By Vikram Khanna
The medical world’s pursuit of the right to self-defense, the most fundamental of all human rights, is heading underground. When responsible gun owners and their advocacy groups ground down the nomination of Vivek Murthy to become Surgeon General, they won a significant political victory. Setting aside that the position itself is an anachronism worthy of elimination, the victory inflamed bureaucrats, politicians, academics, and other master manipulators who, 223 years after ratification of the Second Amendment, still want to pretend it never happened . . .
The struggle by anti-self-defense advocates to learn who owns what kind of gun and what they are doing with it will, I predict, soon head to a very different and much murkier place: the federally mandated, three-layered, electronic medical records swamp. Most Americans are unaware that a critical plank in the Titanic that is Obamacare is the transition from a paper-based medical records system (flawed in its own right) to an electronic one that is, already, deeply troubled. The federally contrived system is a mess that is angering physicians and could actually lead to user-alert fatigue that causes more problems than it solves, especially in places like emergency departments where speed and accuracy are crucial.
But that’s not what should give gun owners pause. It’s this: we have little idea what’s in those electronic records, who sees the data, where it goes, and what they do with it. While the debate over whether physicians should routinely question patients about firearm ownership is quiet for now, that does not mean that healthcare professionals cannot or would not be encouraged, with a wink and a nod, to record gun ownership information in an electronic health record as it emerges in the course of routine conversation with a patient.
Gun owners need to know that there are three kinds of electronic records in play. The first is the electronic medical record (EMR), which replaces the paper chart in a specific clinical setting. Then comes the electronic health record (EHR), which is the granddaddy record; it is supposed to be transportable and contain all the clinical information about you from any medical professional who has interacted with you. Finally, there is the personal health record (PHR), which is the record that the individual patient is supposed to see and manage. Of course, by federal decree, all this information is secure, private, and confidential.
The electronic records systems emerging in the marketplace are all built and sold by private vendors. They are frequently modified by purchasers to meet specific needs and interests. The major incentive for providers to use these tools is federal money: the feds will reward providers who can show that their use of these electronic records improves patient care, a doctrine called Meaningful Use.
Among other things to watch, there are Clinical Quality Measures within Meaningful Use, and two of them, population and public health and patient safety, are potentially areas that providers could be told are appropriate landing grounds for recording even unintentionally disclosed (and medically irrelevant) gun ownership information. Then there is the issue of Syndromic Surveillance, which is a brand new mechanism for reporting clinical data to state and federal agencies. I am all for reporting infectious diseases, which is the historical basis for this process, because viruses and bacteria don’t respect boundaries or laws and frequently behave irresponsibly. But, this process is as yet so ill-defined that there are no boundaries. What will state or federal agencies deem collectable? Will their decisions be open and accessible for comment? How will they communicate their surveillance interests to providers in their jurisdiction?
The lack of transparency about the evolution of EMRs and EHRs has been appalling. Why is that patients are encouraged to access primarily their PHR? Why can’t they easily see their EMR and EHR, despite the government’s chest thumping over their Blue Button initiative? Even more to the point, why don’t I, as a citizen, have the right to see who has looked at my EHR data or the entities to which it has been sold or transmitted (in a de-identified manner, we are assured)? I can log on to my credit report any time and see who has requested it. Why can’t I do the same for my EHR and EMR? Why don’t I have the right to correct the records by removing information that is not medically relevant or opt-out of having my data shipped to federal agencies or academic institutions?
The obsession with big data as the solution to all that ails us is shattering privacy and responsibility walls. As physicians increasingly become employees of large health systems including gigantic health insurer-hospital alliances, their loss of professional independence will imperil their ability to resist calls that emanate from central planners and filter through their employers about what kind of “data” is needed to keep people “safe.” As Florida legislators demonstrated, and a federal appeals court agreed, it is possible to segregate medically legitimate firearms ownership inquiries from intrusive and unwarranted fishing expeditions.
Sadly, people who disavow the very concept of responsible gun ownership are missing the point of why this matters so much. In our very modern era, all fundamental rights are under assault. The medical care bureaucracy has no more legitimate need for routinely gathering information about gun ownership than it does about where you worship, whether you vote, or if you peacefully participated in a political rally.
Vik Khanna is a healthcare consultant and writer in St. Louis, who is author of the forthcoming ebook, Your Personal Affordable Care Act: How to Avoid Obamacare.