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Dark Visions

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Introduction

In May of 1996 I participated in a novel presentation for a meeting discussing progress towards Electronic Patient Records (EPR). Our group largely focused on the positive aspects of the EPR, which is also known by many other acronyms (EMR, CPR, CBPR, LMR, EHR, etc.).

Of course, there is a potential downside to virtually all new technologies. I had the dubious honor of presenting the downside. Although I am one of the people working on developing and implementing these systems, and I look forward to having better tools to take care of my patients, it wasn't too hard to imagine some ways things could go wrong.

I used the device of a television show, called "20 Minutes", looking back from the year 2010 (shorter attention spans then, of course). The US of 2010 is rather like is today. The EPR has brought many benefits, but there's been a price to pay as well. The commentator wonders if things could have been done better, and outlines the remedies emerging in 2010.

How likely are my "Dark Visions"? Not likely, and they are eminently avoidable. The Bennett bill in the US Senate has some good starting points. Certainly not all of them will come true, though some might.

I was asked by several people to put the future timeline I used up on the web. I've not include my commentary, however. Hope you find it interesting ...

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20 Minutes Presents
Dark Visions: 1996-2010. A Look Back.

Anchor: John G. Faughnan M.D.
May 13, 2010

1996-2010: Threads

• elite vs. public health care systems
• power of electronic publication and commerce
• power of data mining and linked databases
• fall of the clinician

1996-2000: Consolidation of health care

• five "Care Corporations" (CareCorps) serve entire US
• international telemedical specialists provide low-cost 24-hr decision support and consultation services
• falling care provider incomes from physician overproduction, operational efficiencies, enabling technologies

1996-2000: Rise of Info-Commerce

• 1998: Digi-Cash supports Net micro-payments
• off-shore data repositories arise "Pirate Webs"
• First suicide following accusations of sexual misconduct on "Amy's Black Wall" Web site

2001 - 2002: Transition

• Physician unionization movement defeated
• Time cover story details emerging "servant class"
• increasing wealth concentration in top 10% US population
• Two hundred people die from toxic herbal concoction placed on an alternative care web site.

2003 - 2004: Transition

• personal health counseling a growth industry, staffed by former physicians and nurses
• standard-tier serves 90% of the population, elite-tier uses subspecialists.
• Pirate Webs market dating screen service
• CareCorp Data-Ring selling private health data to Pirate Web

2003 - 2004: Commerce in Personal Data

• CareCorps offer free dental care to members who allow storage of DNA profiles
• CareCorps waive copays for members who join home monitoring programs: stool lipids, urine drug monitoring
• CareCorps credit card has low interest rates, tracks food, alcohol, and tobacco purchases.

2005

• India world center of clinical expert systems, available on Net.
• Public Service Act: all persons working with public must provide access to medical records and undergo a DNA scan for deviance genes.
• CareCorps CEO passes encryption codes to daughter's kidnappers

2005: Data Mining Saves Manhattan

• terrorists hide nuclear weapon in Manhattan
• NSA overrides medical database security, data mining leads to capture of key terrorist
• the Database Security Act consolidates health databases to enable national security use

2006: Public Concerns Rise

• most employers using Pirate Webs to screen employees.
• hacker places fraudulent retrovirus test results on Pirate Webs.
• elite-tier health care providers return to a paper record system
• national Luddite party launched

2007: Ebola-Alpha strikes Los Angeles

• Los Angeles quarantined after Ebola-Alpha epidemic.
• Database Security Act invoked, CDC and NSA abort epidemic and lift quarantine.
• Database Security Act amended to support epidemic surveillance.

2008: High Tide

• Supreme Court rules that CareCorps may request DNA records as a condition of insurance.
• CareCorps provide incentives for members to carry "mother cards".
• Senator Kelly discovers his HIV-7 status on pirate web
• Class Action suit against CareCorps for "data injury" cases

2009: The Pendulum Shifts

• survey finds pirate webs have entries for 20% of US adults
• President Levin assumes office.
• Health Privacy and Data Commerce Task Force formed.

What have we learned?

• information technology is enabling technology
• digitized data flows in the direction of profit
• privacy threats come from authorized users
• shared risk motivates shared control

What will the task force recommend?

• privacy legislation - patient control over data distribution
• data injury compensation from national insurance pool
• tighten Database Security Act
• misuse of private information a felony
• any person may choose to "opt out" selected records from the network
• ban commerce in private information?

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