There are innumerable articles and legal reviews outlining the challenges associated with balancing a patient’s privacy against the value of information accessibility during the course of providing patient care – what I call the “care value”. The “care value” derived from patient health information (PHI) accessibility is simply defined by increased improvement in and quality of patient care offered as a result of enhanced PHI accessibility.  Enhanced quality of care can be measured many ways, and I don’t presume to know them all.  But, as a patient and a professional in the healthcare market, I feel comfortable suggesting enhanced quality of care certainly includes improved patient outcomes, enhanced patient safety, and avoidance of unnecessary or redundant procedures. 

So, in an era determined to “electronify” PHI (to wit: billions of dollars in government grants and incentives to introduce EMRs, HIEs, and enhanced healthcare information technology infrastructure), how do we reconcile what I call the “privacy paradox”?  The short answer to this question is disappointing – I don’t know.  But, I do know that the inherent contradictions that exist between PHI accessibility and legislated patient privacy rules cannot co-exist – period.  One of the best articles I’ve read on this topic is entitled “Bottom-Up or Top-Down? Removing the Privacy Law Obstacles to Healthcare Reform in the National Healthcare Crisis” by the Indiana Law Journal – this article can be found at the following URL: www.indianalawjournal.org/articles/84/84_Hill.pdf (“Privacy Article”).  I don’t wish to use this blog entry as a book report on the article.  Suffice it to say, the Privacy Article illuminates many of the challenges, contradictions, and dangers associated with the current state of affairs vis-à-vis patient privacy vs. PHI accessibility. 

Let’s get back to my golf metaphor.  HIEs do many things, but their core function is to provide connectivity and PHI accessibility at a level never before seen in healthcare.  The potential benefits are enormous – articulated in part by my “care value”.  But, with HIPAA merely serving as a “privacy floor” (pg. 11, Privacy Article), the myriad different state-based privacy regulations and legislation effectively narrow the fairway at which health systems must aim such that virtually any shot is going to miss.   The strategic thinking deployed by a good golfer must therefore be deployed.  What side of the fairway is safer – the privacy protection side, or the “care value” side?  Or, is that the wrong question to ask?  Should the question be “what side of the fairway is best?”  Which question is the right question most certainly depends on who you ask.

I will leave you with this:  as a patient, I want to receive the best care possible.  Doesn’t every patient?  Moreover, and I can only speculate, but don’t physicians and other care providers want to provide the best care possible?  Of course they do.  So, yes, I’d like my private health condition to remain between me and my care providers.  But, if forced to choose which side of the fairway I will land, on a golf course where the fairways are so narrow as to be virtually hidden, I will always choose enhanced care over privacy.  I suspect if such an option was presented to 100 patients, at least 99 of them would answer the same way. 

But, our culture’s zealous defense of privacy puts the “care value” at risk.  As we enter this new decade, and dollars begin to flow to health systems and states to improve healthcare information technology, the culture of privacy has to catch up.  In short, the regulatory and technology environments must be reconciled.  Only then will we be able to actually see the fairway at which we are aiming, much less land on it.