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Mar 31 2009

The Disease Industrial Complex: Health Insurers Keep Blacklist

Published by at 8:29 am under Heath IT,patient safety

If you go to a restaurant, its very common to find the wait staff swiping a security card before they order your food.  The kitchen computer prints out a perfect copy of your order, and at the end of the meal, you have an itemized list of everything you’ve ordered.  This is an amazingly efficient and secure system – the management doesn’t want the staff slipping their friends free hamburgers or whatever.

If you go to a hospital, however, it’s likely that your doctors orders are hand written, and perhaps faxed to the pharmacy over a public phone line.  This information, which may have life-critical implications, may have no security, no computer verification, be delayed in transmission, misinterpreted by the staff, or misdirected to the wrong patient.  Computer order entry systems have been a hot topic for decades, and the cost of manual system in patient safety has long been recognized. (See 200,000 preventable deaths per year? and The National Health Emporer has no clothes)

If we accept the conclusions of the Institute of Medicine’s study To Err is Human then preventable medical errors (44,000 per year) are one of the leading causes of death in the US)

Why should even mom-and-pop restaurants have secure, online order entry systems to protect their food orders when hospitals dealing with life-critical information, prone to fatal errors still use clumsy, manual, insecure systems?

Having designed hospital computer systems for 30 years, I understand that a hospital order entry system is a complex task, much more complicated than a restaurant.  But with the right initiatives, it can be done.  The VA has been doing online order entry for decades.

The industry IS capable of maintaining integrated data bases… For example, see Health Insurers quietly keep blacklist.  The insurance industry has an extremely efficient blacklisting system that maintains files on you:

Trying to buy health insurance on your own and have gallstones? You’ll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

What’s more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.

So, when it comes to figuring how to deny coverage to you, the industry has managed to create seamlessly integrated, state-of-the-art information systems.  When it comes to protecting patient safety, well, they are still trying to figure out how to deal with this… for over 20 years.

Restaurants and insurance companies didn’t require any federal agency or stimulus money to be stimulated install state of the art secure systems they did it out of their own (possibly nefarious) self-interest.

The problem is a lack of incentives, not lack of stimuluses.

The problem is that we are dealing with a Disease Industrial Complex, not a Health care system.

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