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You Decide!
[By D. Kellus Pruitt DDS]
Yesterday, Don Fluckinger, Features Writer for SearchhealthIT, posted “Blumenthal: Building national health network could take decades”
“When Dr. David Blumenthal was national health IT coordinator, he focused on 2015, the HITECH Act’s original target date for meeting meaningful use criteria. Now that he’s back in civilian life, he’s taking a longer view of the initiative to create a national health network triggered by the HITECH Act’s cash incentives to physicians and hospitals using electronic health record (EHR) systems.”
Even though Fluckinger assures us that post-ONC, Blumenthal is still a “HITECH Act champion,” I’m not so sure. Perhaps in spirit only!
A Multi-Decade Project?
Last week, Dr. Blumenthal was the keynote speaker at the Massachusetts annual health IT conference. According to Fluckinger, he told the audience that building a secure, national, interoperable health information system “was always going to be a multi-year, maybe even multi-decade project.” That’s not what I remember. I remember being told that if I didn’t purchase a network-ready EHR for my dental practice by 2014, I wouldn’t be paid by insurance companies.
What Happened?
So, what happened to President Bush’s 2004 Executive Order of “interoperability (even with dentists) by 2014”? Is it too soon to say that he failed? So who is going to tell the thousands of HIT stakeholders who have been attracted by the smell of stimulus billions? Blumenthal?
Assessment
I can only imagine that now that Dr. Blumenthal left his job as head of the ONC for a new job as a health policy professor at Harvard School of Public Health, the openness of life outside government makes him uncomfortable with the lame talking points he once pushed as part of his job, without cracking a smile.
Conclusion
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Filed under: Information Technology, Pruitt's Platform | Tagged: ACA, ARRA, Darrell Pruitt DDS, David Blumenthal, Don Fluckinger, EHRs, EMRs, health information technology, HI-TECH, HIT |
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Physicians Say IT Is Still the Enemy
Darrell – Understanding the difference between how academic and community physicians think can foster more productive relationships–and perhaps less tension.
http://www.informationweek.com/news/healthcare/clinical-systems/229502444
Sam
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If prevention of disease is a valid healthcare strategy then face time with patients is the under-rated art of medicine that can never be improved with an algorithm.
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HHS gets Rep. Ellmers’ attention
A few days ago, Joseph Goedert, writing for HealthDataManagement posted “House Rep. to HHS: Study Benefits, Cost & Safety of HIT – Rep. Renee Ellmers, (R-NC) has asked HHS Secretary Kathleen Sebelius to consider studying the benefits, cost and safety of health I.T. systems, including electronic health records.”
http://www.healthdatamanagement.com/news/hit-ehr-safety-congress-ellmers-42986-1.html
Ellmers: “One of the frequently mentioned benefits of health IT has been a reduction in medical errors. However, recent news reports have noted incidents of health IT errors. An article in Sunday’s Pittsburgh Post-Gazette cited a baby who was killed when computerized IV equipment prepared a lethal dose of an intravenous sodium chloride solution. The machine did not catch the pharmacy technician’s error. The article also noted that when a hepatitis C-positive kidney was accidentally transplanted from a live donor into a recipient, the physician team missed the electronic health records alert, and the physicians complained that their electronic records system is cumbersome and difficult to adjust to any one physician’s needs.”
Over the last five years, the mandate-driven EHR industry has soaked up billions of tax dollars our grandchildren couldn’t afford to spend. Nevertheless, unresponsive software vendors in the nation continue to churn out cumbersome, dangerous products which offer no hope of return on investment for the physicians, much less dentists. In fact, EMRs are so lousy that without government subsidies, physicians just won’t purchase them. And since the business of dentistry is so simple, it’s not hard to understand how poorly complicated EHRs fit dental patients’ needs. I have always maintained that HIPAA will become a national embarrassment for HHS through dentistry first.
It took Rep. Ellmers a while to notice, but the low-flying HITECH absurdity has finally attracted Congress’ attention. Who would have predicted that billions of dollars could attract so many damned parasites to dentalcare. How can we possibly get out of this mess?
If we could just figure out a way to keep our patients’ Protected Health Information out of our digital records and stakeholders out of our operatories, dentistry would be safer for dentists as well as patients.
D. Kellus Pruitt DDS
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Jim Pyles responds
To: Darrell
Yesterday, I mentioned that Rep. Renee Ellmers, (R-NC) has asked HHS Secretary Kathleen Sebelius to consider studying the benefits, cost and safety of health I.T. systems, including electronic health records.
I suggested that it took Rep. Ellmers a while to notice, but HITECH’s failure has finally attracted Congress’ attention.
Privacy attorney Jim Pyles responds:
——-
RE: HHS gets Rep. Ellmers’ attention
Darrell,
The bar has to be set higher than this. The HITECH Act was enacted based upon flawed interpretations by some (and they know who they are) that studies by the Institute of Medicine and the RAND Corp found that health IT would reduce deaths by 100,000 per year and reduce healthcare costs by $77 billion a year. Has it done that? Shouldn’t Congress ask whether that is happening since it was on that basis that the money was to be spent?
There is a provision in the HITECH Act that some of us insisted be included which provides that “not later than 5 years after the date of enactment” the Government Accountability Office is to report to Congress and HHS on “the impact of any of the provisions of this Act on health insurance premiums, overall health care costs, adoption of electronic health records by providers, and reduction in medical errors and other quality improvements.” See HITECH Act at section 13424(e). So GAO could make that report NOW and later. The HIPAA Privacy Rule was estimated to cost $18 billion over the ten year period 2003-2012. 65 Fed. Reg. at 82,760/2. The incentives in the HITECH Act were estimated to cost $32.7 billion in Medicare and Medicaid dollars between 2009 and 2019. The Health Information Technology for Economic and Clinical Health (HITECH) Act, Congressional Research Service, p. 2 (Feb. 23, 2009).
Both of these costs were to be offset by the “benefits” of HIT in terms of people seeking more preventive care and treatment and reduced errors. Did it, or have we simply diverted health care dollars we do not have from treatment to expedite implementation of an HIT system that is not ready for prime time?
According to HHS, 11.5 million Americans have had their health information privacy breached in breaches involving 500 or more people between September 2009 and June of 2011. According to the Ponemon Institute, breaches are currently costing covered entities about $204 dollars per record. So, if my math is correct, health IT has added at least $2.3 billion in unexpected costs to the cost of health care in just two years and less than half of providers and even fewer practitioners have adopted such systems and even fewer of those systems are interoperable which, most agree, will render them even more likely to produce even more massive privacy breaches (and more costs). This does not count the thousands of electronic privacy breaches involving fewer than 500 individuals. Congress and the Congressional Budget Office work in 10 year budget horizons so it is likely that by 2019 we see breaches of the electronic health records of at least 58 million Americans adding at least $12 billion to the cost of health care. Since one’s health privacy cannot be restored once it is breached electronically (because one can get a different credit card or social security number but not different health care information), electronic breaches cause damage that is perpetual. So in just over 50 years, conservatively speaking, the health information privacy of every living American will have been breached electronically.
This suggests that the HITECH Act was not really cost reduction legislation, rather, it was a jobs bill, and it has created more jobs in the IT industry, but at the expense of practitioners and patients.
Hope this is helpful.
Jim
James C. Pyles, Principal
POWERS PYLES SUTTER & VERVILLE PC
1501 M Street NW, Seventh Floor | Washington, DC 20005-1700
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Cutting HIT waste
If Washington is serious about reducing spending, I know where they can save billions in waste.
Yesterday, the Center for Public Integrity posted “Top Health Information Technology Firms Prefer ‘Revolving Door’ Lobbyists” by Josh Israel.
http://www.huffingtonpost.com/the-center-for-public-integrity/top-health-information-te_b_933031.html
“It has long been a tradition for executive and legislative branch officials to take their Beltway know-how and Rolodexes to the private sector. But even by Washington standards, health information technology companies seem exceptional; fully 70 percent of registered lobbyists who worked for such firms on health IT issues in the past two quarters have passed through Washington’s infamous “revolving door,” an iWatch News analysis reveals ….”
Want to know why EHRs are so lousy that physicians have to be paid to purchase them? Just look who the software vendors have been trying to please. It’s not physicians, and it’s certainly not dentists who have no chance at the billions in stimulus money. EHR vendors market their dangerous and expensive products that won’t sell on their own merits to our elected officials who will never have to use the vendor-friendly garbage.
D. Kellus Pruitt DDS
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De-identification
According to the speed, direction and determination of the HIT industry, here’s the end of the road for interoperability in my estimate: Within a year, HITECH goals will be indefinitely shelved following one or two well-publicized HIT disasters – such as a cyber attack that instantly deletes millions of EHRs, or a brutal death caused by hacked software that controls movements of a surgical robot, or perhaps anaphylactic shock in an emergency room blamed on bad information in a co-mingled EHR. Americans are just a news story away from losing trust in all technological progress in healthcare involving the internet. And that unfortunate loss could easily last a generation. It’s hard for me to become giddy about what I see as certain failure.
Nobody can deny that security is a strict prerequisite to the benefits you, me and everyone wants from interoperable EHRs. Yet security problems are attracting more and more attention. Just today, I read Alicia Caramenco’s FierceHealthcare article, “Emory Healthcare loses records for 315K patients, including CEO’s.”
http://www.fiercehealthcare.com/story/emory-healthcare-loses-records-315k-patients-including-ceos/2012-04-20?utm_medium=nl&utm_source=internal
I bet that doubly pisses off the CEO, don’t you?
Even though de-identification isn’t feasible for protecting the security of CEOs’ medical records, the nature of dental records make them perfect for the science. Software developed years ago for forensic dentistry called WinID allows a nameless chart to be reconciled with its rightful owner within minutes with more certainty than a fingerprint. All a dentist has to do to provide patients more foolproof security than encryption is to resist storing their identities on computers. How difficult can that be?
I believe if a small number of dental communities were given the OK by HHS to freely exchange de-identified dental records without running afoul of the HIPAA Rule, the pleasing results from the interoperability would stimulate renewed thought on ways to make all medical records safer.
Besides, what could it hurt? Between 2010 and 2011 the frequency of breaches of patients’ identities from healthcare organizations doubled, and last I heard, they are expected to double again in 2012.
Wouldn’t that be rich if dentists could show Healthcare IT experts a safer road to follow?
D. Kellus Pruitt DDS
PS: I shared a few more thoughts about de-identification with my buddies at the Health IT LinkedIn group. I’m meeting less and less resistance, and the membership appears to be growing rapidly – perhaps in spite of my unpopular opinions.
http://www.linkedin.com/groupAnswers?viewQuestionAndAnswers=&discussionID=104202753&gid=3993178&commentID=77512115&goback=&trk=NUS_DIG_DISC_Q-ucg_mr#commentID_77512115
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PROVIDERS AND BUSINESS ASSOCIATES MUST HAVE MODIFIED BUSINESS ASSOCIATE AGREEMENTS IN PLACE TO COMPLY WITH HITECH BY TUESDAY, SEPTEMBER 23, 2014
As a reminder, next Tuesday, September 23, 2014 is the deadline for providers and business associates to have their business associate agreements modified and executed in order to comply with the new regulations that were promulgated last year under the Health Information Technology for Economic and Clinical Health Act (“HITECH”).
Garfunkel Wild PC
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Are you HIPAA ready, Doc?
[It’s sort of a hassle, is it not? Sort of scary too]
“United States: HIPAA Omnibus Rule: Deadline Approaching To Update Grandfathered Business Associate Agreements,” by Billee Lightvoet Ward, Dickinson Wright PLLC, September 18 2014.
“Although the HIPAA Omnibus Rule (the ‘Rule’) went into effect nearly 18 months ago, the transition period for bringing business associate agreements into compliance with the Rule’s new requirements will end on September 23, 2014. Business associates were directly regulated and responsible for complying with the Rule as of September 23, 2013, but the Rule provided for a one-year transition period for certain business associate agreements that were in place prior to January 25, 2013 (the date the Rule was published). As of September 23, 2014, all business associate agreements must reflect the Rule’s new requirements. Those requirements include the following:
– Require that the business associate comply, and require its subcontractors to comply, with applicable requirements of the Security Rule;
– Require that the business associate ensure that its subcontractors agree to the same restrictions and conditions that apply to the business associate with respect to protected health information;
– Require that the business associate report breaches of unsecured protected health information to the covered entity;
– If the business associate carries out a covered entity’s obligation under the Privacy Rule, require that the business associate comply with the Privacy Rule requirements that apply to the performance of such obligation; and
– Require the business associate take steps to cure or end the violation (or terminate the relationship) if it knows of a pattern of activity or practice of its subcontractor that constitutes a material breach of the subcontractor’s obligations.”
More at: http://www.mondaq.com/unitedstates/x/340932/Healthcare/HIPAA+Omnibus+Rule+Deadline+Approaching+To+Update+Grandfathered+Business+Associate+Agreements
Hey, MINNESOTA DENTISTS: The paper dental records which your state lawmakers outlawed – taking effect in less than 4 months – are looking better all the time. So was that a smart move after all? I think you’ve been had.
D. Kellus Pruitt DDS
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