Tag Archives: Electronic Health Records

Comment Period Open for HIPAA Rule Changes

Changes may be coming to HIPAA, now that the Department of Health and Human Services proposes to update everyone’s favorite privacy law.

©Yanik Chauvin/iStockphoto.com

Currently, under HIPAA (formally the Health Insurance Privacy and Accountablity Act), covered entities — doctors, hospitals, and the like — are required to track access to electronic health information but required not to disclose that information. Under the proposal, patients would be able to get a report detailing who has requested access to their health records.

Georgina Verdugo, director of the HHS Office of Civil Rights,  said these changes are an effort to ensure patient privacy.
“This proposed rule represents an important step in our continued efforts to promote accountability across the health care system, ensuring that providers properly safeguard private health information,” Ms.Verdugo said. “We need to protect peoples’ rights so that they know how their health information has been used or disclosed.”

But the feds still want to know what you think about the proposed changes — comments will be accepted at www.regulations.gov until Aug. 1 2011.

And tell us too:

—Frances Correa (@FMCReports on Twitter)

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Attestation: A New Milestone for the Medicare EHR Program

Starting today, physicians can begin submitting data to the Medicare program to qualify for thousands of dollars in bonus payments under the federal government’s new electronic health record incentive program. Physicians can attest to their use of EHRs through a new online portal set up by the Centers for Medicare and Medicaid Services.

The program, which was created under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 and officially launched in January of this year, gives doctors a chance to earn up to $44,000 over five years through the so-called meaningful use of EHRs. In their first year of participation, they can earn $18,000 for successfully reporting that they have complied with the government’s standards for using EHRs. Physicians have until the end of 2012 to report on 90 days of meaningful use and still get the full first-year incentive. After that, they must report on a full year of data.

Image via iStock.


Since April 18 is the first day that physicians are able to report to CMS, it’s something of an early test of the incentive program. The program has been touted by the administration as a way to finally close the gap in physician adoption of EHRs, but it’s unclear if the incentives will be enough to motivate a large number of doctors to make the switch from paper records. Interest in the program is high, but many doctors still have their doubts.

While $44,000 is a lot of money, health information technology experts say it’s unlikely to cover the cost of a new EHR system. Even if it did, the CMS payments come only after physicians have made the up-front investment of purchasing and implementing the EHR systems.

And cost isn’t the only factor. There’s also the hassle of switching over to a new system, which may or may not have the functionality necessary to make the office workflow any better. This a concern often voiced by certain subspecialists, who say that most EHRs on the market are geared toward primary care.

What’s your view on the new EHR incentive program? Take our poll and share your thoughts.

Check back with Notes from the Road in the coming months as we follow the progress of the EHR incentive program.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Health Policy, IMNG, Physician Reimbursement, Polls, Practice Trends, Primary care

Professionalism in the Digital Age

Image by Irwin Tan via Dreamstime (http://www.dreamstime.com)

Aside from the financial incentives for moving from paper to electronic health records (the federal government has pledged to help physicians to make the transition in 2011 with up to $44,000 in extra Medicare fees), the financial disincentives for not doing so (reduced Medicare payments beginning 2016), and the public policy argument that a paperless health information system will lead to lower-cost, higher-quality health care, a primary motivation for physicians to become “meaningful users” of electronic health records should be professionalism, Dr. David Blumenthal, National Coordinator for Health Information Technology, said in a plenary address at the annual meeting of the Society of General Internal Medicine in Minneapolis over the weekend.

“I believe that the proper use of information is a core competency of professionalism. I don’t think professionals can claim to be worthy of the licenses they’re granted and privileges they’re granted unless they know how to find information that’s relevant to their patients and use it in the most sophisticated way that’s available to them,” Dr. Blumenthal told the audience.

“Health information technology is the circulatory system for information in a health care system. In a very short time, it will be as commonly used as the stethoscope, electrocardiogram, and imaging of the chest and abdomen in internal medicine practice, and as routine as the scalpel and suture in surgery.” To be a technically competent medical professional in the 21st century, he contended, “you have to be able to manage it.”

—Diana Mahoney

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Filed under Health Policy, health reform, IMNG, Internal Medicine, Primary care, Uncategorized

Protecting Patients in the HIT World

Image via Flickr user southerntabitha by Creative Commons License.

Many electronic health records are equipped with alerts and other safety features, designed specifically to prevent the type of human errors that too often put patients at risk for injury. But the reality is that health information technology (HIT) has its own problems when it comes to patient safety. The Health Information Technology Policy Committee, which advises the federal government’s health IT czar, met earlier today to talk about some of the unique safety risks presented by HIT.

It turns out that only a small part of the problem is caused by faulty technology, said Paul Egerman, who co-chairs the Certification/ Adoption Workgroup for the HIT Policy Committee. While some problems do occur because of software bugs, those are generally easily fixed, provided they are discovered. Instead, the bulk of the problem comes from the complex interactions between people and technology, known as issues of usability. In other words, the technology can be working fine, but if the staff isn’t trained to use it or if using it makes their lives so miserable that they develop workarounds, bad things can happen.

This problem could become magnified as more physicians and hospitals adopt electronic health records with an eye on cashing in on government incentives for the use of the technology. These incentives begin in 2011. Mr. Egerman and his group put out preliminary recommendations for how to solve some of these potential patient safety issues. For starters, they suggest that all training and implementation for HIT devote some time to patient safety as well as how to report patient safety risks. They also want to focus on the near misses and potential hazards to try to prevent unsafe conditions before an error is made. They also called for establishing a national database where providers could report problems and the information could be rapidly disseminated to other institutions that might be doing something similarly risky.

Has health IT helped or hurt patient safety efforts in your institution? Let us know.

— Mary Ellen Schneider (on Twitter @MaryEllenNY)

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Filed under Family Medicine, Health Policy, IMNG, Internal Medicine, Practice Trends, Primary care

Whose Medical Record Is It Anyway?

From a federal advisory committee meeting in Washington, D.C.:

Photo courtesy Flickr Creative Commons user Fabian.Nikon

Courtesy Flickr Creative Commons user Fabian.Nikon

You’d think that a meeting of the federal Health Information Technology Standards Committee would be pretty dull, but actually, the discussions can get interesting. Such was the case on Oct. 14, when the panel discussed how much online access patients should have to their health records.

No one had a problem with patients having access to their diagnoses, lab results, and medication lists; those were no-brainers. A few panelists, such as Jamie Ferguson of Kaiser Permanente, also praised their organizations’ ability to allow patients to refill prescriptions online or have email exchanges with their physicians.

The interesting part of the discussion came when committee chair Jonathan Perlin, of the Hospital Corporation of America, asked whether panelists thought patients should have access to physician notes.

Panel vice-chair Dr. John Halamka of Harvard Medical School said that his organization’s definition of an online personal health record includes a problem list, medication list, allergies, lab results and other test results, but not the physician’s notes. He pointed out that HIPAA regulations permit patients to physically go to the facility’s medical records department and get their complete medical record. However, when his hospital launched its personal health record system,  “we tried to tell our physicians…. ‘We’re going to share every observation you made about the patient with the patient themselves,’ and there was some resistance,” he said. “If I said [in my notes], ‘I have just met with a slightly depressed obese man’ and the patient is now going to see that — that’s controversial.”

Linda Fischetti of the Department of Veterans Affairs (VA) said her agency releases health information electronically “in a way that repects the clinician’s role” in caring for the patient. For example, if a patient has a lab result that is abnormal, the VA will alert the physician — thus creating a delay — before releasing the record.

Judy Murphy of Aurora Health Care in Milwaukee, Wisc., said, “In terms of personal health records, we’ve been real selective in what we’ve been doing — we only [release] lab results and even then it’s at the specific discretion of the physician to release them.” But she added that releasing more information to patients “is where we need to be going if we’re really going to be patient-centric…. This is all about the patient, and we absolutely have to make sure we’re partnering with the patient and not seeing this as our data, but seeing it as data we’re working on together as a team.”

Physicians, how comfortable are you with sharing the electronic medical record? Where would you prefer to draw the line? Take our poll and let us know.

–Joyce Frieden (Twitter @joycefr)
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Hurry Up… and Wait

From the American Academy of Family Physicians Scientific Assembly in Boston.

There was an awful lot of frustration and confusion from the family physicians who turned out for a session at the AAFP meeting about the federal funds available for doctors who adopt health information technology.

Photo Courtesy of Flickr Creative Commons User phil_g

Photo Courtesy of Flickr Creative Commons User phil_g

It was late afternoon and by my count more than 70 doctors packed into the small conference room to hear the AAFP’s technology gurus outline the provisions in the American Recovery and Reinvestment Act–the stimulus law–that make funds available to doctors who successfully use electronic health record systems. But at the end of the presentation, some in the audience seemed more uncertain than ever. Family doctor Norah Walsh of Los Lunas, N.M., summed things up. The government expects physicians to have certified EHR systems up and running in their practices by 2011, but the standards for certification aren’t out yet and no one can say for sure which vendors will be able to offer certified systems. So what’s a doctor to do?

Dr. Walsh, who spent $50,000 on an EHR system in 2000 that was useless to her practice, said she’s not going to rush to buy anything. Right now she’s planning to investigate freely available EHR software.

Dr. David Kibbe, the senior advisor to the AAFP’s Center for Health Information Technology, said he’s confident that the standards will be published soon and that many vendors will rise to the challenge. But it could take several months or a year before the marketplace looks more stable. In the meantime, don’t rush into buying a system. Just do your homework, Dr. Kibbe advised.

But his colleague Dr. Steven Waldren, who runs the center, made things a little more complicated. He told physicians that the longer they wait, the more likely it is that they will choose a system that is certified and will qualify for federal incentive payments. But on the other hand, the longer they wait, the greater the chance that they won’t have implemented the system in time to get the federal funds. Do what is best for you and your practice, Dr. Waldren told attendees.

So what will you do? Are you planning to purchase an EHR in the next two years? Share your thoughts.

— Mary Ellen Schneider (Twitter @MaryEllenNY)

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Filed under Family Medicine, health reform, Practice Trends, Primary care