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nearly 60 years since George Orwell wrote his prophetic novel Nineteen
Eighty-Four, which coined the idiomatic term Big Brother as a
euphemistic way of describing an invasion of our privacy. Obviously, the year
1984 has come and gone, but unfortunately Big Brother and the tacit
implications of Orwell's 1984 are still with us in 2008. This is
especially true for health care in the United States.
our government's effort to try to keep the Big Brother syndrome in check with
the passage of the Health Insurance Portability and Accountability Act (HIPAA)
in 1996, data mining has become pervasive in our society, especially in health
Clearly, the intent of HIPAA
was to protect the health care records of U.S. citizens by providing controls
and the security to ensure the privacy of their health care data. And while
the provisions of this loophole-prone law have arguably helped control the
spread of health care data into wrongful hands, with the move toward
computerized record keeping, I believe it has not gone far enough.
While I was not so naïve as to
believe that the health care data being stored in the tens of thousands of
computers in pharmacies and physicians' offices are ever safe from prying
eyes, a recent article in The Washington Post opened my eyes to what is
really going on in today's computerized health care marketplace.
to the article, insurance companies that have legally been lifting physicians'
medical records for some time are increasingly tapping into computerized
pharmacy drug records to create a kind of health credit score on the more than
200 million American lives they cover. The reason given is that drug records
are more accurate and less expensive to mine than physicians' medical records.
The amazing part of the article is that apparently consumers are knowingly or
unknowingly authorizing such data extraction of their records. And while some
consumers may not want to sign the consent forms, in effect they won't get
insurance unless they allow the insurance company to look at their records.
doubt there is anyone in any business who doesn't operate on the principle of
risk management, including those who run insurance companies. Whether or not
an insurance company writes a policy has always been and will undoubtedly
continue to be based on some kind of health care risk score. Someone who takes
more medications is obviously at a higher risk of getting sick and more likely
to drive up claims. I really can't argue with this rationale. But the question
I pose is, Should pharmacists be a part of the process that gives insurance
companies that information? Shouldn't the collective privacy of the millions
of drug records remain better protected?
makes this situation even more ludicrous is that the very same insurance
companies that are squeezing out every profit dollar from the pharmacist are
looking for pharmacists' help in mining data so that they can deny coverage to
their patients. It is important that pharmacists counsel patients on the
importance of not signing away their privacy rights, because Big Brother is
not a fictional character in an Orwell novel; he is real and not a friend of
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