Medicine is a business. This is the Faustian bargain our society has made with medicine but we may be reaching the limits of the bargain as a Kaiser News Network article on the latest trend in hospital marketing highlighted. The hospitals mentioned in the article broke no laws when they used basic demographic and payment data to aid in developing new marketing campaigns but did they expose a fundamental conflict of interest?
The data was specifically used in a marketing project. How different would we feel if the same data or even more precise data was used by a nurse making calls for the same screening tests? Would it matter if the screenings were are of dubious public health value as the Kaiser article implies or recommended screenings? Would it make a difference if the nurse was actually more profitable because of a higher conversion rate?
As a society we are still struggling with understanding our digital exhaust. We have become inured to some of activities being quasi-private with Google and Facebook serving up personalized ads but what about our trusted advisers? As all of our transactions become loaded into systems that are more interconnected what can be used for what purpose? For example, the Society of Actuaries has sponsored a research project looking at the relationship between socioeconomic and other factors and medical costs. If a significant relationship is found between some marketing variable and health care should it be included in medical records? Should doctors include your magazines subscriptions in a medical record? What happens if a doctor uploads this information into an ad supported electronic medical record, will he find some new magazine to bring up during the appointment?
These questions will only increase with number of new consumer wellness services. Data from services like Runkeeper and The Eatery may have a legitimate place in medical records. Including this type of data makes a medical records more complex but infinitely more valuable. Techniques to sort through social media can easily be altered to mine the much more structured medical record for products or services with medical impact. In the near future, will we get a coupon for the new healthy casual dining restaurant opening down the street with our lose weight reminder?
We have traditionally held that health data needs to be protected between the patient and the provider but what happens why the provider becomes a distribution channel for other products? Most people have come to some kind of peace with the role that pharmaceutical advertising and sales forces have on providers but will we be able to handle providers pushing their own services or worse some tangential service? The rise of data aggregation and the uses that data can be put to will increase the need for providers to clearly state any conflicts of interest. Do we need to segregate doctors like we do financial professionals based on how they are paid? Will some doctors will accept only payment from the patient or the patients insurance to ensure no conflicts of interest while other’s accept payments from a variety of sources to minimize the cost to the patient?