Government Seeking Inclusion of ‘Social and Behavioral’ Data in Health Records

Experts worry about security, use of such information
Kathleen Sebelius / AP

Kathleen Sebelius / AP


The Centers for Medicare and Medicaid Services (CMS) wants to require health care providers to include “social and behavioral” data in Electronic Health Records (EHR) and to link patient’s records to public health departments, it was announced last week.

Health care experts say the proposal raises additional privacy concerns over Americans’ personal health information, on top of worries that the Obamacare “data hub” could lead to abuse by bureaucrats and identity theft.

The CMS currently covers 100 million people through Medicare, Medicaid, and the Children’s Hospital Insurance Program and is tasked with running Obamacare.

According to a solicitation posted by the Department of Health and Human Services on Sept. 4, the CMS is commissioning the National Academy of Sciences to study how best to add social and behavioral factors to electronic health record reporting.

The agency said adding social and behavioral data to patients’ online records will improve health care.

“Increasing EHR adoption has the potential to improve health and health care quality,” the contract’s statement of work (SOW) reads. “Parallel advances in analytic tools applied to such records are fueling new approaches to discovering determinants of population health.”

The project sets out to identify “core data standards for behavioral and social determinants of health to be included in EHRs.”

Critics suggested this would create new bureaucracies and negatively impact health care.

“This sounds like an example of the federal government further intruding on the practice of medicine,” said Chris Jacobs, a senior policy analyst at the Heritage Foundation.

“It’s including more pay for performance requirements on physicians to collect all sorts of data in order to get government reimbursements,” he said.

The 2009 American Recovery and Reinvestment Act gave authority to the CMS to pay hospitals and doctors that make the switch to electronic health records, to “encourage widespread EHR adoption.”

Health care professionals who began participating in the program in 2011 or 2012 can receive up to $44,000 for using EHRs for Medicare and $63,750 for Medicaid over 5 and 6 years, respectively.

Though the program is “totally voluntary,” eligible professionals who are not using EHRs by 2015 will see a 1 percent reduction in their Medicare and Medicaid fees each year.

Jacobs says the government’s “pay for conformance” culture in health care is “telling doctors what they have to do and how they have to do it in order to receive government reimbursement.”

The “meaningful use” program already requires doctors and hospitals to report the demographics of a patient and if he smokes to qualify for its first step. The second stage, planned for 2014, will require recording a patient’s family health history.

The National Academy of Sciences will make recommendations for adding social and behavioral data for stage three, which will be unveiled in 2016.

A spokesman for the CMS told the Washington Free Beacon that the agency is in the early stages of crafting the requirements for this stage.

“While we know that they are considering [clinical quality measures], it would allow a greater variety of specialties and procedures to be included,” said Tony Salters, a spokesman for CMS. “This includes items like behavioral health, dental care, drug, and alcohol use, etc.”

The CMS issued a “sole source” contract to the National Academy of Sciences because of “its caliber and expertise in the medical profession,” they said.

A spokeswoman for the National Academy of Sciences told the Free Beacon that the study began on July 15.

Working with the Institute of Medicine, a committee is currently drafting suggestions for collecting social and behavioral data.

The committee will “identify core social and behavioral domains to be included in all EHRs,” the organization said.

Not only will the committee come up with what behavioral data will be collected, they will also suggest how that data can be shared with public health departments.

The contract orders the committee to identify, “Possibilities for linking EHRs to public health departments, social service agencies, or other relevant non-health care organizations and case studies, if possible, of where this has been done and how issues of privacy have been addressed.”

The committee will also look at the “obstacles” to collecting social data for EHRs, and “how these obstacles can be overcome.”

Jacobs said the study is troubling in light of security issues with the Obamacare “data hub,” which will collect Social Security numbers and personal information to verify participation in the health insurance marketplace, beginning on Oct. 1.

“We’ve already seen with the Obamacare data hub and the significant delays that have been associated with it,” he said. “Government auditors have raised concerns about maintaining timelines and implementation and whether the data hub can be implemented in a secure manner that ensures Americans’ medical and financial records aren’t at risk.”

Others have warned that the database is vulnerable to abuse by the numerous government agencies involved, including the IRS, the Department of Homeland Security, state Medicaid databases, and the Social Security Administration.

The potential for social and behavioral data to be shared with government agencies is only more worrisome, Jacobs said.

“This study raises additional questions about the privacy and security implications of the federal government sharing personal health data with other organizations and entities,” he said.

Elizabeth Harrington   Email | Full Bio | RSS
Elizabeth Harrington is a staff writer for the Washington Free Beacon. Elizabeth graduated from Temple University in 2010. Prior to joining the Free Beacon, she worked as a staff writer for Her email address is Her Twitter handle is @LizWFB.

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