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Adolescent Data Needs Stronger EMR Protections, Group Says

The American Academy of Pediatrics is calling for changes to EMRs to protect the privacy of adolescent patients, whom, it says, don’t currently get the same level of protection as adults.

According to the AAP, there are several reasons adolescents don’t enjoy the same privacy protections as adults.

For one thing, there are the legal issues. HIPAA doesn’t provide specific guidance on adolescent privacy, and the medical industry hasn’t put clear standards in place outlining when adults can access an adolescent’s health records either.

What’s more, states vary in how they handle this issue, according to the AAP report. State laws typically allow minors to consent for their healthcare on the basis of their status — for example, if they’re a pregnant or parenting teen — and on the basis of the services they seek – such as STI diagnosis and treatment or contraception. However, while state and federal laws provide protection of privacy when minors consent for their own care, privacy protections differ widely.

To make sure adolescent privacy is protected across all data platforms, the AAP is recommending a set of principles that it feels should ideally govern not only EMRs, but also PHRs and HIEs. These include :

* Creation of a set of criteria for EMRs that meet adolescent privacy standards

* Creating and implementing technology for EMRs which would allow determination of who has access to, or ability to control access to, any part of the adolescent medical record.

* Making it possible for adolescents to record consents and authorizations according to privacy laws using the HL-7 Child Health Profile DC.1.3.3 standard

* Flexibility within standards to allow for protection of privacy for diagnoses, associated lab tests, problem lists and any other documentation containing confidential data.

* EMR systems must be able to apply state and federal confidentiality rules when assembling aggregate data to prevent identification of individuals.

The AAP has a lot more to say, but in summary, it seems to be putting the burden for protecting adolescent privacy largely on EMR vendors, though I believe it’s hoping members will advocate for these changes as well.

Either way, it doesn’t work well if there’s a protected class (certain adolescents) whose rights simply can’t be protected adequately with today’s technology. Time to get on this issue, I’d say.

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November 13, 2012 I Written By Anne Zieger

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Tags:AAP Adolescent Medical Records Adolescent Privacy American Academy of Pediatrics HIE HIPAA HL-7 Medical Privacy

Health Information Exchange

In an email response to my EMR and HIPAA post on HIE Waste, Edward Fotsch, M.D. and CEO of PDR Network offered these insights into the state and some history of Health Information Exchanges:

The fundamental question for HIEs is two-fold: 1) what is their purpose and 2) who benefits and will pay for them- the latter is a question of revenue model not grant funding which always runs out sooner or later. Relevant facts include:

1. HIEs are not a new concept. I was around when Community Health Information Networks; or CHINs (The ‘C’ in CHIN stands for communism where we all do the right thing because it’s for the good of the order) came and went. Then RHIOs came and went. Now HIEs. What these have in common is grant funding but generally no business model.

2. The idea of providers paying for the opportunity to share their patient (‘read “Client”) information with competitors is novel I must admit. But in the old days when I was seeing patients, when you sold your practice you largely sold your charts. It was the charts as much as anything else that kept patients coming to the new doctor after the sale- ‘it still works this way for many dentists. Now docs are supposed to pay for the privilege of having their charts opened to competitors? Now I know that the hospital execs all salute this flag when the discussion of HIEs occurs at the rubber chicken dinners. But when I was on the exec committee at a community based hospital we spent time trying to compete with, not empower, competing hospitals. You may say that is not right- but that’s a fact.

3. HIEs I’ve seen that have any hope serve a specific business purpose and often exist within an economic entity. Kaiser has a large HIE- they just don’t call it that.

4. Data exchange between competitors has worked in many venues- the obvious example is ATMs where competing banks collaborate. BUT this occurs because customers demand it. Unless or until patients/consumers begin to select healthcare providers who participate in some level (i.e. CCD-level sharing at least) of basic patient information exchange (i.e. refusing to go to providers who hand them a clipboard), the HIE concept is massively challenged. ‘Though it’s always fun right up until the grant funding runs out.

Massachusetts HIE Kicks Off With Golden Spikes

If you’re a history buff, you may know of the Golden Spike connecting the eastgoing and westgoing tracks of the First Transcontinental Railroad in 1869. It’s hard to overestimate how important that day was in the history of U.S. industry and transportation, despite the fact that it didn’t actually mark the day a seamless coast-to-coast rail network was completed.

This week, another big link-up was celebrated with ceremonial golden spikes, with some comparably high hopes attached. This one, however, was between disparate EMRs in Massachusetts, writes John Halamka, MD in Life As A Healthcare CIO:

Today we made history in the Commonwealth of Massachusetts. At 11:35am Governor Deval and his physician sent the Governor’s healthcare record from Massachusetts General Hospital to Baystate Medical Center. It arrived and was integrated into Baystate’s Cerner medical record.

Lots of other demonstrations followed, pingponging data from hospitals to payers to physicians to the Massachusetts eHealth Collaborative (which measures quality and performs data analytics).

Among the most interesting facts Dr. Halamka noted was the list of varied EMRs that shared data, including Partners Healthcare’s LMR, eClinicalWorks, a custom payer system and self-built analytics applications.

What took place was no less than a revolutionary event, suggested Dr. Halamka:

Within seconds, we broke down silos, demonstrating that care coordination, population health, and quality analytics based on healthcare information exchange is now possible in Massachusetts.

By the way, for those who haven’t crossed paths with the indefatigable Dr. Halamka, he’s Chief Information Officer of Beth Israel Deaconess Medical Center. So his institution is central to this new effort (of which he’s quite justifiably proud).

My question is just how this trick was pulled off. Did the participants use the CCD format, Direct Project protocols, discrete data or something else? Regardless of how the data’s being exchanged, it seems to me that the rest of the country should consider following suit.

Senators Join Initiative To Scrutinize Meaningful Use

A couple of weeks ago, four House GOP leaders wrote a letter to HHS head Katherine Sebelius demanding that she account for perceived failures in the Meaningful Use program.

The four congressmen had written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

Politics being what it is, the other shoe had to drop, and now a group of senators have offered their own objections.

Sens. John Thune and Dr. Tom Coburn of the Finance Committee, and Richard Burr and Pat Roberts of the Health, Education, Labor and Pensions Committee have formally requested that CMS and ONC staffers meet with the latter committee regarding the final rule for Stage 2 of Meaningul Use.

In a letter to HHS, the senators raise several questions:

* Do EMRs sometimes increase utilization of diagnostic tests, and if so, how should the government respond?

* Have some providers gotten subsidies for EMR systems they had in place prior to the kickoff of Meaningful Use? If so, what is HHS doing to claw back such payments and prevent future outlays of this kind?

* Has the use of EMRs boosted providers’ billing of Medicare, and thereby raised the cost of the program?

* What is HHS’s strategy for “meaningful interoperability”?

Interestingly, the senators’ letter stops short of demanding a halt on MU payments, which the congressmen did in no uncertain terms. But they’re clearly antsy about the future of the Meaningful Use program, which has paid out $6.6+ billion in incentives to date.

And you know what? It’s about time that Congress got interested in the future of EMRs and Meaningful Use specifically. Better to have them breathing down HHS’ neck now than further down the line when there’s far less opportunity to turn the MU battleship.

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October 23, 2012 I Written By Anne Zieger

Filed Under: Community Hospitals HIE HL7 Hospital EHR Hospital EMR Hospital Healthcare IT Meaningful Use

Tags:Healthcare Interoperability HIE Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Meaningful Use

The Dawn Of “Compliance As A Service”?

A few days ago, I posted a quick report on our EMRandHIPAA.com sister site discussing Verizon’s plans to offer a HIPAA-compliant cloud service.

Verizon, which has beefed up on security services over the past few years, seems to see its role as being compliance vendor rather than just a mere business associate. The carrier notes that not only does it offer super-secure data centers, it has trained staffers on HIPAA-specific data handling issues.

But Verizon obviously isn’t the only cloud vendor out there capable of offering HIPAA-compliant services. Could this be the dawn of CaaS (compliance as a service) for healthcare? (Others industries, like banking, are already well into this approach.)

According to reader Scott Gardner, who commented on the story, this concept has legs. “I’ve been pitching [Compliance As A Service] to cloud-based persistency vendors targeting mobility for some time,” writes Gardner, whose company Inyago focuses on private practice IT services via MacPractice. “Offering this service makes perfect sense, especially in private practice healthcare. And you get interoperability (core #14) right out of the box for all users on the platform.”

The burning question here, I suppose, is whether CIOs feel safe trusting outsiders with clinical data flow. Right now the answer seems to be “no.” As my colleague John noted in a related blog post, at present even those providers who are cloud users are more prone to access it for “commodity” services such as e-mail, file storage, videoconferencing and online learning, according to a CDW survey.

With providers needing interoperability under Meaningful Use Stage 2, the landscape may change, however. Whether or not they’re terribly comfortable with Verizon and its rivals, CIOs might find it easier to delegate compliance than cope with the difficulties of build-your-own-interoperability schemes. So perhaps CaaS really does have a chance at achieving rapid uptake — unless someone invents the insta-install HIE!

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October 5, 2012 I Written By Anne Zieger

Filed Under: Cloud EHR Healthcare CIO HIE Hospital CIO Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems Mid-Size Hospitals Mobile Technology

Tags:HIE HIPAA HIPAA-Compliant Cloud Hospital EHR Hospital Electronic Health Records Hospital Electronic Medical Records Hospital EMR Verizon

Providers Behind The Eight Ball On HIEs

ONCHIT is demanding them. Patients are beginning to understand them. But poor ol’ beleaguered HIEs still aren’t getting the attention they deserve, it seems.

A new survey by patient care organization ECRI Institute, done with strategic partner s2a, has concluded that while they understand the importance of HIEs, only 54 percent of providers have formally assessed their HIE and interoperability needs. (See the study here.)

Given the speed at which Meaningful Use data exchange requirements are barreling down on providers, that seems like a pretty low number to me. After all, the final rule for MU Stage 2 requires providers to at least be able to electronically transmit a Summary care record using a certified EMR system or HIE for 10 percent or more of care transitions and referrals.

It’s also a pretty low number given that 93 percent of hospitals surveyed agreed that interoperability of health systems was one of their top strategic priorities. Provider CIOs are well aware that getting HIE connectivity in play is a long and difficult process, and while they can’t do everything at once, one would assume that most providers would have a team in place to at least begin the assessments by this point.

The ECRI analysts conclude that two major factors are holding providers back:

* Working with non-employed physicians: For the moment, hospitals are focused largely on interoperability with their employed physicians, who typically use the same EMR as the facility does. Working with non-employed physicians is a major challenge for many reasons, including that they typically aren’t using the same EMR as the hospital. There’s also legal issues that come into play: for example, what happens is non-employeds end up sharing data intended for Hospital B with Hospital A?

* Medical device connectivity: Meaningful Use is putting great pressure on hospitals to exchange information between medical devices and EMRs. However, interoperability even between a blood pressure cuff and and EMR is no picnic. ECRI found that 40 percent of respondents hadn’t established policies and procedures for EMR interoperability with medical devices.

Of course, the sheer work and expense involved in becoming an HIE participant is immense, as well. Given those expenses, time demands, and the issues in connecting with physicians, I have to believe that a fair number of hospitals won’t be ready when Meaningful Use Stage 2 requirements hit.

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October 4, 2012 I Written By Anne Zieger

Filed Under: Community Hospitals HIE HIE Vendor Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT Hospital IT Systems Meaningful Use Medical Devices

Tags:ECRI Institute HIE Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Medical Device Connectivity

Study Suggests Most HIEs Aren’t Sustainable

According to an EHR Intelligence piece, most HIEs spend more than $1 million per year on operational expenses. That number is probably well on the low end for regional HIEs with multiple health system partners. All told, I think we can agree we’re talking about a money pit here.

The question is, and has been for many years, whether those investments offer any financial or clinical payback. After all, you can only lay out that kind of money for so long before there’s no business case for the exchange.

Unfortunately, it looks like the answer may still be “no” in many cases, according to the authors of a study appearing in Perspectives in Health Information Management. Of the 96 HIEs that responded to the researchers’ survey, the “vast majority” didn’t have a business model in place that would sustain itself even into the near future.

What’s worse, there’s little evidence that things are due to change anytime soon, the authors write: “The last decade has seen significant progress in HIE technologies and substantial investments in HIT adoption, yet the lack of evidence on the value delivered by such efforts remains a major hurdle in making a strong case for both adoption and investment at the local level.”

Even more troubling is the apparently lack of insight into this state of affairs by HIE leaders, the authors assert. When asked how they measured ROI, the authors apparently got very squishy answers, such as that they “believed” their HIE was showing positive ROI without having any metrics to make this case.

I don’t know about you, readers, but I’ve been following health data exchanges of various kinds since the early 1990s, and this is just depressing. If the government’s strategy in doling out some HITECH dollars to HIEs was to help build the core of the Nationwide Health Information Network, I think it’s pretty much proving to be a bust.

No, I’ll come out and say it: I think the government ought to pour massive funding into building out the NHIN and just get it over with without waiting for the politics and competing priorities of healthcare to gum up the works. At this point, I doubt anything else CAN work.

Largest Two Kansas Health Systems Take First HIE Steps

While the project still seems to be in its early days, the two largest health systems in Kansas have completed the first stage of connecting up to a common HIE. The two systems did so by joining forces with KHIN, an HIE which serves 130 hospitals and more than 4,500 physicians across the state.

The two systems — Via Christi Health Systems and HCA Wesley, both of Wichita — haven’t gone very far with the process. The two simply managed to transfer clinical data successfully into the KHIN production environment. The two systems prepared for a year to conduct the exchange, including a two-week final period during which both sides verified that patient data was coming into the system properly.

According to a report in HIEanswers.net, the implementation allows for interoperability across all certified EMR vendors in the network (would like to know more about that!) and had appropriate controls in place to let patients specify privacy preferences.

The next step for KHIN is to connect with the Lewis and Clark Health Information Exchange, a Missouri-based HIE which stretches into northern Kansas. The idea is to begin pushing data from one HIE to the other, broadening KHIN’s 83,000 square mile reach further.

As a veteran, cynical HIE watcher, I’d give this effort better chances than most. For one thing, it’s backed by the state medical society and state hospital association, which certainly never hurts. And if — a big if, I’d say — KHIN has somehow achieved interoperability between the varied EMRs on the network, they’re miles ahead of the game.

That being said, I smell a rat when it comes to the interoperability claims. If hospitals and clinics can’t connect slightly different installations of the same EMR, making a large handful of ambulatory and hospital-based EMRs talk to one another sounds rather unlikely. But as I’ve often said here, I suppose it’s a matter of “wait and see, folks.”

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August 23, 2012 I Written By Anne Zieger

Filed Under: HIE Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Hospital Healthcare IT IDN

Tags:HCA Health Information Exchange HIE Hospital EHR Hospital Electronic Health Record Hospital Electronic Medical Record Hospital EMR Via Christi

Is There Such A Thing As Too Much Patient Info Sharing?

Today, when I was skimming my tweetstream, I caught a message that stopped me dead in my tracks:

The ability to press one button and send a patient’s entire 600 page medical record to the new doctor belies the wisdom of doing so. #EMR

— John Trainer (@JohnTrainerMD) July 12, 2012

We spend a lot of time on these pages mulling over the best ways to get information from one provider to another, be it via the Direct Project approach, EMR integration across sites or HIEs. And all of this discussion is predicated on the notion that more sharing is largely a Very Good Thing.

And we have good reason to do so. For all of the bitterly skeptical things we can say about EMRs, in the rare cases where they’re humming like a fine ‘Vette they can improve care and avoid patient harm in a long list of ways. They can also serve as a repository for data which can be manipulated, studied, and learned from for both commercial and public health purposes.

But I had never taken a moment to stop and think how ease of sharing patient records might come with downsides of its own. I’m not sure which ones Dr. Trainer had in mind, but my guesses would be:

- HIPAA mistakes become much easier to make and much harder to fix, as data tends to stay where its sent.

- Clicking one button and sending 600 pages of information may be easier for the sending provider, but it may be far more data than needed, which can actually distract from finding the right information.

While security is of course a top priority for the business, making it simple for doctors to send just what’s needed isn’t at the top of the charts for EMR vendors to my knowledge. Maybe it should be.

UPMC Kicks Off Competitive HIE

The University of Pittsburgh Medical Center has kicked off a new HIE connecting its properties with other health systems in western Pennsylvania. The project, which should bring together access to more than 7 million patient records, goes into direct competition with that being launched by major state health insurer Highmark Inc.

UPMC’s HIE, ClinicalConnect, brings together its facilities with clinicians at Butler Health System, Heritage Valley Health System, Altoona Regional Health System, Armstrong County Memorial Hospital, Excela Health, Jefferson Regional Medical Center, St. Claire Hospital and Washington Hospital. While reports don’t describe how ClinicalConnect is being funded, you’ve gotta believe the $9 billion UPMC is fronting a lot of cash.

This move sets up an interesting competitive situation on the state, a fairly unusual one given that it’s built around an HIE.

Right now, UPMC is the 2,000 pound gorilla of western PA. Meanwhile, $14.6 billion Highmark is one of the dominant health insurers in the state. And now they’re going head to head on the HIE front. Mean ol’ Highmark has publicly announced its intention to build a system with UPMC’s bitter rival West Penn Allegheny Health, and as part of its plans, expects to launch a statewide HIE that could conceivably bypass UPMC’s regional effort.

When asked by a reporter whether the two HIEs can work together, their spokespeople basically said “Humph!” and denied that anyone cared about competition. Oh yeah, we definitely believe that.

What interests me about this hoo-haw is that it both organizations seem to see their HIE as critical to their delivery network development efforts. While it makes perfect sense, it hasn’t been a big theme in HIE discussions to date. (My sense is that most hospital CIOs have seen HIEs as plumbing rather than a value-add.)

Interesting stuff here. I’m eager to see what happens next.

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Adolescent Data Needs Stronger EMR Protections, Group Says

Health Information Exchange

Massachusetts HIE Kicks Off With Golden Spikes

Senators Join Initiative To Scrutinize Meaningful Use

The Dawn Of “Compliance As A Service”?

Providers Behind The Eight Ball On HIEs

Study Suggests Most HIEs Aren’t Sustainable

Largest Two Kansas Health Systems Take First HIE Steps

Is There Such A Thing As Too Much Patient Info Sharing?

UPMC Kicks Off Competitive HIE

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