Alan Goldberg of Goulston & Storrs (and HealthLawyer) is giving a Tuesday lunchtime talk on the national health information infrastructure.

He says it’s a big deal: Medicare has 1 million providers who are involved in 1 billion claims per year. NHII crosses political boundaries; everyone from Bush to Hillary, from Ted to Newt, all support having an infrastructure that enables electronic record sharing. The NHII will require technologies, standards, systems, values, applications, and laws.

The standards are arising from the industry (says Alan), not from the government, although the government’s adoption of these standards counts for a lot.

He says NHII has four areas of concern:

First area of concern: Uniformity of privacy laws. HIPAA says that stricter state laws on privacy override the baseline federal standards. That complicates things. And you have to balance privacy against the desire to share medical information among providers. “Maybe we have to change HIPAA” says Alan.

Second area: Access & control of patient medical information. NHII can exacerbate the tension between the “duty to warn” patients of medical risks vs. the right to privacy. “Should you be entitled to access information via the NHII to find out if your spouse-to-be” has a sexually transmitted disease?

Third area: Secondary uses of medical information. Secondary users of health information may not be covered by the HIPAA privacy rules.

Fourth area: Miscellany. Is NHII conduit, custodian or architecture? Who owns the info contained in NHII? Should the data be mined for the greater good? Should the FDA regulate parts of NHII?

A couple of days ago, the head of the NHII issued a Request for Information, i.e., public comment, about communication among doctors and health institutions.

Alan says that Bush is the more committed to creating an NHII than any other president. [On the other hand, he set up the NHII without budget, employees or the mandate to propose law.]

Q: The linchpin is patient privacy. If people think the system doesn’t protect their privacy, they’ll filter the information they provide, which will result in worse medicine and more malpractice cases. In fact, AG Ashcroft in the partial birth abortion case said that HIPAA means there’s no longer a presumption of privacy. What’s missing from this infrastructure if patient consent.

[HealthLawyer.com looks useful but, jeez is it ugly and overly disclaimed.]

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