Forget about jugglers and magicians, Allscripts took things up a notch in terms of booth attractions at this year’s Healthcare Information and Management Systems Society (HIMSS) annual meeting in Orlando, Fla. by hosting the former Speaker of the House of Representatives, Newt Gingrich. Also founder of the Center for Health Transformation, Gingrich is a strong advocate for the way healthcare is handled in the United States, and an even stronger proponent of healthcare IT as part of the solution. HCI Editor-in-Chief Anthony Guerra got a chance to sit down with Gingrich at HIMSS to talk about his vision for the future, and how to get there.
AG: Many health information exchange initiatives are thwarted by privacy concerns. How do you think that can be addressed?
NG: First of all, I favor strongly a federal law that would make it a felony to release or use personal health information without the consent of the person involved. And I would make it an automatic matter of slander for any news organization to use your health record without your permission.
When George Clooney’s record gets released and it’s on Entertainment Tonight, that’s fundamentally a violation, and it is not in society’s interests.
I say this in particular because one of our members is deCODE. They are an Icelandic company that has been engaged in creating the largest genetic database, as a percent of the population, of any place in the world, because virtually everybody in Iceland has had their database encoded and their genetic data encoded. I just submitted my swab to deCODE, so we’re supposedly getting our genetic code back. It’s very interesting, one of our folks, Laura Lynn, did that and learned a lot of stuff, it was fascinating, by looking at her genetic code. She had no idea. But to have that happen, people have to be confident that their employer and their insurance company isn't going to use genetic data to isolate it.
First of all, you’ve got to have a federal law that says — and we’ve been very strongly advocating the Genetic Privacy Act for the same reason — your genetic data shouldn’t be usable by your employer or insurance company. It’s unfortunately held up in the Senate right now, but we’re trying to get the Senate to pass it despite that. So I would say it’s an important topic; however, I would also suggest to you that first of all, out of curiosity, an amazing number of Americans are going to get their data about their own genetic code. They’re going to get data that’s electronic. Second, as a matter of safety, when you realize the difference in your relative safety as you travel, if you have a stroke, if you get in a car wreck, if any of a thousand things happen, if you show up at the emergency room and somebody can pull up your electronic record (versus they don’t know who you are) most Americans will rapidly migrate to it.
The last point I make is one where I think the hardest line privacy advocates actually get caught in a formula that in the long run doesn’t make much sense. It is clear that we’re going to have some method of knowing who you are. Because we present in an emergency room or you present to get a drug, if we don’t know who you are, how can we have safety in terms of medication, how can we have safety in terms of treatments. It turns out to be irrelevant, whether it’s a single identifier or five items that identify you. All the big credit card companies who allow you to use a piece of plastic worldwide have multiple methods of determining who you really are. If you said to the average person, in order to protect your privacy, we’re going to take away your credit card, they would think you were crazy. There are some people — but to be fair in a free country, there are a significant number of people who won’t shop on the Internet, who won’t use a credit card — there is a minority that actually have no bank accounts deliberately as an act of policy. It’s a pretty small minority, but it’s several million people who are deliberately living in a cash society.
AG: If you come up with a system where people have to opt in, you are necessarily going to get much lower adoption, so do you think it will have to be an opt out model?
NG: I think it will almost certainly be an opt out model in the long run. One of the first tests of this is going to come as we finally go to the fast track model for the Transportation Security Administration, because you’re going to have people who give them their retinal scan and their thumbprint in order to go through a fast track line and you will discover among frequent travelers, 99 percent adoptions. People will say. ‘I can go through this really quick or I can protect my privacy and stand over here, I’m gone.’
AG: Our readers are largely CIOs, however, they are either empowered or not depending on the priorities of their CEOs. How critical is the role of those CEOs in facilitating technology adoption?
NG: I studied both Deming and Drucker who are arguably two of the greatest management advisers of the 20th century. Both believe that if the CEO didn’t take a lead on big change, it never happened, because you don’t have the moral force and you don’t have the drive to break through. So I would argue that any CEO who wants to be a part of the 21st century has to have as a part of their portfolio how are they going to stay on top of information technology and how are they going to stay on top of rethinking reimbursement systems. If you look at the great catalytic forces in the next 15 years, information technology and models of payment are going to be two of the great catalysts for fundamental change. If the CEO doesn’t have as a regular part of their portfolio, getting briefed, understanding it, talking to experts, really getting a sensitivity to this, they can’t be making informed decisions.
AG: To support all this, CIOs need staffing. Do you feel the United States is set up to provide that staffing over the next 20-30 years?
NG: I think what we have to have is a very substantial rethinking of math and science education in K-12, because we’re not producing enough people today who can actually do the work. Beyond the question of how many do you want to have in the pipeline at the junior college and college level, we’re not having people enter junior college and college capable of a level of thinking and the level of analysis that are going to be required by the 21st century. I think that requires very, very fundamental rethinking. That’s part of why I wrote a book recently called, “Real Change,” to argue that the level of change you need, for example, in K-12 education, is beyond anybody’s current expectations.
I would say that you, secondly, want to think about bias and things like federal student loan programs and other things in favor of very needed capabilities where you would make it more desirable economically for people to do harder things. I think you have to distinguish between hard degrees to get and easy degrees to get and recognize that if they are exactly the same value, the human psychological bias to get the easy degree is pretty powerful.