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Just what kind of questions will doctors ask for new electronic health records? Just what kind of questions will doctors ask for new electronic health records?

Just what kind of questions will doctors ask for new electronic health records?

Becky Bowers
By Becky Bowers September 19, 2013

Betsy McCaughey says on next doctor visit, ‘Obamacare will question your sex life’

"Obamacare will question your sex life," says a New York Post headline this week.

The opinion piece underneath, written by former lieutenant governor of New York Betsy McCaughey, author of Beating Obamacare, begins:

"‘Are you sexually active? If so, with one partner, multiple partners or same-sex partners?’

"Be ready to answer those questions and more the next time you go to the doctor, whether it’s the dermatologist or the cardiologist and no matter if the questions are unrelated to why you’re seeking medical help. And you can thank the Obama health law."

McCaughey then claims that the law offers incentive payments, and eventually penalties, to pressure doctors and hospitals to convert to electronic health records. She quotes a cardiologist saying sex questions are "insensitive, stupid and very intrusive" and a nephrologist declaring that new requirements turn your medical record "into an interrogation, and the data will not be confidential."

Readers sent us the op-ed and asked us to fact-check it. So does Obamacare require your dermatologist to ask you about your sex life?

‘Sex questions’

We talked with the Centers for Medicare & Medicaid Services, two members of a federal committee on health information technology, and the president of a national physicians group.

We reached out to McCaughey and the two doctors she quoted, but we didn’t hear back.

(The last time we rated a claim from McCaughey, it was her 2009 comment that the health care law would require mandatory counseling for Medicare patients "that will tell them how to end their life sooner" — a Pants on Fire falsehood.)

Here’s what we learned.

The federal government did create incentives and eventually penalties to encourage doctors and hospitals to make "meaningful use" of electronic health records. The government says the switch from paper will offer easier access to health records and data, provide reminders and alerts for doctors and patients, and reduce medical errors.

The change wasn’t part of Obamacare, though. And it doesn’t require any "sex questions" — except for whether you’re male or female. You might hear the words, "Are you sexually active?" from your doctor, but it wouldn’t have anything to do with the health care law.

In other words, McCaughey’s claim was utterly at odds with the evidence.

"Arrgghhh — now I have heard it all!" said Molly Cooke, president of the American College of Physicians.

Cooke, an internist, told PolitiFact that when she was in medical school in the 1970s, she was taught to ask:

• Are you sexually active (with other people)?

• If yes, are your partners men, women or both?

• If no, is that out of choice, because you don’t currently have an appealing partner, because you have no privacy, or some other reason?

• Are you happy with your sex life, however it is?

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"My classmates and I were taught to ask all patients all four questions," she said. "I am not saying that we always did it, but these questions are as old as the hills."

The rationale is that patients’ answers may reveal important information about their health, safety and well-being, she said. Her medical practice happens to focus on patients with HIV and other complex chronic illnesses.

But let’s say some doctors, such as the cardiologist quoted by McCaughey, find such questions "insensitive, stupid and very intrusive."

McCaughey wrote that the president’s "reforms" aim to "turn doctors into government agents, pressuring them financially to ask questions they consider inappropriate and unnecessary."

Yet that cardiologist could earn government incentives for meaningful use of electronic health records whether he asked "sex questions" or not.

‘Electronic health records’

We looked at the specifications ourselves.

The financial push toward electronic records came not from the Patient Protection and Affordable Care Act of 2010, commonly called Obamacare, but from the federal stimulus bill the year before — the American Recovery and Reinvestment Act of 2009.

In the first stage of the incentives program, paid through the Centers for Medicare & Medicaid Services, doctors must use electronic records to keep up with basics on their patients.

They need to check for drug interactions, keep an up-to-date list of diagnoses, transmit prescriptions, keep medication and allergy lists, and record demographics and vital signs. They need to note preferred language, gender, race, ethnicity, date of birth, height, weight, blood pressure, body mass index, smoking status.

The demographic information helps doctors catch disparities in care, said Paul Tang, an internist who chairs the workgroup on "meaningful use" for the health information technology committee created by the Recovery Act.

Just as with paper records, that information is protected by federal health privacy laws, such as HIPAA, and in some cases additional state law.

In the second stage, the requirements for doctors get more sophisticated, with provisions for electronic access for patients to their health information, ability to transmit data to immunization registries, and more. Some optional steps include entering electronic notes for at least 30 percent of the patients they see, and recording family health history as structured data.

There’s a requirement to protect electronic health information. But there aren’t any requirements to ask questions about sexual history.

That’s not to say they won’t be common: past medical history, family history and social history are fairly standard questions, and it would make sense for vendors of electronic health records systems to include them in their software.

But if McCaughey’s cardiologist didn’t want to ask, he could still collect government money for using the records.

What makes McCaughey’s claim even more bizarre is that it isn’t necessary to exaggerate concerns about electronic health records. There’s plenty of evidence-based debate about whether current privacy protections are enough in the new world of electronic records, and how to give patients a "meaningful choice."

A New York Civil Liberties Union report she mentions says current regulations don’t give patients enough control over sensitive health information. A recent blog post at the website of the journal Health Affairs discusses how to earn patient trust and get meaningful consent for participation in health information exchange organizations.

But the federal push toward electronic health records doesn’t require your doctor to grill you about your sex life.

Our ruling

McCaughey says in "Obamacare will question your sex life" that you can thank the president’s health law for questions about your sexual activity, even if your doctor finds them unnecessary.

She suggests it’s part of Obamacare’s move toward electronic health records. But incentives for electronic health records were part of the Recovery Act, not Obamacare. And they don’t require participating doctors to ask questions about your sex life.

McCaughey frames her concern for patient privacy with an evidence-free attack on Obamacare that veers toward the ridiculous. We call it Pants on Fire.

Our Sources

New York Post, "Obamacare will question your sex life," Sept. 15, 2013

Centers for Medicare and Medicaid Services, "EHR Incentive Programs," accessed Sept. 19, 2013

Centers for Medicare and Medicaid Services, "EHR Incentive Program: Eligible Professional Meaningful Use Table of Contents Core and Menu Set Objectives — Stage 1," accessed Sept. 19, 2013

Centers for Medicare and Medicaid Services, "Stage 2 — Eligible Professional (EP) Meaningful Use Core and Menu Measures Table of Contents," October 2012

White House, "More than Half of Doctors Now Use Electronic Health Records Thanks to Administration Policies," May 24, 2013

Centers for Medicare & Medicaid Services, "A RECORD OF PROGRESS ON HEALTH INFORMATION TECHNOLOGY," April 23, 2013

American Medical Association, "Medicare/Medicaid EHR Incentive Program," accessed Sept. 18, 2013

American College of Physicians, "American College of Physicians issues recommendations for Meaningful Use," Sept. 12, 2013, "Protecting the Privacy and Security of Your Health Information," accessed Sept. 18, 2013, "Your Health Information Privacy," accessed Sept. 18, 2013

Health Affairs, "Meaningful Consent In Electronic Health Information Exchange: A Technology-Centric Approach," Sept. 17, 2013

New York Civil Liberties Union, "New NYCLU Report Reveals Privacy Threats in Sharing of Electronic Health Records," March 6, 2012

PolitiFact, "McCaughey claims end-of-life counseling will be required for Medicare patients," July 23, 2009

Email interview with Rachel Maisler, press officer, Centers for Medicare & Medicaid Services, Sept. 18, 2013

Email interview with Molly Cooke, doctor of internal medicine, president, American College of Physicians, Sept. 18, 2013

Interview with Deven McGraw, director, Health Privacy Project at the Center for Democracy & Technology, member, Health Information Technology Policy Committee, Sept. 18, 2013

Email interview with Paul Tang, doctor of internal medicine, vice president and chief innovation and technology officer at the Palo Alto Medical Foundation, vice chair, Health Information Technology Policy Committee, Sept. 19, 2013

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