Electronic health record systems should expand to meet the needs of children and other vulnerable populations, experts said last week during a meeting of the Health IT Policy Committee’s meaningful use work group, Federal Computer Week reports.
EHRs for Children
Carolyn Clancy, director of the Agency for Healthcare Research and Quality, said studies show that about 21% of pediatricians use EHR systems, but only 6% say their EHR system features all the functionalities they believe are necessary.
AHRQ and CMS are collaborating to create a pediatric EHR template for children enrolled in Medicaid or the Children’s Health Insurance Program, Clancy said.
To design the pediatric EHR model, experts will conduct an environmental scan and gap analysis to identify up to three core functions for pediatric EHRs that currently are not available in most EHR systems. The new system likely will incorporate growth charts and vaccination data, Federal Computer Week reports.
EHRs for Other Groups
Howard Hays — acting program manager of the EHR system at the Indian Health Service — called for future EHR systems to assess uncommon factors that influence health status in certain communities, such as:
Hays said IHS’ EHR system already features software and standards that allow users to track information from nontraditional data fields, including some that address domestic violence (Lipowicz, Federal Computer Week, 6/4).
Leveraging EHRs To Address Health Disparities
Work group members also discussed the possibility of requiring health care providers to report how EHRs could reduce health disparities as part of the criteria for demonstrating “meaningful use” of health IT.
Paul Tang — co-chair of the work group and chief medical information officer of the Palo Alto Medical Foundation — said the second stage meaningful use requirements could require health care providers to leverage EHR data to address health needs for underserved populations.
Chris Gibbons, associate director of the Johns Hopkins Urban Health Institute, said health care providers could use EHR data to evaluate and monitor reductions in specific disparities (Mosquera, Government Health IT, 6/7).
Source: iHealthBeat
If health IT is to meet the challenges of a reformed healthcare system, the industry needs greater investment in health IT innovation, more integrated systems, and a focus on finding ways to enable patients to better manage their health, a Hewlett Packard executive says.
In an interview with InformationWeek, Harry Kim, HP’s director of enterprise business healthcare, argued that the United States is not driving the level of innovation needed to meet the new healthcare realities.
“We have the best medical technology, but our information technology to bring it all together is lacking investments. It lacks the structure inside the country to drive progress,” Kim said.
According to Kim, the healthcare industry currently invests more in medical technology than health IT, and the imbalance is having an impact on vendors’ approach to providing solutions in healthcare.
“When you compare IT investments with medical technology investments, IT always loses and what wins is medical technology investments in, for example, the latest MRI, CT scan, or mammogram equipment. With this medical technology you are essentially building expensive islands of information,” Kim said. “The lack of investment around information technology to bridge those disparate information sets together, that’s where the lack in investments has been,” Kim explains.
Kim’s observations are supported by a recent Dow Jones VentureSource report that revealed that venture capital investments in the medical software and information services segment dropped from 17 deals totaling $69 million in the first quarter of 2009 to eight deals totaling $53 million during the corresponding period in 2010, a 77% decline.
This lackluster investment climate occurred during a recession, but also at a time when the government signed into law the American Recovery and Reinvestment Act of 2009, which authorized $20 billion to assist in the development of a robust health IT infrastructure.
HP is closely working with federal and state authorities as the ongoing push to revamp health IT continues. For example, HP handles 35% of all Medicare and Medicaid claims in the United States and each year performs 2.4 billion healthcare transactions, including 1 billion healthcare claims.
Souce: InformationWeek Healthcare
A key government advisory panel on healthcare information privacy continues to wrestle with how much—if any—control patients should have over the use and movement of their electronic health records.
Patient consent for movement and use of records “is absolutely a part of this framework,” said Deven McGraw, chair of the Privacy and Security Workgroup of the Health IT Policy Committee. Still, patient consent should not be the linchpin of healthcare information privacy, she argued at the committee’s May 19 meeting, “because then you’ve asked the patient to bear that burden.”
The privacy and security work group made three recommendations to the committee:
Construct specific privacy and security-protection policies and technologies in all forms of electronic health-information exchange, and implement principles of the Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information, which was issued in the waning days of the George W. Bush administration.
Encrypt messages, even in one-to-one information exchanges, and limit potentially identifiable information used to identify patients and their records and in electronic communication.
Enforce these “strong” new policies so that there is no need for “any additional individual consent beyond what is already required by current law.”
The last recommendation would leave a lot of latitude for data-sharing without patient consent.
In December 2008, the Office of the National Coordinator for Health Information Technology at HHS issued its 12-page National Privacy and Security Framework , the plan the work group says should be implemented. It defines privacy not as a patient’s right to control the movement of his or her medical information, but rather as “an individual’s interest in protecting his or her individually identifiable health information.” In 2006, however, the National Committee on Vital and Health Statistics, in a list of 26 recommendations, defined health information privacy as “an individual’s right to control the acquisition, uses or disclosures of his or her identifiable health data.”
The role of patient control and consent—whether it is a right or merely an interest—remains unresolved. The issue is important because under a 2002 revision of the privacy rule under HIPAA, the federal government overturned the consent requirement in the original rule and provides “regulatory permission” for disclosure of patient information without consent for treatment, payment and a broadly defined catch-all category of “other healthcare operations.” Some states, whose more-stringent privacy laws pre-empt HIPAA’s provisions, still require patient consent for certain types of record-sharing, such as lab test results; some, such as New York, do so even for treatment.
McGraw said the work group began its discussions by focusing on consent but found quickly that consent “is just one piece of a bigger puzzle.”
Even if patients are fully empowered to make decisions about controlling the use of their medical information, she said, “Just what kind of a decision is that if there is a fair degree of uncertainty about how exchange is going to operate and who can access data and for what purposes?”
If consent were deemed to be “your one and only or most important protection, you might end up with individuals essentially bearing the burden of protecting their own privacy through the decisions that they make about whether to participate,” McGraw said.
For example, the ONC is supporting development of NHIN Direct, a lightweight version of the proposed national health information network.
According to McGraw, NHIN Direct contemplates peer-to-peer movement of patient information between providers, as in a computerized transfer of a referral letter from one physician’s electronic health-record system to another’s. In more-sophisticated forms of exchange, as in the transfer of data to a state or regional health-information organization, the risk of privacy loss is heightened from the patient’s perspective.
“We have such a plethora of potential (data-exchange) models out there that grappling with this from a policy standpoint is incredibly challenging,” McGraw said. “We don’t think what we have in current law today adequately addresses the activities of these exchange facilitators.”
And that, she said, “led to some great difficulty coming to some resolution on the issue of consent.”
McGraw said the work group adopted as a “touchstone” to guide their discussions what she described as the “Paul Tang principle,” which is, “What would a reasonable patient expect?”
McGraw said the principle was named for the physician informaticist and chief medical information officer of the Palo Alto, Calif., Medical Foundation, who serves as vice chairman of the Health IT Policy Committee and is a member of the privacy and security work group.
“One of the places where we quite often fall down is transparency,” she said. “Patients often don’t know what’s done with their data, who has access to it and for what purposes. There is a sense that, when you have that direct, one-to-one exchange, it’s more consistent with what the patient expects versus a more robust query/response system, creating separate databases, or lack of strong protections on what the entities in the middle can do with the data.”
In applying the Tang principle to these latter forms of exchange, McGraw said, “You can see where the patient expectation test is telling you, we’re straying into territory that is well beyond what many reasonable patients would expect and we have a responsibility to meet that with a strong set of policies in order to build trust and create a set of circumstance where what patients expect is in fact what we’re doing.”
Source: ModernHealthcare.com
Urgent care clinics and emergency departments are increasingly installing automated medication dispensing machines to address pharmacist shortages, particularly in rural areas, HealthLeaders Media reports.
In addition, the automated prescription dispensing machines can give pharmacy staff more time to interact with patients or work with more complex medications. The machines are not seen as a replacement to a pharmacist and typically do not dispense prescriptions that require regular refills.
One company, InstyMeds, has installed about 200 automated medication machines in urgent-care clinics and emergency departments throughout the U.S.
While interest in the technology appears to be increasing, some states regulate or prohibit the use of such machines (Bakhtiari, HealthLeaders Media, 5/11).
Source: iHealthBeat
The White House announced a shift in national drug policy that would treat illegal drug use more as a public health issue and plunge more resources into prevention and treatment.
The new drug-control strategy boosts community-based anti-drug programs, encourages healthcare providers to screen for drug problems before addiction sets in and expands treatment beyond specialty centers to mainstream healthcare facilities. President Barack Obama called the plan a “balanced approach to confronting the complex challenge of drug use and its consequences.”
His drug czar, Gil Kerlikowske, was more blunt. “Calling it a war really limits your resources,” Kerlikowske told reporters. “Looking at this as both a public safety problem and a public health problem seems to make a lot more sense.”
The plan—the first drug strategy unveiled by the Obama White House—calls for reducing the rate of youth drug use by 15% over the next five years and for similar reductions in chronic drug use, drug-abuse deaths and drugged driving. The new drug plan encourages healthcare professionals to ask patients questions about drug use even during routine treatment so that early intervention is possible. It also helps more states set up electronic databases to identify doctors who are over prescribing addictive pain killers. “Putting treatment into the primary healthcare discussion is critical,” Kerlikowske said in an interview.
Source: Associated Press
Mobile phone applications are increasingly being developed and tested worldwide to help bolster treatment options for mental health patients, NPR’s “Morning Edition” reports.
Several studies are being conducted in countries such as Australia, Ireland and the U.S. to explore how the computing power of mobile phones can help patients monitor moods, follow treatment recommendations and manage stress.
According to researchers, the mobile applications can provide new insight into a patient’s emotional variability and promote patient participation in therapy sessions.
The applications are being used to target certain conditions, such as depression and schizophrenia. Some researchers hope eventually to expand use of the technology to treat anxiety, phobias, eating disorders and other mental health issues.
The segment includes comments from:
Source: iHealthBeat
The use of home-based blood pressure monitoring devices and online reporting tools can help patients manage hypertension, according to preliminary research from a new study, Healthcare IT News reports.
Researchers from Kaiser Permanente Colorado, the American Heart Association and Microsoft conducted the study, which was presented last week at AHA’s 11th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke.
Study Details
The study involved 348 patients ages 18 through 85 who had uncontrolled high blood pressure. Researchers randomly divided the study participants into a home monitoring group and a usual care group (Millard, Healthcare IT News, 5/21).
The home monitoring patients received a blood pressure device with a USB connection that allowed users to transmit readings to AHA’s Heart 360 website and a Microsoft HealthVault personal health record account (Hobson, “Health Blog,” Wall Street Journal, 5/21).
The system also uploaded the information to Kaiser’s electronic disease registry, which allows clinical pharmacists to monitor readings and consult with patients to adjust their medications (Goedert, Health Data Management, 5/24).
After six months, researchers found that 58% of patients using the monitoring device had lowered their blood pressure to healthy levels, compared with 38% of patients in the control group (Dotinga, HealthDay/BusinessWeek, 5/21).
Study authors said more research would be necessary to confirm the findings (“Health Blog,” Wall Street Journal, 5/21).
Source: iHealthBeat
On Tuesday, Sens. John Thune (R-S.D.) and Mark Begich (D-Alaska) introduced a bill (S 3416) that would exempt certain small businesses — including physician and dentist offices — from the Federal Trade Commission’s so-called “Red Flags Rule,” which aims to minimize identity theft, Health Data Management reports (Goedert, Health Data Management, 5/26).
The FTC rule classifies physicians and other small businesses as “creditors,” thus requiring them to adopt certain measures to prevent identity theft (Rapid City Journal, 5/25).
The regulations are scheduled to take effect on June 1. Several medical associations recently filed a lawsuit to prevent federal officials from applying the rule to physicians (Health Data Management, 5/26).
Thune said FTC’s regulations “are too broad and ensnare businesses that pose little risk to consumers.” He added that S 3416 “will help small businesses avoid the costly implementation of unnecessary measures to guard against identity theft” (Rapid City Journal, 5/25).
Next Steps, Outlook
The bill was referred to the Senate Banking, Housing and Urban Affairs Committee, but a hearing has yet to be scheduled.
Last year, a similar bill (HR 3763) passed the House in a 400-0 vote (Health Data Management, 5/26).
Source: iHealthBeat
HCA, Nashville, said it has hired Thomas Garthwaite, M.D., to be chief operations officer of its clinical services group, effective June 1. Garthwaite, 62, has been executive vice president and chief medical officer of Catholic Health East, Newtown Square, Pa., since 2006.
Source: Modern Physician
Patient records can contain information that is both life-saving and life-threatening. Physicians consult over the Internet; orders are sent via e-mail; data are accessible and stored in any number of ways. For the most part, the health care industry is chock-full of data security challenges.
The high level of interest in computerized patient record systems means that more people have access to the patient record, opening the door to new liability issues. Simply stated, organizations are at greater risk of violating a patient’s legal right to privacy.
Due to increased attention to quality, cost, utilization, and increased access as a result of automation, the list of people who potentially have access to the electronic patient chart could easily exceed 50 in any given 24-hour period. This list includes not only direct caregivers, but also case managers, utilization review and quality management staff, allied health professionals, financial managers, medical records personnel, billing specialists, payer representatives, and federal and state government agencies.
Computerized medical records can improve the costs and outcomes of health care delivery by providing improved efficiency and access to data. The advent of new and expanded information technology in health care has created both concern and liberation for health care organizations. Topping the list of these concerns are security, confidentiality, accessibility, and integrity of information. As discussed in the December issue, negative publicity about the Internet has created increased public concern about the security and confidentially of information. While rushing to implement new systems and address year 2000 issues, health care organizations must ensure that the confidentiality and security of patient data are not jeopardized.
Source: BNET
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