The DOD Searched the Chart and Built a Target List | 2 Minute Drill with Drex DeFord
Apple Podcasts
Questions Answered in This Episode
- Who can run a population-wide query by diagnosis code in your shop, and who has to sign off before they do it?
- If somebody asked for a list of every patient with a specific condition, would anybody stop and ask why?
- Do your patients and your own people trust that what they tell a clinician is used for care and will not be used against them?
About This Episode
Army Major Kara Corcoran wears a Ranger tab and two Afghanistan tours. This summer she sat in a separation board five days short of 18 years. The board was not there to weigh her combat record. It was there for one line in her medical record. On July 31, an internal Air Force email said the Secretary of Defense's office had identified service members who may have a current diagnosis or history of, or exhibit symptoms consistent with, gender dysphoria in their electronic healthcare record. The DOD ran a population-wide search of the military EHR, about 9.5 million people, by diagnosis codes, prescriptions, counseling notes, and Tricare-billed civilian care. Over about two months that search outed several hundred active duty and reserve members, academy cadets, and ROTC. One military justice attorney is getting about 25 calls a week from people facing involuntary separation. Data handed over to get care became a target list.
In this Two Minute Drill, Drex DeFord asks the question hospitals should be asking now: who can run a population-wide query by diagnosis code in your shop, and who has to sign off before they do it?
Remember, Stay a Little Paranoid.
Thank You to Our Episode Partner
Transcript
This transcript was generated with AI and may contain errors.
The DOD Searched the Chart and Built a Target List | 2 Minute Drill with Drex DeFord
[00:00:01] Drex: Hey everyone, I'm Drex, and this is the Two Minute Drill, thanks to Fortified Health Security for sponsoring the podcast. It's great to see you today. Here's some stuff you might want to know about. Let me tell you the story about the privacy that's being stolen from Kara Corcoran and hundreds of other U.S. military members.
[00:00:20] Drex: Kara's an Army major. She wears the Ranger tab, two tours in Afghanistan, where she led an infantry platoon in combat. By any measure, she's the kind of officer that the Army spends years building. This summer, she sat in a separation board hearing. She was five days short of 18 years of service.
[00:00:41] Drex: That's kind of the doorway to retirement, and the healthcare benefits and retirement pay that she needs to support her two daughters. The board wasn't there to weigh her combat record or her duty performance record. They were there to weigh in on one line in her medical record. So how does something that you told a doctor in confidence and recorded in an electronic health record end up in a military separation packet?
[00:01:13] Drex: One system, military's electronic health record, covers about nine and a half million people, active duty families, retirees. But on July 31st, an internal Air Force email spelled it out. The Secretary of Defense's office had identified service members who, quote, may have current diagnosis or history of or exhibit symptoms consistent with gender dysphoria in their electronic health care record, end quote.
[00:01:43] Drex: Think about that. The DOD did a universal search designed specifically to find then persecute military members based on a specific diagnosis. The Secretary of Defense looked at diagnosis codes, prescriptions, counseling notes, civilian care billed through Tricare, in some cases even records from before the person had even enlisted.
[00:02:09] Drex: Over about two months, that search outed several hundred active duty members and reserve members, cadets at the service academies, military members in ROTC. One military justice attorney says that she's now getting about 25 calls a week from people facing involuntary separation. Data that people handed over to get care quietly turned into a target list and now openly weaponized.
[00:02:37] Drex: I spent 20 years in the service, medical service corps officer, two trips to combat zones. I was the CIO in military facilities, large and small. I was the CIO for one of the Air Force's largest regions. And I have to say, I'm shocked to see how the military's electronic health record is being abused in all of this.
[00:03:00] Drex: These are service members making a private call about what to disclose to their doctors. And this is their institution, their employer, the Secretary of Defense, reaching into the electronic health record and pulling people out by the exact condition they went in to be treated for and then kicking them out of the service because of that condition.
[00:03:25] Drex: This isn't a fitness for duty decision. These are troops that perform at the top of the mission, combat veterans, real leaders. This is plain and simple, the misuse of an electronic health record using treatment and counseling data to go after their own people, not based on performance, but based on their prejudice, going after people like Army Ranger Kara Corcoran.
[00:03:51] Drex: So if you run a health care system, don't file this under a military problem. The machine is the same. The same query that finds every diabetic patient overdue for an eye exam can be used to build a roster of everyone carrying a diagnosis. Somebody like the government decides they don't like.
[00:04:11] Drex: The EHR doesn't judge the request. It trusts whoever holds the keys. And there's a second cost. And it's even worse for care because when people believe their chart can be used against them, they stop telling the truth in the exam room or they skip the visit altogether. The patient who won't tell you the truth is a patient that you can't keep safe.
[00:04:33] Drex: So here's a few questions before you head back into your day. Who can run a population wide query by diagnosis code in your shop and who has to sign off on that before they do it? And if somebody asked for a list of every patient with a specific condition, would anybody stop and ask why?
[00:04:54] Drex: And do your patients and your own people trust that what they tell a clinician is used for care and that it won't be used against them at some point down the road? That's it for today's two-minute drill. Drop me a note. Let me know what you're working on. I'm always happy to hear from you. I'm Drex at 229project.com.
[00:05:14] Drex: And thanks again to Fortified Health Security for sponsoring the two-minute drill. And thank you for being here. Stay a little paranoid and I will see you around campus.
