Monday, February 7, 2011

Health Reform and the Dark Side of the Internet

The Internet’s contradictions and confusions are just becoming visible through the fading mist of Internet euphoria.

Lee Siegel, Review of The Net Delusion, New York Times, February 6, 2011

I am, by nature, an optimist. I believe, on the whole, the Internet, with all of its ramifications and applications, is a good thing, for health care and society.

But the Internet has a dark side, too.

In The Net Delusion: The Dark Side of Internet Freedom (Public Affairs, 2011), Eugeny Marozov argues there is nothing inherently liberating about social networks. Indeed, the opposite may be true.

As I was reading the book review of The Net Delusion, I was simultaneously indexing my 240 page book Good Intentions: the Consequences of Health Reform. While doing so, It occurred to me I had multiple entries on the Internet, electronic health records, and the social media. I counted the pages on which these subjects were mentioned, and they numbered 138. That means, in one way or another, more than half the book’s pages relate to the electronic revolution and its effects on health reform.

The miraculously convenient technology of the Internet has come to be seen as all empowering, the salvation, and the Holy Grail of modern medicine. The Internet and the social media are seen as tools for emancipating health care consumers, as a means of judging and measuring health quality, as the health 2.0 and health 3.0 roads to some sort of health care Nirvana.

Yet my book contains mini-chapters warning of the Internet’s dark side. For example, I have entries on electronic health records bearing these titles.

• Bonanza or Boondoggle
• “Inevitability” and “Waiting Game”
• Is “Free’ EHR for Real?
• Unnatural Communications
• Talking to Your EHR
• Patients and Wikileaks
• Need for Physician Friendly and Useful Information
• Hospitals and Doctors Not Walking the EHR Line

Unlike cyber-utopians, I do not view all Internet applications as desirable. The Net can be used to suppress patient and physician freedoms, to invade personal privacies and confidentialities, and to measure the immeasurables – social, culture, political subtleties, and indeterminates of human interaction.

Not everything on the human scene can be searched, twittered, or facebooked. Keep in mind what happened with the Iranian revolution. The Iranian regime used Twitter and Facebook to identify protestors through their Facebook photographs , to dig out personal information and where-abouts, and to distribute government propaganda.

Likewise, it seems to me to be possible to use these powerful tools to identify physician non-compliers, to root out those who don’t go along with government health policies, to exclude them from caring for them in entitlement programs, and to broadcast the government’s point of view on who and who should not be cared for and for what.

The Internet has two sides - emancipation of individuals to find everything they want to know about everything, and its use by authorities to infiltrate every nook and cranny of our personal and professional lives.
The Internet has consequences, a bright side and a dark side. Physicians, who are closer to human realities than most, know this.

• That is why the implementation of a universal interoperable system of electronic health records is so slow to take root – with only 4.5% of doctors and 1,5%% of hospitals having fully-loaded EHRs.

• That is why Drs. David Brailer and David Blumenthal , the first two National Coordinators of Information Technology for Health and Human Services, have left government service to return to the real world. Each served two years. Five days ago, Blumenthal announced he was returning to Harvard to qualify for tenure.

Both Brailer and Blumenthal found implementing “interoperative” use of EHRs across the health care system slow and frustrating going. Early on, Brailer recognized small physician practices did not have the wherewithal or incentives to bring EHRs into their offices. Blumenthal, though backed by $27 billion in government stimulus money, and a vigorous proponent of “meaningful use” of EHRs, must have left his government post frustrated, with his mission far from accomplished and the end not clearly in sight.


1, DesRoches, CM et al, "Electronic Health Records in Ambulatory Care - a National Survey of Physicians,"New England Journal of Medicine, 2008: 359: 50-60.

2. Jha, AK, et al: "Use of Electronic Health Records in U.S. Hospitals," New England Journal of Medicine, 360:1628-38

Richard L. Reece, MD, blogs a Medinnovation and has a website under constuction. He is the author of three recent books, Obama, Doctors, and Health Reform (Iuniverse, 2009), Innovation Driven Health Care (Jones and Bartlett, 2007), and an E-book, Pros and Cons of Accountable Care Organizations (Practice Support Resources, 2011). He works with but does not speak for The Physicians Foundation, a 501C3 organization representing physicians in state medical societies. Opinions expressed in his blogs are his alone. He can be reached at

No comments: