Game Over for Health IT?

In health care, we have been working to establish an IT infrastructure for many years with slow progress and mixed results. What we failed to anticipate was the potential criminalization of providing or accessing specific health care services. We do have a precedent for protecting health information from the criminal justice system (42 CFR Part 2) when it comes to substance abuse and mental health data, at least under some conditions.

The current and potential impact of recent Supreme Court decisions on the health and well-being of people living in this country is huge. Developing technology is the easy part. Developing it to meet specific policy requirements is the hard part. We did not appropriately anticipate the reality of additional types of health data becoming sensitive in similar or more complex ways. It is now time to change gears.

Now would be a good time for the top tier of health care (second tier being public health) to realize it is in over its head. The traditional health care system has been reinforcing the status quo by largely ignoring knowledge gained and lessons learned from other areas (mainly the long and painful history of racist social service provision in this country).

We need to accept the reality that the chances of the medical establishment gaining or regaining trust from marginalized populations are basically zero. This also applies to health IT and health research in general. We need to accept the fact that attempts to codify what the health care system likes to call “social determinants of health” data into health IT systems is more likely to be used for profit purposes than challenging the status quo. Now we need to face the strong possibility of this type of data being used for criminalization purposes.

The health care system has historically received a disproportionate amount of funding relative to public health and social services. Not only for technology, but service provision in general. Just as white and more privileged people need to stop centering themselves in human rights conversations, the health care system needs to stop centering itself when it comes to attempting to addressing social problems in a meaningful way.

[image description: Colorful Splatter Painting by Steve Johnson]