Privacy an issue with records bill

WASHINGTON -- A bill to encourage computerized medical records has provoked opposition from privacy advocates, consumer groups, and civil libertarians who point to recent security breaches, including the theft of a Veterans Administration laptop with personal information on millions of veterans.

The groups fear that the legislation, now moving through the final stages of approval, wouldn't provide enough safeguards.

Lawmakers hope to bring the benefits of computerized medical records systems like the one used by the Veterans Administration to the whole country.

Reducing reliance on paper records, supporters say, will save billions of dollars. And tying computerized records systems together in networks could reduce medical errors by making information instantly available wherever it is needed.

On one side of the debate is the issue of ensuring adequate protection for a person's most personal information. On the other side is the imperative from government, employers, and insurers to curb the seemingly unsustainable growth of healthcare spending, as well as to improve medical treatment.

``We are not going to be able to get healthcare costs under control and improve quality without dramatic implementation of health [technology] over the next 10 years," said Robert Laszewski, a health policy consultant. ``It's one of those things where choices are going to have to be made.

``That doesn't mean give the healthcare industry a blank check -- we've got to have standards -- but I'm afraid we're going to have to take some risks," he said.

Privacy advocates say the legislation needs stronger protections, such as provisions that would allow patients to control who sees their records or even to opt out of the electronic system. Agencies also should be required to notify patients of a security breach, and patients should have the right to sue over unauthorized disclosures, privacy advocates say.

``The main thing we are concerned about is that if this information leaks out to employers, it can destroy people's reputations and livelihoods," said Dr. Deborah Peel, a leading critic and a psychiatrist who heads the Patient Privacy Rights Foundation in Austin, Texas.

Under the legislation, patients would not ``have the basic right to control who can see and use the most sensitive information on earth about you," Peel added.

Supporters of the legislation, which is known as the Health IT bill, say existing federal medical privacy laws offer sufficient safeguards. Such laws ``already provide absolute protection of our health information," said Representative Nancy L. Johnson, Republican of Connecticut, a coauthor of the legislation.

The Senate unanimously approved a version of the Health IT bill last year. The House version sparked partisan battles over complex technical and legal issues, as well as privacy. But House Republicans won passage over Democratic opposition last month.

A House-Senate conference to try to iron out differences promises to be contentious. Senator Edward M. Kennedy, Democrat of Massachusetts, has branded the House legislation ``a weak, partisan bill."

Both versions share the same goal -- to establish a legal and technical framework for a records system that would guarantee that doctors and hospitals anywhere could seamlessly share patient files.

Private industry would design and build the system and pay for most of the cost. A federal technology director in the Health and Human Services Department would oversee standards and ensure that computer systems could communicate with one another.

Architects of the system envision achieving more than a vast records repository. It could help doctors, for example, by warning them if they are about to prescribe a medication to which a patient is allergic. Patients also would have access.

The Bush administration strongly supports the legislation.

``We would love nothing more than to see the entire country covered," Veterans Affairs Secretary Jim Nicholson said. ``And most especially the Department of Defense -- they come to us with paper files, which is sort of an anachronism."

Independent analyses suggest the cost savings would be considerable. A RAND Corporation study last year estimated savings of at least $81 billion a year, mostly from lower administrative costs. And with increasing use of the system, the practice of medicine could become more efficient, eventually saving as much as $346 billion annually.

Even for a country that spends about $2 trillion a year on healthcare, the savings would be substantial.

Opponents of the legislation deny that they are trying to hold back progress. ``I want medical science to go forward," said Representative Lois Capps, Democrat of California, ``as long as we take care that what we are going to do is not going to expose people's privacy."