US Pharm. 2008:33(12):4.

been 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.

Despite 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 care.

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.

According 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.

I 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?

What 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 pharmacy.

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