RFID Tags for Nurses, then Everybody?
posted by Frank Pasquale
As an opinion piece by Theresa Brown explains, maintaining proper staffing levels in hospitals is becoming increasingly difficult. Surveillance systems are offering one way to address the problem; work can be performed more intensively and efficiently as it is recorded and studied. But such monitoring has many troubling implications, according to Torin Monahan (in his excellent book, Surveillance in a Time of Insecurity):
The tracking of people [via Radio Frequency Identification Tags] represents a . . . mechanism of surveillance and social control in hospital settings. This includes the tagging of patients and hospital staff. . . . When administrators demand the tagging of nurses themselves, the level of surveillance can become oppressive. . . . [because nurses face] labor intensification, job insecurity, undesired scrutiny, and privacy loss. . . . To date, such efforts at top-down micromanagement of staff by means of RFID have met with resistance. . . . One desired feature for nurses and others is an ‘off’ switch on each RFID badge so that they can take breaks without subjecting themselves to remote tracking. (122)
Like the “nannycam” employed by many a wary parent, the nurse-cam may be seen as a way to protect vulnerable patients (and perhaps increase the accuracy of evidence in malpractice cases). On the other hand, inserting a watchful electronic eye to monitor what is already an extremely stressful job may create many unintended consequences, or deter people from going into nursing altogether. Even advocates of pervasive surveillance recognize these difficulties.
The increasing pressure to monitor what happens inside hospitals reminds me of a recent article by Thomas Goetz in Wired (no link yet) on Google co-founder Sergey Brin’s quest to find a cure for Parkinson’s disease. As Goetz describes it, a new form of “high-speed science” depends on rapid accumulation of as much data as possible:
In Brin’s way of thinking, each of our lives is a potential contribution to scientific insight. We all go about our days, making choices, eating things, taking medications, doing things—generating what is inelegantly called data exhaust. . . . With contemporary computing power, that data can be tracked and analyzed. “Any experience that we have or drug that we may take, all those things are individual pieces of information. Individually, they’re worthless, they’re anecdotal. But taken together they can be very powerful.” In computer science, the process of mining such large data sets for useful associations is known as a market-basket analysis.
Goetz has promoted this as a new way to “do science in the petabyte age.”
I had a few responses to these ideas.
On the one hand, I do support methods to make electronic health records, once properly anonymized, a foundation for good medical research. But we do need to recognize what Paul Ohm has demonstrated in his recent work: there is an inverse relationship between anonymization and utility for a broad range of data. To use just one example—there may not be that many 6’7″ individuals in a given zip code, but tagging records from such individuals with their height may be a key part of solving certain medical puzzles that researchers are looking at. We can either “cleanse” the data of height information in order to help anonymize the tall (and thus frustrate some research), or we can leave it in and possibly compromise the identity of the tall individuals who are possibly identified by it. Having recently spoken to an epigenetics researcher who aspired to track all aspects of the life of a certain group of individuals, I have a sense the latter path is going to be taken more often in the future.
Second, on a cultural level, there is a gradual melding of surveillance programs with a) what Daniel Callahan calls the “research imperative” and b) the rhetoric of war. Nobel Laureate Joshua Lederberg expressed the research imperative in its purest form when he said, “The blood of those who will die if biomedical research is not pursued will be upon the hands of those who don’t do it.” Privacy advocates will need to find equally pithy and dramatic encapsulations of their values if the research imperative is not to run roughshod over extant privacy rights.
Related “war rhetoric” was thoughtfully debated at an Intelligence Squared debate on cyberwar that included Jonathan Zittrain and Bruce Schneier. Your attitude toward military access to internet communications depends a lot on whether you think a disruption of the network will result in mere inconvenience or, say, the collapse of the banking system. When the specter of death or war is invoked, it is difficult for advocates or privacy or workplace autonomy to promote values of comparable importance. However, they can at least try to clarify exactly what interests are motivating the promotion of certain programs of surveillance.
Photo Credit: Glutnix.
June 22, 2010 at 9:54 pm
Posted in: Cyberlaw, Economic Analysis of Law, Google & Search Engines, Health Law, Privacy, Privacy (Electronic Surveillance), Privacy (Medical), Technology
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Responses (5)
Ken Rhodes - June 22, 2010 at 10:38 pm
I am about to sound like Scrooge. Well, so be it …
When my employee is on my clock, earning my dollars for doing my work, I am entitled to know where he is, what he is doing, how efficiently he is doing it, and how effectively. And if he isn’t doing it, I darn well want to know why.
To conflate this simple rule of business with the important issue of PERSONAL privacy is suspect, and makes one ask why.
Frank Pasquale - June 23, 2010 at 8:53 am
Ken, I think that point of view makes sense in many employment contexts. But I do have some worries about it in health care. The nurse is an agent with many principals; the patient, doctors s/he works with, the hospital as employer, possibly a nurse’s union, etc. These principals have conflicting interests; for example, any one patient may want constant attention, but the hospital can’t afford that. I think that what makes the situation bearable is some degree of autonomy in juggling these multiple roles. But I could be wrong on that and welcome alternative views.
Ken Rhodes - June 23, 2010 at 11:26 pm
Frank, I absolutely 100.0% agree with your assessment of the complexities of the nurses workload and frequently conflicting priorities, and the necessity for each nurse to have a high degree of autonomy in allocating their most precious resource–their time.
However, I see no disconnect between that and the need for the hospital administrator to know what his doctors, nurses, and support staff are doing, what their conflicts are, and how yesterdays decisions and policies are impacting his people.
“You can’t manage what you can’t measure” was never more true than in personnel management.
seth edenbaum - June 29, 2010 at 2:05 am
“The blood of those who will die if biomedical research is not pursued will be upon the hands of those who don’t do it.”
So anyone who is not employed in the role of maintaining human life is a criminal. That includes architects and scientists at NASA, zookeepers and literature professors. Studying lizards in the rain forest? For medicinal herbs? If not, quit. Pure mathematics? a waste of time. Lawyers we need prosecutors and specialists in medical patent law And if you’re not in the top 2 percent perhaps you should find something more useful to do. Anyone with free should volunteer for blood donations and drug studies. If you need to sleep than do sleep study. We have to find a cure for that too. We waste a third of our lives asleep and think of how many we could be saving.
It’s war communism in the war for human betterment. It’s Stalinism for the good of the race. It’s obscene.
Is that pithy enough for you? It should be obvious..
seth edenbaum - June 29, 2010 at 2:11 am
Too many typos but I made my point. Productivism is anti-democratic and anti-social. It doesn’t matter what the product is.
War is not a valid model for general human organization. It’s called fascism.
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