An Argument for Wikileaks in US Healthcare

On Allscripts CEO Glen Tullman

By Darrel K. Pruitt DDS

In 2008, Allscripts CEO Glen Tullman told Alex Nussbaurm of Bloomberg.com that physicians should take out loans to invest in his EHR product “to ensure that doctors have some skin in the game.” What did you expect? How much charm does it take to sell federally subsidized products when everyone knows that they’re mandated anyway?

Life Sans Blumenthal 

Yesterday, Nicole Lewis posted “Health IT’s Future without David Blumenthal” – a glowing and arguably deserved tribute to Dr. David Blumenthal who is leaving the ONC

http://www.informationweek.com/news/healthcare/leadership/showArticle.jhtml;jsessionid=0OLOEMENGCENJQE1GHRSKH4ATMY32JVN?articleID=229201216&pgno=1&queryText=&isPrev=

From where I’m sitting, it’s clear that Tullman used Lewis and InformationWeek to score more points with Washington and Wall Street, while continuing to marginalize the interests of those who actually take out loans to purchase his product: “David shepherded ONC through a very critical time . . . the creation, definition, and implementation of meaningful use, which really is a way to ensure that physicians actually use electronic records to improve care, but also that taxpayers get good value for their investment.” What about the doctor’s investment and more importantly, if a doctor is busy clicking on links to qualify for meaningful use dollars, who is accountable to the patients?

I don’t know about you, but it’s not difficult for me to recognize that like other HIT stakeholders whose careers are propped up by easy mandates rather than finicky satisfied customers, Tullman indeed has solid free-market reasons to play to investors and politicians while fearing his customers. They’re pissed at the man.

A Nationwide Survey           

HCPlexus recently partnered with Thompson Reuters to conduct a nationwide survey of almost 3,000 physicians concerning their opinions of the quality of health care in the near future considering the Patient Protection and Affordable Care Act (PPACA), Electronic Medical Records, and their effects on physicians and their patients. (See “5-page Executive Summary”)

http://www.hcplexus.com/PDFs/Summary—2011-Thomson-Reuters-HCPlexus-National-P

“Sixty-five percent of respondents believe that the quality of health care in the country will deteriorate in the near term. Many cited political reasons, anger directed at insurance companies, and critiques of the reform act – some articulating the strong feelings they have regarding the negative effects they expect from the PPACA.”

At this crucial time when Republicans are already threatening to cut off remaining HITECH funding, whose job will it be to break the news to HHS Secretary Kathleen Sebelius that the EHR savings she was counting on to fund a major portion of healthcare reform are only as valuable as CEO Tullman’s politically-correct fantasy? Pop! From what Nicole Lewis writes, my bet is that the Secretary won’t take the news well: “[Sebelius] reiterated that the successful adoption and use of HIT is fundamental to virtually every other important goal in the reform of the nation’s health care system.” Such pressure from the top down will make it even more difficult for HIT stakeholders, including insurers and politicians, to disown the most egregious. crowd-pleasin’, bi-partisan blunder in medical history since blood-letting was declared Best Practice by popular demand.

According to the HCPlexus-Reuters survey results, one in four physicians think EHRs will actually cause more harm than help in spite of Dr. Blumenthal’s best efforts. I wonder if the escalating bad press about EHRs helped Blumenthal decide to return to his academic position at Harvard. Of course, the controversy over HITECH is nothing new. There have been signs for years that EHRs, including Allscripts products, will neither improve care nor provide taxpayers (our grandchildren) a good value for their investment.

If Tullman was unaware of the highly critical HCPlexus-Reuters study when he assured InformationWeek that his subsidized product has value in the marketplace, he must have been aware of the disappointing news concerning two other recent studies performed by Public Library of Sciences (PLoS) and Stanford which also confirm that EHRs do not improve care. So imagine what it’s like to be one of Tullman’s new, naïve and trusting customers who are expected to use the product for something it’s not designed to do.

My Opinion 

It’s my opinion that Tullman’s apparently incorrigible business ethics have no place in the land of the free, and that more transparency in healthcare would help protect the nation from such politically-connected tyrants. Tullman, a long-time Chicago friend of Barack Obama and a Wall Street sweetheart, would still be just another domesticated CEO if it weren’t for the bi-partisan mandate for electronic health records that help Allscripts, Obama and Wall Street more than clueless patients.

Assessment 

If you want to seriously cut costs in US healthcare as well as cut our grandchildren’s taxes, demand transparency from not just the doctors and patients, but from stakeholders as well. Protected communications between good ol’ boys in healthcare are hardly diplomatic cables about military secrets and always increase the cost of healthcare.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. So when do you want to get the website started? I’m here to serve wherever you need me. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Of WikiLeaks, Politics and eMRs [A Voting Opinion Poll]

Is Reporting for “Accidental” Political Downloads a HIT Security Game-Changer?

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

Recently, I read in The New York Times that Federal workers are being told to avoid the website WikiLeaks and stay away from those classified cables leaked from the US State Department! Classified information, whether or not already posted on public websites or disclosed to the media, remains classified, and must be treated as such by federal employees and contractors”,  the Office of Management and Budget [OMB] said in a notice sent out last Friday.

Link: http://www.msnbc.msn.com/id/40512200/ns/us_news-wikileaks_in_security

Of Advice … Not Threats?

According the release, The New York Times was told by a White House official that it does not advise agencies to block WikiLeaks or other websites on government computer systems. Nor does it bar federal employees from reading news stories about the leaks! But – and this is a big one – if they “accidentally download” any leaked cables, they are being told to notify their “information security offices.”

Too Many Conflicting Questions 

  • Is document leaker PFC Bradley Manning a hero and a real patriot – not the mislabeling of an ACT as THE PATRIOT ACT – or traitor goat? What about Julian Assange – is he a full-disclosure hero or guilty of treason – should he be treated as an enemy combatant of the US Government?
  • How could a mere PFC download a quarter million classified documents without raising a red flag? Is the government incompetent? Has it just issued a not so thinly veiled threat to its own citizens with this admonishment? Are we becoming more like China in our use and restrictions of the Internet? Was the big brother prescience of George Orwell’s 1984, correct?
  • Is the admonishment of security officer notification following “accidental download” akin to the “don’t ask – don’t tell” policy on gays in the armed forces? So much for the transparency we were told our current administration wanted.
  • Should we forget about, or modify, the eMR privacy debate and/or should HIPAA be modernized?
  • Should Hillary Clinton resign?

Health Care Security Questions

  • Who exactly is a government employee anyway? And, does this include workers in the VA system, prison health system, Indian Health Service, postal workers, Medicare and Medicaid recipients, school kids with government meal subsidies and/or independent contractors and recipients of budgetary pork projects, US tax credits or federal unemployment benefits, etc?
  • Have these employed folks signed a HIPAA-like “business associate agreement” with Uncle Sam? Should government workers close their eyes and ears, too! And, with the expansion of federal government, does this mean that even more folks will have access to classified information [and more accidental downloads] than ever before? Who is left and allowed to read WikiLeaks and who is actually immune, or not?
  • If government can not protect its own data, records, confidential information or websites with certainty, how does it expect a solo medical professional [DPM, DO, DDS, DC, etc] to do the same with eMRs, and at what cost! HIPAA rules and regulations spell ou very specific health policy mandates and onerous legal punishments and fines for protected health information [PHI] data breach don’t they; not just the notification of a Chief Medical Information Security Officer [CMISO]. Is this a federal double standard?

Historical Re-Do

Federal employees were told to not read the Pentagon Papers. The leaker, economist Daniel Ellsberg PhD, precipitated a national controversy in 1971 when he released them. The right of the press to publish the papers was upheld in New York Times Co. v. United States. As a response, the Nixon administration began a campaign against further leaks – and  a smear campaign against Ellsberg personally – by creating the White House “plumbers”, which in turn led to the Watergate burglary of the LA office of Dr. Lewis Fielding MD [Ellsberg’s psychiatrist] in an effort to discredit him. According to Ellsberg;

“The public is lied to every day by the President, by his spokespeople, by his officers. If you can’t handle the thought that the President lies to the public for all kinds of reasons, you couldn’t stay in the government at that level, or you’re made aware of it, a week … The fact is Presidents rarely say the whole truth—essentially, never say the whole truth—of what they expect and what they’re doing and what they believe and why they’re doing it and rarely refrain from lying, actually, about these matters.”

Note: “Presidential Decisions and Public Dissent”, Conversations with History, July 29, 1998].

Now … Four Decades Later

Has anything changed since the above scandal? Almost forty years later, those with security clearance across the board were given this same directive about WikiLeaks. Will they comply; nope! Did little Johnny refrain when his mother told him not to read Playboy magazine; of course not! The surest way to perusal, or unwanted behavior, is prohibition. Just tell someone NOT to do something, and watch that activity increase.  Human nature is human nature. Recall, the 18th. amendment [1919-1933] was repealed by the 21st. amendment whose 77th. anniversary is celebrated just this week.  

Assessment

Look, like most traditional news organizations and journalists, we at the ME-P fiercely advocate for our First Amendment Rights. Anyone looking at classified information without clearance, while not necessarily illegal when posted by a media organization, is considered to be making an “ethics” violation of the rules of secrecy as established by the intelligence community. And, we always strive to be ethical as part of our Judeo-Christian heritage.

But, citizens and members of the fourth estate are not in the intelligence community. What does this mean for average citizens and private doctors … nothing at all. What a HIPAA breach means to a medical professional however, is another serious matter! Fear the government’s admonition: Do as I say – Not as I do. Use paper medical records; eschew eMRs?

Voting Poll and Survey

Conclusion

Is reporting for “accidental” downloads, or security breaches, an HIT security game-changer? Your thoughts and comments on this ME-P are appreciated. Is WikiLeaks like eMR security; more potentially legal and economically damaging to the leaker than the outed? What about Julian Assange and the need to revise the HIPAA statutes? Is there an analogy here; or not?Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com and http://www.springerpub.com/Search/marcinko

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