am interested in your clarification of this part of the statement.
• “The fact that much of the data in the system is inaccurate, irrelevant and of little use medically is not important when it comes to snooping”-this is a very good point. Even the current systems that do not have the PCEHR model and are used to measure health care and support health measurement such as DRGs, Case-Mix, Activity-Based Funding all rely on similar data and the captured data is not timely nor able to be fed back into the care process to modify clinical information management behaviour. It is the atomised clinical data that is critical. A recent example is ClinicalTime: Identification of Patients with Acute Kidney Injury using Temporal Abstractions and Temporal Pattern Matching. Daniel Capurro, et. al. AMIA Jt Summits Transl Sci Proc. 2015 Mar 25;2015:46-50. eCollection 2015.

I have responded to your posting because I see significant value in the issues you have raised and hope this feedback adds value to the discussions.

Bernard Robertson-Dunn said...

Thanks Terry, your support is most welcome.

Re '“It won't do much for health outcomes, that's what real Health Record systems run by the states and other health organisations will do”- you are correct in the first part of this sentence. The second part seems to imply that the States know how to do it. I am not sure about this and I am interested in your clarification of this part of the statement.'

If I change "will" to "should" and add some, I'd be more accurate:
“It won't do much for health outcomes, that's what real Health Record systems run by the states and other health care delivery organisations should do, assuming they know how to.”

The states deliver health outcomes, the Federal government doesn't.

Which of course raises the question "why is the Federal Government getting involved in (supposedly) delivering health care?"

Possible answer - they aren't they are snooping, for many and sometimes, it would seem, nefarious reasons.

Is any of this constitutionally valid? My guess is that they have written laws to make it legal and these laws have not been challenged - so we don't know.


Anonymous said...

Possible answer - they aren't they are snooping, for many and sometimes, it would seem, nefarious reasons.

You make it sound all so very Machiavellian. Perhaps its all a lot simpler and a lot more innocent than that.

Perhaps it's that for years proponents of ehealth urged the Department to support eHealth to help and then projects were established and well meaning bureaucrats saw new career paths popping up before their very eyes and more energy and momentum was brought to bear and a whole new bureaucratically led eHealth industry grew up employing busloads of busy people who not what they were trying to achieve or how to achieve it. And it all go out of control and fell into a big deep hole.

Bernard Robertson-Dunn said...

re "Perhaps it's all a lot simpler and a lot more innocent than that.

Perfectly correct. However that only covers intent, not result.

Unintended consequences are very common, in this case one of the unintended consequences may turn out to be very useful for those intent on snooping, even if their objectives are justifiable.

If a system can be used in a particular way, it probably will be, by someone.

All the government has to do to allay fears is:

- Leave the system as opt-in,
- Delete the Law Enforcement/Revenue Protection section of the PCEHR act.
- Keep the court ordered release aspects as long as the order (not necessarily the content) is made public.

Then the market/population can make its own assessment as to the value of the system.

And the whole approach would be more in line with the Liberal party's "small government is good" philosophy. The fact that the PCEHR/My Health Record approach is so anti small government just adds to the suspicion.

Anonymous said...

Hello Bernard ---- Thank you for your comment. I (February 04, 2016 11:31 AM) agree entirely with you. I do like the way you think.

Anonymous said...

Anonymous, February 04, 2016 11:31 AM
Perhaps its all a lot simpler and a lot more innocent than that.

Seen on Slashhdot:
"Never ascribe to malice that which is caused by greed and ignorance."
-- Cal Keegan

... none of which is innocent.