Have you ever objected to a nurse taking your height and weight? That’s what I did just a few weeks ago, at my allergist’s office. It’s the first time I’ve ever done that. And the head nurse agreed with my objection.
Over the past year, I noticed that every time I visited my primary care doctor, the nurse measured my height and weight. It happened once a quarter at the allergist’s office. I decided to do some investigating.
I learned that under a law called the HITECH Act,[1] doctors and hospitals must move to electronic medical records (EMR) by 2015, and demonstrate “meaningful use.” One of the criteria is to record the weight, height, and body mass index (BMI), for at least 50% of all patients over the age of two.[2] I read that “providers will have to electronically share their patients’ BMI scores with the CDC and other health agencies.”[3]
This triggered a number of potential ethical issues: privacy, consent, the physician-patient relationship, and public health concerns.
First, privacy. Why should the government have access to my personal health information? Our health information is already shared with dozens of individuals and organizations, ranging from other doctors to accountants to insurance companies. They are bound by privacy laws, but over 50% of hospitals admit to data breaches.[4] Will “the CDC and other health agencies” be able to do better in protecting the privacy of my information? Or yours?
Second, consent. The BMI index data is used not only to improve patient health, but also in research on obesity. Thus, my data can be used for research purposes without my consent. I was never specifically asked to consent to the measurement, or told why it was necessary. Ever since the Nuremberg Code, there has been a long-term commitment not to do research on human subjects without their consent. This includes telling the person what will be done, the purpose, and how the data will be used. Even though it seems trivial, the mandatory BMI index might be a violation of this commitment to consent before research.
I was also concerned about the impact on the physician-patient relationship. The nurse told me that the measurement was required as part of the “meaningful use” mandate, and that it was not part of my care. I was also told my weight has nothing to do with my allergy medications, and that the measurement and reporting is an administrative burden for the nurses.
A fourth issue is the need for public health research to solve problems that affect large groups of people, such as epidemics, and, yes, obesity. Is this the best way? The assumption seems to be that if some data is good, than Big Data is better.
I'm still working through the issues, and this may end up being a tempest in a teapot. But, I wanted to let you see how a doctor’s visit might be an occasion for bioethical investigation.
[1] Health Information Technology for Economic and Clinical Health.
[2] “Meaningful Use: Introduction,” The Centers for Disease Control and Prevention. The website includes links to the Final Rules for Stage 1 and Stage 2. http://www.cdc.gov/ehrmeaningfuluse/introduction.html.
[3] Healthcare Reform Resource Center. http://homscales.com/healthcare-reform-resource-center.
[4] “2009 HIMSS Analytics Report: Evaluating HITECH’s Impact on Healthcare Privacy and Security,” HiMSS analytics for ID Experts, November 2009. https://www.himssanalytics.org/docs/ID_Experts_111509.pdf.