Dr. Peel's Ludd calculator

Dr. Deborah Peel has been crusading against health reform since the Clinton years. Readers of Modern Healthcare have named her one of the 100 most powerful people in the field for three years running.

She is also (and there is no polite way to say this) a Luddite. The aim of her pressure group, Patient Privacy Rights, appears to be keeping health care in the paper-based dark ages.

My final evidence is the so-called Privacy Risk Calculator posted to her site last week.

The only way to avoid risks to your privacy, according to Dr. Peel's Ludd Calculator, is for you to pay cash for all health transactions, avoid prescriptions and insurance, and in all ways avoid that nasty Internet machine. The more paranoia you display, the better.

Well you can do that. You can try for complete anonymity if you like. You can also be completely isolated, never get any help, and die decades before you might otherwise.

It's true there are risks to privacy in all data exchanges. It is also true that health insurers and employers have been routinely violating patient privacy for decades, in order to reduce their health care costs.

But the answer to that is not to build a bridge to the 18th century. The answer is to reduce and (if possible) eliminate their incentive for doing this. This was one of the primary motives for health reform, which Dr. Peel opposed in the name, she said, of protecting privacy.

The time has come for the industry to face the real threat. Our health IT infrastructure is 20 years behind the times because fear mongers like Dr. Deborah Peel have fought computing every step of the way, as well as reform.

HIPAA was a great victory for those activists, but it turned out to be a Pyrrhic one. Rather than protecting privacy, all it did was create some phony hoops doctors could easily leap through forms, and to further reduce any incentive for computerizing and exchanging patient records.

It was a cynical law that only bred cynicism, which is how Luddism gains a foothold.

The overhead thus introduced to our health IT system, which is finally being overcome through efforts like the HITECH stimulus and NHIN Direct, is aimed at automating this paper flow, controlling who has access to records, recording when they do access for auditing purposes.

The result is not going to be perfect, because the incentives to spy remain, but on a transaction-per-transaction basis things will improve a lot. Plus we will get the benefits of information sharing -- lower transaction costs, personal control over a wide array of health data, and the ability to study large populations efficiently being just a few.

But there will be many, many more information transactions, so there will be breaches. Auditing and law enforcement will be needed to keep the damage to a minimum, and make sure leaks are never routine.

The answer to a fear of people breaking into your house is not to live on the street. And it's clear from her "calculator" and the way it asks questions that this is Dr. Peel's aim.

It's time for the industry to stop fearing her, and for government to stop listening to her.