CABG vs. stenting--clinical implications of the SYNTAX trial.


749 risks misdirecting health care and otherwise undermining important social goals. At the same time, we welcome the considerable opportunities these tracks provide for targeting efforts to improve health care’s quality and value. The question for policymakers is whether the social harm (e.g., increased use of costly health care products with minimal marginal benefit or detrimental effects on quality) outweighs the benefits from a particular use. These harms and benefits will be difficult to quantify, but assessing them will be an increasingly necessary exercise as information technology becomes more widespread. Many physicians are probably unaware that their routine clinical activities are being tracked or for what purposes. To our thinking, the appropriateness of following these tracks depends critically on the purpose, and the First Circuit Court has spoken loudly in indicating that limits can be placed on the use of health care data for advancing commercial marketing goals. The medical profession needs to lead the relevant policy discussions — not just because it is physicians’ tracks that are being monitored, but also to ensure that the profession is at the forefront of efforts to enhance public trust and improve the quality and value of health care. Individual physicians can be thoughtful about when to allow their tracks to be watched. Professional organizations can assess the privacy policies of commercial information technology systems and tools to determine how information should be shared and what uses should be off-limits. These organizations should avoid financial ties with commercial vendors, such as sellers of electronic medical-record systems, that might limit their objectivity in such discussions. Legislators can investigate uses of data, imposing restrictions on inappropriate use in some cases or facilitating use in others. Federal agencies, such as the Department of Health and Human Services, can assist in these discussions, as they have done with data policies concerning health information exchanges. In the end, governmental agencies may need to assume a direct role in acquiring data and licensing it for specific uses through data-use agreements if a regulated market cannot simultaneously facilitate positive use and restrict negative use. The First Circuit Court’s ruling urges physicians and policymakers to better define the benefits to society of various uses of health information going forward. Dr. Grande reports serving on the board of directors of the National Physicians Alliance and as an expert witness for the State of Vermont in a case concerning the commercial use of physician prescribing data. No other potential conflict of interest relevant to this article was reported.

DOI: 10.1056/NEJMp0900462

Cite this paper

@article{Lee2009CABGVS, title={CABG vs. stenting--clinical implications of the SYNTAX trial.}, author={Thomas H. Lee and Leslie David Hillis and Elizabeth G. Nabel}, journal={The New England journal of medicine}, year={2009}, volume={360 8}, pages={e10} }