Before the release of the omnibus privacy rule earlier his year, or passage of the more stringent privacy provisions of the American Recovery and Reinvestment Act of 2009, or even the main federal health information privacy law, the Health Insurance Portability and Accountability Act of 1996, there were state, federal and common law provisions in full force about the handling of particularly sensitive patient information.
That special class of patient information includes patient records about treatment for drug and alcohol abuse, mental health, HIV/AIDs and sickle cell.
A workgroup of the federally chartered Health IT Policy Committee spent the better part of an hour Tuesday going over its recommendations on how to handle the legal and ethical privacy concerns over the exchange of digitized patient records. The gnarliest problem, evidenced by the longest discussion, related to the exchange of these particularly sensitive types of patient information, some with unique legal protections that are far more stringent than the rather lax restrictions under the current HHS interpretation of HIPAA.
Recommendations to the HITPC by its privacy and security tiger team, as the workgroup is officially called, were formally accepted for two of three classes of exchange. From there, they will be forwarded to the Office of the National Coordinator for Health Information Technology at HHS. The HITPC was created by the American Recovery and Reinvestment Act of 2009 to give such advice to the ONC.
Approved were recommendations on routine, “targeted” exchanges between providers with established relationships, exchanges in the paper world long since covered by HIPAA. In these transactions, after a 2002 HHS rewrite of the HIPAA privacy rule, patient consent is no longer required when the exchange occurs for treatment, payment and—this is where the laxity comes in—a host of “other healthcare operations.”
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A pair of new reports from the Office of the National Coordinator for Health Information Technology deserve your click-throughs.
Two surveys conducted with the help of the American Hospital Association show strong growth in overall electronic health-record adoption and substantial increases in literally dozens of key EHR functions. The reports cover the years 2008 through 2012.
The first report (PDF) focuses on growth in the percentages of EHR acquisition and adoption. It provides a state-by-state comparison of hospital “basic” EHR adoption rates. Some 14 states have achieved rates of 90% or higher, including Vermont and New Hampshire with 100%.
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A reader was confused by an article we ran saying 48% of doctors were e-prescribing using an electronic health-record system. Another article, published Dec. 6, based on an annual survey of ambulatory care physicians by the National Center for Health Statistics at the Centers for Disease Control, placed "basic" EHR adoption at 39.6%. A basic EHR includes e-prescribing capabilities. That seemed like an 8-point spread in physician EHR use.
To make matters worse, the NCHS surveyors calculated two other EHR penetration rates (PDF) for ambulatory care physicians of 71.8% and 23.5%, while Dr. Farzad Mostashari, head of HHS' Office of the National Coordinator for Health Information Technology, quoted in a third article, said 31% of physicians and other eligible professionals have been paid federal EHR incentive money, which means they'd also have to be e-prescribers.
So, that leaves us with quite a range of physician EHR users—71.8% to 23.5%— and several rates in between.
Why so many?
Here's some background and an explanation.
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What am I thankful for today?
The usual stuff. A loving family. My faith and my church home. Good health. An interesting job where I can put my skills to good use.
And—as a professional skeptic, this is weird for me to say—I'm also grateful for our government, or at least some aspects of it.
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I have to give a hat tip to Facebook friend Peter Groen for pointing me to this fascinating TED lecture by technology guru Clay Shirky.
Shirky, who holds several appointments at New York University, has never limited his futuristic gaze to the confines of healthcare, but he is well known among the health IT pundit class. In 2009, Health Affairs published an article on health IT that Shirky co-authored with Dr. Carol Diamond of the Markle Foundation and a then-promising young New York public health assistant commissioner, Dr. Farzad Mostashari.
Shirky is a familiar face at TED, too. His latest lecture, recorded in June but not posted until late last month, is “How the Internet Will One Day Transform Government.”
One element of Shirky's latest TED talk focuses on a new organizational structure for managing open-source software projects that could catalyze a democratization of democracy, making governments of democracies more responsive to their citizenry and less beholden to financial interests. The Empire will strike back, of course, but Shirky didn't go there in his 18 minutes on the TED stage, maybe to leave himself an opening for a sequel.
Groen, who was born abroad and grew up a globetrotter, consistently maintains an open, outward and upward worldview. He didn't retire in 2006 when he left the U.S. Veterans Affairs Department after working there for three decades, having last served as the VA's liaison to outside agencies wanting to use its public-domain VistA electronic health-record system in their own operations. He remained a VistA apostle, but broadened his open-source perspective and outreach as an educator and a blogger at OpenHealthNews.com, a website he helped launch.
Thanks for the link, Peter.
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We heard from our healthcare information technology cheerleader-in-chief Dr. Farzad Mostashari on Tuesday that many office-based physicians are, if not deliriously happy with their electronic health-record systems, at least not storming EHR vendor headquarters with flaming torches and pitchforks.
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