The Rising Public Health Leviathan: How Medical Records Are Poised to Create an American Social Credit System
The health data infrastructure being built now is on track to turn your ID, and eventually your face, into a social credit document and vaccine passport. You won't be able to opt out of the system.
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Many people speculate about how a social credit system could be foisted upon a wary American public. Some say it will creep in through the financial services industry as a natural extension of credit and consumer scores, or filter down to individuals from corporate ESG (Environmental, Social, and Governance) scores. Others envision a social-media-driven system straight out of Black Mirror.
I don’t think any of those are the top candidate.
Your medical records are.
If you want a system for maintaining a detailed file on every individual in the United States, and using it to distribute benefits and services, impose restrictions, and enforce punishments, the health information system that’s being built now is the clear choice. In terms of reach, comprehensiveness, legality, and cultural compatibility, nothing else comes close.
As I explained in my last article in this series, every American’s “medical records” can contain far more than just medical information—far more than most people realize. (If you missed the earlier articles in this series, I recommend starting from the beginning to get up to speed on social determinants of health and data network infrastructure.)
Just as paper medical records have been digitized into electronic medical records (EMRs) kept by individual medical practices, EMRs are being transformed into electronic health records (EHRs) that can include much more extensive information and be shared across vast networks. Right now, everyone’s records are stored in a patchwork of disconnected EMR databases and regional EHR networks.
State-level projects like New York’s SHIN-NY modernization are quickly connecting all of the databases where records are stored to create statewide EHR networks. When that effort has been completed, national and international networks will be possible, making an extremely detailed personal profile of you available any time, anywhere to whoever has the legal authority to access it.
We are at the beginning of a new era of Big Health Data. We’re in the equivalent of the Friendster/MySpace period of social media, before Facebook and the social data economy took off. We’re in 2005, when everyone was tapping away on tiny Blackberry keyboards and snapping VGA photos on their Nokia flip phones—while the mobile data infrastructure and iOS platform were being built to make the iPhone app universe possible.
Big Health Data and its pervasive health information network promise to be similarly transformative.
Their potential benefits shouldn’t be underestimated. Having a massive pool of health data and AI tools to analyze it will surely lead to new cures and treatments. You’ll have better access to your own medical records and the personal information collected about you through apps and online portals. And giving health professionals instant access to up-to-date records promises to reduce medical errors. More integrated medical and social service information could also truly be used to help people in need more efficiently and effectively.
Those are some of the upsides.
This article is about the potential downsides.
It’s about what can happen when powerful new technologies and thousands of well-intentioned public health workers come together to create a complex new infrastructure. There are three factors that will make the new health information system so powerful:
Convergence: the integration of our health care, social services, and public health systems
Expansion: the inclusion of data on every aspect of an individual’s life in electronic health records
Accessibility: the transformation of a patchwork of separate medical record databases into a fully interoperable health information network that is accessible everywhere to authorized users
We’re entering a new world of digital-native ICD-11 data encoding, FHIR- and TEFCA-driven pervasive interoperability, rich SDOH and biometric data collection, AI medical scribes, and QR credentialing. If that all sounds like a foreign language to you, read on. This article, and the rest of this series, will break down the jargon into plain language and give you insight into what the EHR era will mean for you.
The new health information infrastructure will have the power to transform our society and each of our lives. We, the public, should be included in the public health discussion about how it will be used.
Here are the details I’ll get into in the rest of this article:
What Is a Social Credit System Anyway?
Your Social Credit User Experience
The Legal Leverage of Public Health
De-identification Is Bunk
Health: The Path to American Cultural Acceptance