Viewpoint

Can America have its cake and eat it too? The Health Insurance Portability and Accountability Act (HIPAA)—good legislation originally intended to enable patients to retain their healthcare when changing jobs—has grown into something of a nuisance for researchers who now spend more time placating government bureaucracy than they do completing research studies. According to a recent national survey of more than 1,500 epidemiologists, which was commissioned by the Institute of Medicine (IOM) and published in The Journal of the American Medical Association (JAMA), three quarters of the respondents believe that HIPAA has not "enhanced participants' confidentiality and privacy," but instead, has "had a substantial, negative influence on the conduct of human-subjects health research, often adding uncertainty, cost and delay."

On November 5, 2007, CCHIT announced it had certified 40 percent of ambulatory EMRs and 25 percent of inpatient EMRs. Around the same time I visited my doctor to receive treatment for a mild condition and was surprised when he pulled a tattered old formulary book from his pocket to look up the medication he wanted to prescribe. He's a young man and wore an electronic device on his hip, and yet he turned to a book when he needed facts on medications. I realized my perception of him was wrong. I had assumed he used a decision-support device when in reality he did not. I inquired and he explained that his brain was faster and better than the database, but that he always checked himself before prescribing medications.

Much is happening in healthcare. As I write this column, Washington battles over SCHIP; health coverage for all Americans is the primary issue of the presidential race; and, Microsoft, Wal-Mart and Google are adding personal health records (PHR) to their product portfolios, which, for many Americans, may provide an entirely new way of controlling their health. In a statement following the recent unveiling of HealthVault, Microsoft's online PHR, The Robert Wood Johnson Foundation noted that access to one's own health information is "a vital step in helping physicians and patients work together to improve care." It's a true statement, however, there are chasms to be crossed before PHRs become practical, not the least of which is privacy.

Do Americans like self-service? I do. I know others that do. I also know people that miss the man with the star that pumped the gas and checked the oil. I was in the self-checkout line of a major retailer just yesterday listening to the elderly married couple behind me grouse about self-checkout lines, even though they were standing in one. The husband resented having to scan the items himself and his wife worried about fewer jobs for cashiers. However, neither was willing to go stand in the longer non-automated lines. I marveled at the dichotomy.