In response to my post about incorporating behavioral and social data into EHR, I got the following email from one of our readers:
My worry on the collection of such behavioral and social data is that it will get used to further prescribe people with the psychiatric drugs that have such horrendous side effects to the benefit of big pharma rather than move towards diet, health education, nutrition and other non-medical remedies that can have long lasting benefits for a lifetime.
It’s a very fine point. In my previous article I didn’t spend enough time talking about the potential downsides of incorporating all that data into an EHR. The reader pointed out the potential abuse by big pharma to sell more drugs. No doubt, pharma is trying to sell more drugs. I’m sure the creative minds at pharma will try and find ways to leverage this data and sell more drugs. That’s the nature of healthcare.
However, I think pharma would try to do this whether the data was in the EHR or not. In fact, having this data in the EHR for the doctor might mean the doctor makes better choices and doesn’t always default to pharma to treat a patient. For example, if you know they’re living in a poor area, then you can ask them if they have enough food or heat in the winter in order to avoid them returning to you a few weeks later with another cold. This would actually lead to less drugs because you’re actually treating the cause of the problem as opposed to just the presenting problem.
While this example paints a pretty picture, you could also paint an awful picture where this data is used for discrimination. This could be in the office itself or by insurance companies. Some of the new ACA laws help when it comes to insurance discrimination, but many fear that the move to ACOs will cause these organization to discriminate against the unhealthy and poor. I have this fear as well. When you pay to keep people healthy, who do you want to have in your patient population? The healthy.
When you start talking about including all this new data in an EHR, there are a lot of privacy and security questions that come up as well. We’ve always known that the patient record was a treasure trove of personal information that needed to be safeguarded and protected from abuse. Social and behavioral data makes the health record even that much more desirable to nefarious groups who want to abuse the data. HIPAA along with privacy and security will become that much more important.
I’m sure I’m just touching the surface on the challenges and problems associated with all this new data. Although, the thing that scares me most is the way people could abuse the data. I don’t think these are reasons to not use this data. We need to use this data to move healthcare forward. However, it is a call to be very thoughtful about how we collect, secure, and use the data we’re collecting.