I am stepping out on a huge, bowing limb here, fully expecting it to break under the weight of my unreasonably high expectations.
That being said, if I can't have high expectations about a Bill that is supposed to support my right to my health information, what the hell good are ascribing to principles of any kind?
Again. This is my patienthood we're talking about here. That has been, historically, a huge compositional element of my personhood in total.
I have not endorsed the first draft of Health Data Rights, despite spending significant time with several composers whom I love and respect and utterly believe have people-who-are-patients best interests at heart.
I must apologize now for the criticisms I am about to offer, which I also offered several times before the bill was made public.
I know many of you who worked tirelessly on this - putting in weekend hours and pooling political, personal, and professional capital to get this done.
I realize I am jeopardizing political, personal, and professional capital by NOT endorsing this draft.
I recognize and applaud your efforts at this early stage. However...
While I wholeheartedly support this initiative, I cannot in good conscience endorse this product.
I feel the results of the first round are problematic for several reasons, namely:
1. The language as is, opaque by necessity in order to get many important signatories (which I understand and accept), is largely not actionable. Terms are so loosely used that it will be very challenging to state with certainty when a 'right' to health data has been abused. Example: What does "minimal cost" mean to those who hold my health data in the bowels of their systems?
2. How will we hold organizations (or individuals) accountable if they abuse our rights to health data? There are no suggestions given, in the preamble or media blitz materials.
3. How will we build tools, systems, services, and conversations that help people who have been, will be, and are today patients, navigate these rights? Were they provided in any other language? Are they different for children and adults?
4. Where are the patient advocacy organizations? Where is NAMI and the like? Many employees and volunteers at organizations like this one would have plenty to say on the issue of composing a Bill of Health Data Rights, and useful or not, it would at least help refine the concepts displayed here with more specific and stirring language.
Maybe I expect too much. Maybe I want the impossible. Maybe I would sacrifice several (or all) 'large' or 'famous' signatories of the Bill in the fight to have the language that I feel is life-saving included.
Maybe I would also fight from within the system to encourage all of the parties who currently hold MY health data that it is, in fact, mine to choose to access (or not), to share (or not), and to control (or not).
Maybe I have. Maybe I am still.
But overall, there is one central tenet missing from the current Bill that, if included in explicit language, would result in me signing, and it is this:
My health data is my own.
End of story. I don't have to reclaim it. It's already mine.
Please note - It is a completely different issue for my health data to be tricky or dangerously expensive/time-consuming to obtain or inaccurately kept/updated/shared within the system.
These issues, and these differences, are not even mentioned in the bill or accompanying language, and I fear that is a near fatal diagnosis that will prevent this effort from playing any lasting role in my pursuit of wellness beyond some extra blog hits and sound bytes.
My health data rights already are being abused, and I will stand up against that abuse, personally and for others, and advocate for change. I am utterly committed to doing so.
Here's where I get myself into real trouble...
That also means I don't do things in half-measures. If it's not good enough, it doesn't go out.
If a Bill of Health Data Rights doesn't acknowledge vital programs CURRENTLY IN PLACE in hospitals to help make people who are patients aware of our rights, like the JCAHO Speak UP! Program, it fails to connect patients with resources OUT THERE IN THE REAL WORLD more tangible than a Hallmark-card-esque Bill of Rights.
If a Bill of Health Data Rights doesn't direct me to SOMETHING, SOMEONE to call, or email, or txt, or tweet, or a senator to whom to write a letter or fax a protest, then it has failed me as a patient.
It has failed me because now I've got my rights, but what the hell do I do with them?
Perhaps worst of all is the last omission, which I find most aggregious - if a Bill of Health Data rights doesn't use terminology that ties the ABUSE of those rights to ACTIONABLE CONSEQUENCE then it has failed me.
The failure (conscious or not) to include the term "personal health information" or PHI, that would 'link' these rights to actionable, legal consequences under current legislation is a failure of the worst kind. It is either a failure of ignorance or of fear, or of both.
And revolutions, my friends, do not light a bonfire by being afraid of tyranny. Revolutionaries throw firebombs at the doorways. Yes, revolutionaries build barricades. Revolutionaries lay themselves down in protest in the line of fire.
This Bill of Rights does none of those things.
It is the equivalent, at best, of holding up a lighter in protest. Peaceable (not necessarily a bad thing). Lukewarm. Ineffectual.
I must be a radical, and God help me, I'll probably never work in this town again.
But apparently I'll have plenty of work to do lobbying for a Bill of Rights that has some sticking power. I hope to do it with those of you who are committed to holding the match, if I haven't just burned all my connections to cinders.
Here's the accelerant I'd use to start:
BASIC HUMAN RIGHTS: Health. Life. Liberty. The Pursuit of Happiness.
PREAMBLE
We the people hold these truth(s) to be self-evident:
1. Our health data is our own.
2. Our health data is an asset. It shall be legally described, and protected, as such.
3. Our health data is a part of who we are - it is not the sum and total of our identity.
BILL OF RIGHTS
1. It is my right to know which people and organizations are writing, recording, sending, and receiving my health data.
2. It is my right to have included in my record a listing of who, what, when, where, why and how my information is stored and shared.
3. I have the right share my health data with whom I want, when I want, through any means of communication I choose.
I'd then take the above rights and reword them to demonstrate that people who are patients have the choice and control over personal health information (PHI) to release it only when and where and to whom we choose.
This is my right - to have choice and control over my health data. These rights, more fully explained (but still in very blunt-force-trauma form) look a bit like this:
5. I have the right to choose and control who sees my health information.
6. I have the right to choose and control who shares my health information.
7. I have the right to choose and control who profits from my health information.
8. I have the right to refuse access to my health information.
9. I have the right to correct inaccuracies in my record.
10. I have the right to protest data I view as inaccurate, and to have a record of that contestation included in the record.
11. I have the right to report inaccuracies in my record(s), or abuses of my health data rights, to a HealthDataRights.org, the Better Business Bureau, and my elected representatives.
If I still have a job tomorrow, I'll see you all 'online' then. Where I'll be working to protect health data rights I already own.
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