Junkfood Science: Grading compliance — the information free for all begins

March 05, 2009

Grading compliance — the information free for all begins

As predicted, private electronic medical records of consumers are being freely accessed, exchanged and used to document and grade doctors and hospitals according to their compliance with performance measures set by the state. The nation’s first such statewide program has just been launched in Georgia.

The public is being told that the power of health information technology is being focused on “quality measures” and “evidence-based medicine.” Informed readers understand the doublespeak. As we’ve examined, “quality measures” developed by third parties don’t mean quality care that improves health outcomes, saves lives or reduces healthcare costs. And “evidence-based” doesn’t mean medical care supported by sound research, paired with the experienced clinical judgment of doctors.

Healthcare IT News reported this disturbing story that flew under the mainstream media radar, perhaps because its full implications weren’t understood by lay press. As a third party for the state, Georgia Cancer Coalition will use the statewide health IT database exchange to acquire, analyze and share de-identified patient data around quality measures. Molly Merrill went on to write in “Georgia Cancer Coalition uses HIE to share evidence-based medicine:”

The project will also integrate the de-identified patient data into the exchange's analytics dashboard solution for measurement of provider and hospital performance, based on 52 quality-of-care indicators for Georgia identified by the Institute of Medicine.

“Medicity [its technology platform] enables HIE [health information exchange] and hospital customers to deliver seamless access to patient information stored in disparate systems across multiple care locations, resulting in improved patient care and reduced healthcare costs,” said Kipp Lassetter, MD, the CEO of Medicity. “We are pleased to partner with the Georgia Cancer Coalition to launch what we believe is the first evidence-based, statewide cancer quality measurement program in the country. This ground-breaking initiative provides a replicable model for other states or regions seeking to establish similar HIEs.”…

“[T]he exchange will be able to pull de-identified patient data from multiple hospitals, physicians and other ancillary clinical data sources and integrate that data, regardless of its origin, directly into our core platform, thus enabling state-wide interoperability.”

Georgia Cancer Coalition was created by the state of Georgia in 1998 when it was looking for a way to use some of its $5 billion windfall from the tobacco Master Settlement Agreement. Its stated mission was to make Georgia a national leader in cancer prevention, treatment and research, with a focus on breast, colorectal, prostate and lung cancers.

The Coalition commissioned the private group, the Institute of Medicine, to create a set of 52 performance measures the state could use to measure progress of cancer preventive programs. The IOM report, “Assessing the Quality of Cancer Care: An Approach to Measurement in Georgia,” followed its other national government strategies for cancer prevention and early detection, focused on diet and lifestyle modification and screening:

The report concludes that in order to save the most lives, health care providers, health plans, insurers, employers, policymakers and researchers should concentrate on helping people to:

● stop smoking,

● maintain a healthy weight and diet,

● exercise regularly,

● moderate alcohol consumption, and

●get screened for breast, cervical, and colorectal cancer.

While prevention sounds well-meaning and beneficial, the evidence has consistently shown that most cancers cannot be credibly blamed on patients for eating the wrong foods, enjoying an alcoholic drink, having a certain body type, or failing to get requisite screening tests. These performance measures, however, not only give government cause to monitor and legislate certain lifestyles, but risk far more serious adverse consequences.

When cancers, like other chronic diseases, are falsely believed to be patients' own fault — due to “bad,” “irresponsible” or “noncompliant” behavior — it makes it easier to convince the public that the state is justified in restricting or denying medical care to them, especially when the treatment is said to be too costly to the state or the person’s “quality of life” not worth saving.

And by using compliance with these pay-for-performance measures to grade doctors and hospitals, how long will it be before healthcare providers, who see their third-party payer reimbursements cut, don’t want to care for patients who smoke, drink, are fat, aging, don’t agree to screening tests or weight loss treatments, or who get a chronic disease?

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