Civic Engagement in Healthcare Policy: Why Bother?

Somewhere along the lifecycle of the Boomer generation—maybe it was somewhere after the founding of Apple, the rise of the personal computer, and the personal digital assistant, but after the rise of personalized web sites and online shopping experiences—all of which I am an appreciative and sometimes frustrated user—we forgot about the personal engagement as members of “we the people.”  Was it the hanging chads or the multiple year presidential campaigns or something entirely different that caused us to ho-hum our way over to the nearest form of pure entertainment and turn off the world around us?

Does anyone remember life before credit cards?  Have you noticed that some businesses now actually prefer that you don’t use cash?  What a change in the last couple of generations.  How did we ever determine who to trust and who to hire before the FICO score came along in 1958?  Criminal background checks for new employees now make regular use of this credit index to determine trustworthiness.  Perhaps this obviates the need for character references.

Another cultural change is upon our collective doorsteps, and the Obama administration is this change funding through grants to states and nongovernmental organizations in the healthcare business sector.  It is commonly referred to as the “digitalization of healthcare,” and is known among technologists and healthcare policy makers as HIE (Healthcare Information Exchange) and EHR (Electronic Health Record) or EMR (Electronic Medical Record).   This foray into data-driven healthcare and healthcare policy is welcomed by the information technology industry, which is hungry for another challenge.  For example, in Oregon state, which is proud of it’s “Silicon Forest,” the Oregon Health Information Technology Oversight Council (HITOC) has been founded to oversee and usher in this brilliant new baby.

Some people believe that Health Information Exchanges (HIE’s) are an expensive social good which strain the capabilities of information security and can easily be misused and result in the curtailing of civil liberties.  However, many individuals inside and outside the healthcare system see massive benefits to the population as a whole through implementing both HIE’s and EHR’s.  Whether or not your expertise is in information systems, public policy, healthcare, or some other domain, such as raising children or running a small business, you will likely be affected by the implementation of an HIE.  You will certainly be taxed to fund a public implementation, and it is very likely that your personal healthcare information, and that of those you care about, will be included in it.

Fortunately, we live in a democracy which still provides venues for citizens to speak to issues important to them, and while you may not now know whether your state has an HIE initiative, you can find out by browsing the web site of, for instance, your state department of human services.  You can also research health information technology policy at the federal level, and do your own musing about what the impact to you is likely to be. Consider, for instance, the following list of pro’s and con’s:


  • The public is informed through increased public health surveillance and reporting.
  • Better quality healthcare.
  • Greater patient safety.
  • Better population health.
  • Access to data in emergencies.
  • Decreased medical insurance costs.
  • Population patterns more easily identified resulting in more rapid development of cures.
  • More rapid records transfer.
  • Easier collaboration among providers.


  • Dirty data resulting in inaccurate diagnoses.
  • Poor timeliness of data feeds resulting in inaccurate diagnoses.
  • Privacy violations due to misuse of data or data breaches.
  • Lack of legal readiness to deal with privacy related issues.
  • Lack of choice regarding inclusion of data in the HIE.
  • Development of a HICO score similar to a FICO score but designed to characterize health, health habits, longevity, and risks.
  • Cost of implementation of the HIE.
  • Engagement with IT systems focuses the healthcare provider on the computer rather than on the patient.

All in all the evolution of Health Information Exchanges in America could prove to be a very interesting and perhaps profound cultural change—maybe even more profound than moving from cash to plastic.  And here you sit on the cusp of it full of ideas and concerns.  You’re an interested party in this social and political movement.  Include yourself and educate yourself.  If nothing else, you’ll have something interesting to say at that next gathering of family and friends in the upcoming holiday season.

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