Blog: A missed opportunity on patient records access

Sarah Krug, president of the Society for Participatory Medicine, had taken her stab at diplomacy before I spoke with her over the phone last week.

I had been reading news releases and calling people I know to put together a story about industry leaders' reaction to the massive, 1,354-page, three-rule phone book the feds dropped on the industry Aug. 23 and Aug. 24 when I received a hedged e-mail from Krug's group.

"Although we're disappointed this final rule does not give patients next-day access to their electronic medical record after they leave the hospital, we believe that on balance the Stage 2 meaningful-use requirements go a long way towards patient empowerment and feature a number of important patient-centered innovations," it said.

In a follow-up phone call, she was more direct: "Long story short, we're disappointed."

The goal of the New York-based not-for-profit, Krug said, is for patients to have immediate access to their updated records. They had been hoping for next-day access in the Stage 2 rule. Instead, the rule requires hospitals to make available online to more than 50% of their patients their information within 36 hours of discharge.

"It's definitely a step in the right direction,' Krug said, before adding, "I'm sure there are going to be a lot of patients that are going to be just as disappointed."

Admittedly, federal rulemakers have a tough job finding the right balance between moving the industry in a new direction in terms of using technology to improve care and control costs and what's possible based on what current technology can do and how long it will take IT systems developers and users to build and implement those new tools and procedures.

Sometimes, though, the feds don't push as hard as they might. Krug is not alone in her criticism of the new rules on that score.

For example, the new rule by the CMS on health plan identifiers won't go into full use until 2016, some 20 years after the health plan ID requirement was first passed into law in the Health Insurance Portability and Accountability Act. And even after 20 years, the health plan ID requirement is incomplete, allowing plans to not fully enumerate all of their products, a laxity that has drawn criticism from both the American Medical Association and the MGMA-ACPME.

And yet, the rousing success the Veterans Affairs Department has had with its simple Blue Button technology means providing patients ready access to plain ASCII or PDF copies of their records is both possible and popular.

The American healthcare industry is like a big ship. It turns slowly. In today's financially troubled waters, the nation should no longer tolerate that historic lack of agility.

Breaking down the silos of information is critical to creating the agile healthcare delivery system we all need. Patients having timely access to their records will be a big part of that. I'm with Krug on this one. Next-day access should have been the goal for 2014. Not requiring it is disappointing.