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When It Comes To Meaningful Use, Some Vendors May Have An Edge

Posted on December 1, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

A new article appearing in the Journal of the American Medical Informatics Association has concluded that while EHRs certified under the meaningful use program should perform more or less equally, they don’t.

After conducting an analysis, researchers found that there were significant associations between specific vendors and level of hospital performance for all six meaningful use criteria they were using as a yardstick. Epic came out on top by this measure, demonstrating significantly higher performance on five of the six criteria.

However, it’s also worth noting that EHR vendor choice by hospitals accounted for anywhere between 7% and 34% of performance variation across the six meaningful use criteria. In other words, researchers found that at least in some cases, EHR performance was influenced as much by the fit between platform and hospital as the platform itself.

To conduct the study, researchers used recent national data on certified EHR vendors hospitals and implemented, along with hospital performance on six meaningful use criteria. They sought to find out:

  • Whether certain vendors were found more frequently among the highest performing hospitals, as measured by performance on Stage 2 meaningful use criteria;
  • Whether the relationship between vendor and hospital performance was consistent across the meaningful use criteria, or whether vendors specialized in certain areas; and
  • What proportion of variation in performance across hospitals could be explained by the vendor characteristics

To measure the performance of various vendors, the researchers chose six core stage two meaningful use criteria, including 60% of medication orders entered using CPOE;  providing 50% of patients with the ability to view/download/transmit their health information; for 50% of patients received from another setting or care provider, medication reconciliation is performed; for 50% of patient transitions to another setting or care provider, a summary of care record is provided; and for 10% of patient transitions to another setting or care provider, a summary of care record is electronically transmitted.

After completing their analysis, researchers found that three hospitals were in the top performance quartile for all meaningful use criteria, and all used Epic. Of the 17 hospitals in the top performance quartile for five criteria, 15 used Epic, one used MEDITECH and one another smaller vendor. Among the 68 hospitals in the top quartile for four criteria, 64.7% used Epic, 11.8% used Cerner and 8.8% used MEDITECH.

When it came to hospitals that were not in the top quartile for any of the criteria, there was no overwhelming connection between vendor and results. For the 355 hospitals in this category, 28.7% used MEDITECH, 25.1% used McKesson, 20.3% used Cerner, 14.4% used MEDHOST and 6.8% used Epic.

All of this being said, the researchers noted that news the hospital characteristics nor the vendor choice explained were then a small amount of the performance variation they saw. This won’t surprise anybody who’s seen firsthand how much other issues, notably human factors, can change the outcome of processes like these.

It’s also worth noting that there might be other causes for these differences. For example, if you can afford the notably expensive Epic systems, then your hospital and health system could likely afford to invest in meaningful use compliance as well. This added investment could explain hospitals meaningful use performance as much as EHR choice.

AHA Asks Congress To Reduce Health IT Regulations for Medicare Providers

Posted on September 22, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

The American Hospital Association has sent a letter to Congress asking members to reduce regulatory burdens for Medicare providers, including mandates affecting a wide range of health IT services.

The letter, which is addressed to the House Ways and Means Health subcommittee, notes that in 2016, CMS and other HHS agencies released 49 rules impacting hospitals and health systems, which make up nearly 24,000 pages of text.

“In addition to the sheer volume, the scope of changes required by the new regulations is beginning to outstrip the field’s ability to absorb them,” says the letter, which was signed by Thomas Nickels, executive vice president of government relations and public policy for the AHA. The letter came with a list of specific changes AHA is proposing.

Proposals of potential interest to health IT leaders include the following. The AHA is asking Congress to:

  • Expand Medicare coverage of telehealth to patients outside of rural areas and expand the types of technology that can be used. It also suggests that CMS should automatically reimburse for Medicare-covered services when delivered via telehealth unless there’s an individual exception.
  • Remove HIPAA barriers to sharing patient medical information with providers that don’t have a direct relationship with that patient, in the interests of improving care coordination and outcomes in a clinically-integrated setting.
  • Cancel Stage 3 of the Meaningful Use program, institute a 90-day reporting period for future program years and eliminate the all-or-nothing approach to compliance.
  • Suspend eCQM reporting requirements, given how difficult it is at present to pull outside data into certified EHRs for quality reporting.
  • Remove requirements that hospitals attest that they have bought technology which supports health data interoperability, as well as that they responded quickly and in good faith to requests for exchange with others. At present, hospitals could face penalties for technical issues outside their control.
  • Refocus the ONC to address a narrower scope of issues, largely EMR standards and certification, including testing products to assure health data interoperability.

I am actually somewhat surprised to say that these proposals seem to be largely reasonable. Typically, when they’re developed by trade groups, they tend to be a bit too stacked in favor of that group’s subgroup of concerns. (By the way, I’m not taking a position on the rest of the regulatory ideas the AHA put forth.)

For example, expanding Medicare telehealth coverage seems prudent. Given their age, level of chronic illness and attendant mobility issues, telehealth could potentially do great things for Medicare beneficiaries.

Though it should be done carefully, tweaking HIPAA rules to address the realities of clinical integration could be a good thing. Certainly, no one is suggesting that we ought to throw the rulebook out the window, it probably makes sense to square it with today’s clinical realities.

Also, the idea of torquing down MU 3 makes some sense to me as well, given the uncertainties around the entirety of MU. I don’t know if limiting future reporting to 90-day intervals is wise, but I wouldn’t take it off of the table.

In other words, despite spending much of my career ripping apart trade groups’ legislative proposals, I find myself in the unusual position of supporting the majority of the ones I list above. I hope Congress gives these suggestions some serious consideration.

Hospital Execs Underestimate QPP Impact

Posted on July 7, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

A new survey by Nuance Communications suggests that hospital finance leaders aren’t prepared to meet the demands of MACRA’s Merit-Based Incentive Payment System (MIPS), and may not understand the extent to which MIPS could impact their bottom line. Worse, survey results suggest that many of those who were convinced they knew what was involved in meeting program demands were dead wrong.

The survey found that many hospital finance leaders weren’t aware that if they don’t participate in the MIPS Quality Payment Program (QPP), they could see a 4% reduction in Medicare reimbursements by 2019.

Not only that, those who were aware of the program didn’t have a great grasp of the details. More than 75% respondents that claimed to be somewhat or very confident about their understanding of QPP got the 4% at-risk number wrong. Meanwhile, 60% of respondents either underestimated the percent of revenue at risk or simply did not know what the number was.

In addition, a significant number of respondents weren’t aware of key QPP reporting requirements. For example, just 35% of finance respondents that felt confident they understood QPP requirements actually knew that they had to submit 90 day of quality data to participate. Meanwhile, 50% either underestimated or did not know how many days of data they needed to provide.

On a broader level, as Nuance noted, the issue is that hospitals aren’t ready to meet QPP demands even if they do know what’s at stake. Too many aren’t prepared to capture complete clinical documentation, develop business processes to support this data capture and raise provider awareness of these issues. In other words, not only are finance leaders unaware of some key QPP requirements, they may not have the infrastructure to meet them.

This is a big deal. Not only will their organizations lose money if they don’t meet QPP requirements, but they’ll miss out on a 5% positive Medicare payment adjustment if they play by the rules.

Lest the respondents sound careless, let’s do a reality check here. Without a doubt, the transition into the world of MIPS isn’t a simple one. Hospitals and medical practices will have to meet deadlines and present quality data in new ways. That would be a hassle in any event, but it’s particularly difficult given how many other quality data reporting requirements they must meet.

That being said, I’d argue that even if they’ve gotten a slow start, hospitals have enough time to meet the basic requirements of QPP compliance. For example, turning over 90 days of quality data by March of next year shouldn’t be a gigantic stretch in contrast to, say, submitting a year’s worth of data under advanced Meaningful Use models. Not to mention the Pick Your Pace option of only 1 measure which avoids all penalties.

Clearly, having the right health IT tools will be important to this process. (Not surprisingly, Nuance is picking its own reporting tools as part of the mix.) But I’m struck by the notion that organizations can’t live on technology alone in this case. As with many problems in healthcare, tech solutions aren’t worth much if the business doesn’t have the right processes in place. Let’s see if finance executives know at least that much.

Meaningful Use Has Done Its Job

Posted on September 19, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

While Meaningful Use has been challenging at times, the vast majority of hospitals seem to have stayed on top of things. In its new report on the IPPS negative payment adjustments for fiscal 2017, CMS said that 98% of eligible hospitals and critical access hospitals managed to avoid Medicare payment dialbacks for next year, because they successfully attested to stage 1 or stage 2 Meaningful Use compliance, according to EHR Intelligence.

CMS began making Medicare payment adjustments on October 1, 2014 for eligible hospitals, of which there are more than 4,800 in the United States. The current adjustment will fall into place on October 1, 2016, as a reduction in the percentage increase to the Inpatient Perspective Payment System.

The negative payment adjustments to the IPPS now stand at 75%, up from 25% for the 2013 reporting period. Eligible hospitals had a chance to apply for hardship exceptions to the payment adjustments, though if they haven’t done so already it’s too late, as the window for seeking those exceptions for 2017 closed in April of this year. But as noted, few hospitals will be affected.

At this point, it’s worth taking time to stop and admire how this took place. Even when you consider that the feds handed lot a lot of money in incentives, this has all happened relatively quickly as IT investments go. Everyone likes to talk about how successful the banking industry was at rolling out interoperability with ATMs, but I doubt the backroom negotiations went any faster than the cascade of Meaningful Use attestations. In other words, Meaningful Use did its job.

After all, very few programs achieve close to 100% compliance under any circumstances. Even if providers face large government fines, no initiative is going to get 100% of the industry on board. So bringing 98% of eligible hospitals on board within a few scant years is an impressive achievement, particularly considering the healthcare industry’s record of foot dragging when it comes to new technologies.

Of course, the industry has clearly gone well beyond the need for Meaningful Use’s rather mechanical reporting requirements, valuable though they may have been as a training ground. So if we assume that Meaningful Use isn’t that, well, meaningful anymore, what’s next?

The answer is….drumroll…quality. Most hospitals will be focusing on the larger and more complex quality measurement demands imposed by the next generation of incentive payments proposed by CMS.

As many readers know, the Medicare Meaningful Use program for ambulatory is being rolled into the Merit-Based Incentive Payment System (MIPS), along with the Physician Quality Reporting System and Value-Based Modifier programs. beginning with the 2017 performance year.

Meaningful Use now has a new name in ambulatory care, Advancing Care Information, and strong performance on this measure can contribute up to 25% of the MIPS score a provider receives – or in other words, smart health IT deployment still counts. But that’s dwarfed by the 50% of the score contributed by strong quality performance.

This shift away from IT-specific performance measures is necessary and valuable. But as federal authorities lay out their new incentive programs, it’s worth giving good ol’ Meaningful Use a send-off. A job needed to be done, and however unsubtly, MU did it. We’ll see how quickly the MIPS program rolls over to replace MU in hospitals.

Bad Handwriting Could Cost a Doctor His License

Posted on September 16, 2016 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children's hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

I admit that I don’t have very good handwriting. My signature is no better, and often leads people to ask if I am a doctor. Because it is commonly known that doctors don’t excel at handwriting skills. Thankfully, I rarely hand-write anything anymore. With computers, I can write quickly while still producing a result that is easy to read.

One benefit of an EHR solution is that we don’t have to worry about deciphering handwritting! But for one Nevada doctor, poor penmanship may lead to the loss of his medical license!

Read this story in the Review Journal for more information or this excerpt of the situation below:

The Nevada State Medical Board has formally threatened to revoke the medical license of Dr. James Gabroy, a 69-year-old Henderson internist who has never had malpractice or professional incompetence problems, nor has he ever had sexual misconduct, patient abandonment or fraudulent billing issues.

why is the board taking action against Gabroy — punishment ranges from a $5,000 fine to license revocation — with a Sept. 28 hearing scheduled in Reno?

His handwriting.

Citing confidentiality, Ed Cousineau, the board’s executive director, won’t stray far from the Oct. 23, 2015, board complaint that alleges the medical records of three unnamed patients were illegible, inaccurate and incomplete.

Are we heading for an environment where you’ll have to have an EHR in order to have a medical license?

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

HHS OIG Says Unplanned Hospital EMR Outages Are Fairly Common

Posted on August 24, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

More than half of U.S. hospitals responding to a new survey reported having unplanned EMR outages, according to a new report issued by the HHS Office of the Inspector General, due to a variety of common but difficult-to-predict technical problems. Some of these outages have merely been inconveniences, but some resulted in patient care problems, the OIG report said.

The agency said that it conducted this study as a follow up to its prior research, which found that both natural disasters and cyberattacks were having a major impact on EMR availability. For example, it noted, hospitals faced substantial health IT availability challenges in the wake of Superstorm Sandy, include damage to HIT systems and problems with access to patient records.

According to the survey, 59% of the hospitals reported having unplanned EMR outages. One-quarter said that the outages created delays in patient care and 15% said that the outage lead to rerouted patient care. Only 1 percent of outages were caused by hacking or breaches.

The most common causes, in order, were topped by hardware malfunctions, followed by Internet connectivity problems, power failures and natural disasters. (For more detail on the root causes of outages, see this great post by my colleague John Lynn.)

It’s worth noting that these hospitals were selected for having their act together to some degree. To conduct the study, researchers spoke with 400 hospitals which were getting Meaningful Use incentive payments for using a certified EMR system in place as of September 2014.

Nearly all of these hospitals reported having a HIPAA-required EMR contingency plan in place. Also, two thirds of the hospitals addressed the four HIPAA requirements reviewed by OIG researchers. Eighty-three percent of surveyed hospitals reported having a data backup plan, 95% had an emergency mode operations mode plan, 95% said they had a disaster recovery plan and 73% said they had testing and revision procedures in place.

Not only that, most of the hospitals contacted by the study were implementing many ONC and NIST-recommended practices for creating EMR contingency plans. Nearly all had implemented practices such as using paper records for backup and putting alternative power sources like generators in place.

Also, most hospitals said that they reviewed their EMR contingency plans regularly to stay current with system or organizational changes, and 88% said they’d reviewed such plans within the previous two years. Most responding hospitals said they regularly trained their staff on EMR outage contingency plans, though just 45% reported training staff through recommended drills on how to address EMR system downtime. And 40% of hospitals that activated contingency plans in the wake of an outage reported that they saw no disruption to patient care or adverse events.

Still, the OIG’s take on this data is that it’s time to better monitor hospitals’ ability to address EMR outages. Now more than ever, the agency would like to see the HHS Office for Civil Rights fully implement a permanent HIPAA compliance program, particularly given the mounting level of cyberattacks endured by the industry. The OIG admitted that HIPAA standards aren’t crafted specifically to address these types of outages, so it’s not clear such monitoring can solve the problem, but the agency would prefer to forge ahead with existing standards given the risks that are emerging.

Most Hospitals Offer Patients Online Access To Medical Records

Posted on July 27, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

New research from the American Hospital Association suggests that nearly all hospitals now offer individual patients online access to their medical records, and most offer them the ability to perform related tasks as well.

According to AHA research, 92% of hospitals gave patients access to their medical records in 2015, up from 43% in 2013. Also, 84% allowed them to download information from the record, 78% let them request changes to their record and 70% made it possible for them to send a referral summary. (The latter has seen the biggest change since 2013, as only 13% could send such a summary at that time.)

In addition, hospitals have begun giving patients the ability to schedule appointments, order prescription refills and pay bills. As the AHA notes, progress on this front isn’t universal, as organizations need to integrate data from revenue cycle, pharmacy and scheduling systems to make it happen. But as hospitals invest in integration engines they will have a greater ability to roll out these options.

As of 2015, 74% of hospitals let patients pay bills online, up from 56% in 2013. However, progress on other consumer-friendly functions has been slower. Only 45% of hospitals let patients schedule appointments online, a modest increase from 31% in 2013, and just 44% let patients refill prescriptions, up from 30% in 2013.

Meanwhile, hospitals are slowly but surely expanding tools letting patients communicate with physicians. The AHA found that 63% let patients securely message care providers, up from 55% in 2014, and 37% let patients submit self-generated data, a big jump from the 14% who did so in 2013.

All of this suggests that rollouts of patient portal tools are likely to continue well after Meaningful Use has landed in the dustbin. After all, research suggests that dollars spent on these technologies will pay off, especially under at-risk value-based care models.

For example, an eye-opening study appearing in Health Affairs found that use of patient-physician email at Kaiser Permanente is associated with a 2% to 6.5% improvement in HEDIS performance measures like HbA1c levels, cholesterol and blood press screening and control. The same study noted that users of its My Health Manager were 2.6 times more likely to remain KP members than non-users, a phenomenon which may well apply to providers.

On the other hand, hospitals need to evaluate any potential portal solutions carefully. According to a study by research firm Peer60, many solutions have serious limitations that could lead providers to violate state laws or limit parent and minor engagement. Also, some organizations might not be ready to support patients who have issues adequately. Concerns like these might explain why 28% of the 200 healthcare execs surveyed by Peer60 said they weren’t looking at portal technology at the moment.

$34.7 Billion Spent on Meaningful Use

Posted on July 8, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS has put out the latest data on meaningful use participation and payments. They broke the Medicare dollars out by meaningful use stage 1 and stage 2. Meaningful use stage 1 cost nearly $20 billion. Meaningful use stage 2 cost $3.4 billion. The amounts were less for stage 2, but that’s still a massive drop off.

Less than half of eligible providers participated in stage 2 that participated in stage 1 (308k compared to 145k). Participating hospitals dropped from 4600 hospitals to 3096. This illustrates well what we’ve been saying for a while as far as hospitals still largely participating in meaningful use and most doctors choosing not to participate.

Also interesting to note is that at its peak, meaningful use was paying about $10 billion per year. In 2015, they spent $2.8 billion.

What I didn’t see in this report was any numbers on the cost savings that the meaningful use program provided. All the OIG estimates for meaningful use talked about how much money would be spent, but they also calculated how much money would be saved as well. As I recall they estimated about $36 billion in spending, but about $16 billion in savings. That would put the cost of the meaningful use program at $20 billion instead of the full $36 billion which it looks like we’ve now pretty much spent.

I like that HHS puts out this accountability as far as where the meaningful use money was spent. Shouldn’t we have some accountability as far as the savings as well? Do they not have a way to calculate it? Are they afraid that there weren’t cost savings? Or that meaningful use actually added costs? Maybe it’s in another report and I just missed it. If you know of that other report, I’d love to see it.

What do you think of these numbers? What’s been the benefit of the $34.7 billion that’s been spent? I’d love to hear your thoughts in the comments.

Data Sharing Largely Isn’t Informing Hospital Clinical Decisions

Posted on July 6, 2016 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Some new data released by ONC suggests that while healthcare data is being shared far more frequently between hospitals than in the past, few hospital clinicians use such data regularly as part of providing patient care.

The ONC report, which is based on a supplement to the 2015 edition of an annual survey by the American Hospital Association, concluded that 96% of hospitals had an EHR in place which was federally tested and certified for the Meaningful Use program. That’s an enormous leap from 2009, the year federal economic stimulus law creating the program was signed, when only 12.2% of hospitals had even a basic EHR in place.

Also, hospitals have improved dramatically in their ability to share data with other facilities outside their system, according to an AHA article from February. While just 22% of hospitals shared data with peer facilities in 2011, that number had shot up to 57% in 2014. Also, the share of hospitals exchanging data with ambulatory care providers outside the system climbed from 37% to 60% during the same period.

On the other hand, hospitals are not meeting federal goals for data use, particularly the use of data not created within their institution. While 82% of hospitals shared lab results, radiology reports, clinical care summaries or medication lists with hospitals or ambulatory care centers outside of their orbit — up from 45% in 2009 — the date isn’t having as much of an impact as it could.

Only 18% of those surveyed by the AHA said that hospital clinicians often used patient information gathered electronically from outside sources. Another 35% reported that clinicians used such information “sometimes,” 20% used it “rarely” and 16% “never” used such data. (The remaining 11% said that they didn’t know how such data was used.)

So what’s holding hospital clinicians back? More than half of AHA respondents (53%) said that the biggest barrier to using interoperable data integrating that data into physician routines. They noted that since shared information usually wasn’t available to clinicians in their EHRs, they had to go out of the regular workflows to review the data.

Another major barrier, cited by 45% of survey respondents, was difficulty integrating exchange information into their EHR. According to the AHA survey, only 4 in 10 hospitals had the ability to integrate data into their EHRs without manual data entry.

Other problems with clinician use of shared data concluded that information was not always available when needed (40%), that it wasn’t presented in a useful format (29%) and that clinicians did not trust the accuracy of the information (11%). Also, 31% of survey respondents said that many recipients of care summaries felt that the data itself was not useful, up from 26% in 2014.

What’s more, some technical problems in sharing data between EHRs seem to have gotten slightly worse between the 2014 and 2015 surveys. For example, 24% of respondents the 2014 survey said that matching or identifying patients was a concern in data exchange. That number jumped to 33% in the 2015 results.

By the way, you might want to check out this related chart, which suggests that paper-based data exchange remains wildly popular. Given the challenges that still exist in sharing such data digitally, I guess we shouldn’t be surprised.

The Cost of Encouraging Patient Engagement

Posted on June 15, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

We all know that healthcare providers want to encourage patient engagement to ensure patients have the information they need to manage conditions and share information with other providers. There has been a longstanding push for the adoption and maintenance of personal health records for many years to give patients the power to share and disseminate information wherever it is needed. We have seen a remarkable new interest in this with Meaningful Use and population health initiatives. Since HIM professionals are charged with maintaining and producing legal copies of records, we are aware that the tasks surrounding these processes can be very expensive. This is especially true if any of the tasks are not handled properly and breaches of protected information occur.

My concern is that lately I have heard many discussions that are pushing for more access yet with fewer costs to patients to encourage patient engagement. Some are even pushing for patients to have “free” access to records- paper or electronic. Don’t get me wrong, I am a huge proponent for patients having copies of their records and I personally keep copies of my own records. The Office of Civil Rights (OCR) recently published further guidance on charging for records. In a nutshell, the OCR says: “copying fees should be reasonable. They may include the cost of labor for creating and delivering electronic or paper copies; the cost of supplies, including paper and portable media such as CDs or USB drives; and the cost of postage when copies of records are mailed to patients at their request.” The OCR actually has the authority to audit the costs of producing records if they feel your organization is violating this patient right and overcharging for release of information.

Living in a state such as Florida where the state law has allowed facilities to charge up to $1 per page means most facilities have charged $1 per page without blinking an eye. The latest OCR guidance has led to questioning if that amount is actually “reasonable” or true to cost. Afterall, HIM professionals must use expensive systems, supplies, and labor costs to produce these records. Many organizations have outsourced release of information functions (another cost) but it is still the responsibility of the custodian of records to oversee the processes for compliance.

That being said, it is beneficial for HIM departments to evaluate the expenses and methods used to produce records as technologies and laws change. Dr. Karen Desalvo of the Office of the National Coordinator (ONC) strives to lead the EMR interoperability movement. At the top of the ONC’s list of commitments is consumer access to records. HIM professionals should continue to assist in the quest for interoperability and electronic data sharing at the notion of patient engagement. We must lead patients to use EMR patient portals and facilitate the efficient electronic data sharing among healthcare providers. We must be creative in lowering overhead costs to produce and maintain the records in order to ensure costs are affordable for healthcare consumers. There will always be costs associated with this important task, whether on the provider’s end or the patient’s end, just as costs are incurred with most services or products in every industry.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.