- BIOETHICS FORUM ESSAY
The 28th Amendment: The Pursuit of Health
I am a physician who has long believed that the single best way to “reform” our broken system (not just re-arrange the present Byzantine payment mechanism) is to hand over access to patient’s medical information to the patients themselves. Take all the jealously guarded medical information about patients away from the hospitals, doctor’s offices, and insurance databases, encrypt it on a portable medical information card (MICard), give it to the patient (or guardian) and let the patient decide who gets access. Sound crazy?
Crazy enough that I remained baffled and intimidated about speaking out until I happened to visit the National Archives and reread our founding documents. Those guys knew how to cut through the petty arguments and address the big picture.
So with apologies to Thomas Jefferson et al, I would like to frame my humble proposal as the 28th Amendment to the Constitution of the United States.
Like Life, Liberty, and the Pursuit of Happiness, the Pursuit of Health is an unalienable right of every human being. Each of us has a right to medically useful information about our own body, and the responsibility to use it in the pursuit of health.”
If each of us has a right to the pursuit of health (not a right to health itself or any particular level of care), it follows that each of us has a right to medical information about our body. An electronic record of our own personal health information (ePHI) would function as a “user’s manual” for our body as well as a vital link to the medical care system.
A priority of health care reform should be creation of an electronic personal health information system for every person in our country. The information must be comprehensive, compact (it should be on a thumb drive, cell phone chip, or ATM card, for example), portable by the patient, securely encrypted, password protected, and tied to the individual by a biometric identifier (such as a fingerprint or facial recognition). Fortunately, the technology is available now and quite affordable.
What about security and privacy? Biometrics. I have my own ePHI on Google Health and on a password- and fingerprint-protected thumb drive that accidentally went through our washing machine without problem (not recommended).
Privacy concerns (the HIPPA hyper-anxiety that paralyzes our present medical information systems) disappear when the patient owns the information and decides who gets access. Yes hacking that same info from the patient is a big potential problem, but no more difficult to overcome than hacking credit card or bank card information. Easily solvable by our techies, especially when you consider that the very best patient identifier is the patient’s living body; it’s difficult to fake finger prints, iris pattern, facial characteristics, blood type, eye color, height and weight, diseases, and, yes, eventually DNA fingerprint. (Heads up homeland security: this is your tamper proof ID.)
Under the system I propose, access to an individual’s electronic personal health information would be controlled by the individual or the person’s legal guardian and would require the person’s biomarker (fingerprint, etc.) to match the password-protected identifiers. Selected information or the entire record could be quickly and efficiently downloaded to any licensed provider, hospital, emergency facility, insurance carrier, or government agency that has the appropriate electronic communication device (maybe a simple USB port).
Most information would be “read only,” and only approved and licensed providers would be able to enter or alter data. Most of the heavy data (multiple CT scans, MRIs, etc) could be stored securely in online databases (such as Google Health or Health Vault) and accessed through a patient’s MICard (perhaps best pronounced MY Card, to convey that it belongs to the patient).
Reform of our complex health care system would then become a matter of regulating and facilitating access to patients. Each person, armed with his or her personal health information, might eventually be able to choose from a slate of competing insurance plans, providers, even treatments. The vast health care complex of providers, hospitals, and third party administrators might then reorganize around the patient and his or her electronic personal medical information, competing to offer the most cost-effective treatment. Patients empowered with their medical information are consumers, and perhaps the only force that can “bend the curve” of relentless health care cost inflation.
Michael R. Harrison, M.D., is a professor of surgery, pediatrics, obstetrics, gynecology and reproductive sciences; emeritus director of the Fetal Treatment Center; and director of the Pediatric Device Consortium at the University of California, San Francisco.