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The eEHR Privacy Debate Continues
[By Staff Reporters]
According to our colleague Richard Mata; MD, MIS, writing in the premium print-journal Healthcare Organizations [Financial Management Strategies], a critical feature of any healthcare information system [HIS] is compliance with privacy requirements. Of course, the most important compliance regulation is the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
The key here is to have computer systems, terminals, workstations, servers and hand-held systems fully in communication with each other — including the ability to send data outside the fire-walls of the institution; interoperability as needed — while ensuring the confidentiality of protected health information (PHI), which is health information where the person to whom it belongs is identifiable
Federal Privacy Regulations
The federal government required hospital and healthcare entity compliance with HIPAA security regulations since April 2005. Briefly, the following are features of HIPAA which concern HIS:
· HIPAA presents a unique opportunity for automation of information since it is easier to protect secure information electronically as compared to having a paper chart that can be lost or open in front of patients and visitors.
· Secure password protection must be in place at multiple levels to ensure that access to PHI is restricted to those who need the information at that time.
· Appropriate encryption of data is essential for transmission between systems in order to prevent the interception of data.
National Spotlight
Yet, in this video clip, CNN’s Campbell Brown and Elizabeth Cohen examined how easy it is for someone to obtain private medical information online by simply using someone’s Social Security number and date of birth www.HealthDictionarySeries.com
Assessment
Whenever the subject of proliferating eHRs catches the national spotlight, you can bet that debates about privacy aren’t far behind. Indeed the privacy issue has already started to gain some traction in the media with the above video, and more.
Conclusion
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Filed under: Health Law & Policy, Information Technology, Professional Liability, Risk Management, Videos | Tagged: Campbell Brown, CNN, EHRs, Elizabeth Cohen, EMRs, health information technology, HIPAA, HIS, PHI, protected health information, Richard Mata |
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At Last! Truth about eHRs
An article called “Bad Bet on Medical Records” was posted on washingtonpost.com today.
Link: http://www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602618.html
For those who are enthusiastic about electronic dental records, it’s a kick in the teeth.
A person after my own heart named John Hamm posted selected quotes from the article on the DrBicuspid.com forum today.
Link: http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=301541
It looks like he is trying to bait emotionally involved eDR cheerleaders with news about what evidently is their expensive and dangerous hobby. He’s such a stinker.
Personally, I don’t think he’ll get a response.
D. Kellus Pruitt DDS
—————————————
Bad Bet on Medical Records
By Stephen B. Soumerai
By Sumit R. Majumdar
Tuesday, March 17, 2009; Page A15
President Obama’s proposed health-care reforms include investing $50 billion over five years to promote health information technology. Most notably, paper medical records would be replaced with linked electronic records to try to improve quality of care and lower medical costs. The recently enacted stimulus package included $20 billion for health IT, and, indeed, the $50 billion the administration initially earmarked is almost twice the annual budget of the National Institutes of Health. Yet while this sort of reform has popular support, there is little evidence that currently available computerized systems will improve care. In short, it’s the wrong investment to make at this time.
The assumption underlying the proposed investment in health IT is that more and better clinical information will improve care and save money. It is true that computerized records in some settings might improve care, such as by preventing duplicative prescriptions, medical errors caused by illegible handwriting and even inappropriate treatments. But the benefits of health IT have been greatly exaggerated. Large, randomized controlled studies — the “gold standard” of evidence — in this country and Britain have found that electronic records with computerized decision support did not result in a single improvement in any measure of quality of care for patients with chronic conditions including heart disease and asthma. While computerized systems seek to reduce the overapplication or misuse of care, they do little to prompt greater and more widespread health-care practices that are known to be effective. Health IT has not been proven to save money. Moreover, personal financial ties have been found between some researchers and the companies that produce these systems, and as far back as 2005 studies have shown that health IT developers are about three times more likely to report “success” than evaluators who had no part in system development.
What’s more, evidence suggests that adoption of some computerized systems has not helped but harmed patients. After the Children’s Hospital of Pittsburgh added automated prescribing recommendations to a commercial electronic records system, the institution documented a more than threefold increase in the death rate among child patients. Another leading system contributed to more than 20 different types of medical errors.
There are thousands of small groups of physicians in the United States, the majority of which are not ready for this sea change of interconnected health information. The latest national survey, published in the New England Journal of Medicine, shows that only 4 percent of doctors have fully functional electronic records that can provide any kind of clinical recommendations. Health information technology is expensive, and government subsidies may not be sufficient to persuade doctors to use them. Studies in U.S. hospitals suggest that these systems can add a half-hour or more to a day for tasks such as electronic ordering, and the false alerts that systems sometimes send can desensitize doctors to legitimate clinical recommendations. Yet, as things stand, doctors who rightly worry about these problems and delay adoption of certain types of health IT solutions beyond 2014 will be penalized through lower Medicare reimbursements. No one benefits, and reform is likely to stall, or worse, if doctors are forced to adopt flawed or unproven health IT systems.
There are, of course, places where advances in health information technology may have modestly reduced medical errors. But most such improvements came under the very large, integrated systems such as those used by Kaiser Permanente and the Veterans Administration, or the national health plans in countries such as Denmark, Britain and Israel. In those countries, physicians are required and trained to use the national systems. That isn’t standard in the United States, where such large systems cover only a small fraction of patients.
In the near term, health IT systems are an expensive and still unproven technology for most physicians in the United States. Before moving ahead, the administration should first consider conducting well-controlled research on the cost-effectiveness of health IT in office practices, which are the bulk of the U.S. medical system. It should base any investments of taxpayer funds on solid evidence of benefit and safety. Finally, it should invest in proven but underused health programs that do not bankrupt the budget, such as physician and nurse-practitioner teams that help homebound elderly people avoid hospitalization and institutionalization.
For many chronically ill and vulnerable patients, it does not matter much whether their health records are digital or their prescriptions typed. Without patient access to clinicians and adequate health insurance that includes affordable drug coverage, a $50 billion investment in health information technology won’t do much for many Americans. These funds are needed elsewhere.
Stephen B. Soumerai is a professor of ambulatory care and prevention at Harvard Medical School.
Sumit R. Majumdar is an associate professor at the University of Alberta’s Department of Medicine.
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