It's fashionable these days to call every cluster of U.S. Senators a gang.
The Gang of Six. The Gang of Eight.
This week, six Republican senators, having formed their own grouping—let's call it the Gang of Carp—released what they called a “white paper.” In it, they carped about problems with the management and direction of several federal health information technology programs funded by the American Recovery and Reinvestment Act of 2009. They said we need to “reboot” the program, as if it had crashed. That assessment was unbalanced and unfair.
Also this week, a group of 10 healthcare IT cognoscenti—let's call them the Gang of Good Cheer—put out their own “discussion paper,” finding bliss in healthcare IT. Pangloss would have beamed at their grand vision of “an exponential rate of progress in the use of health and health-related data” as if there weren't serious shortcomings thus far. Their paper, too, was unbalanced; cheerleading bordering on euphoria.
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Here's a thought. When it comes to privacy and security, all patient information is equal.
This isn't a new idea, of course.
I have a copy of the Oath of Hippocrates on my wall. It says, “Whatever … I may see or hear … which ought not be spoken abroad I will not divulge, as reckoning that all such should be kept secret.”
In the U.S., however, that's all Greek to the feds and many states. They have created legal gradations of health information sensitivity. Patient information about mental health, drug and alcohol abuse treatment and HIV/AIDs, for example, is earmarked for special treatment, particularly when it comes to health information exchange.
Typically, U.S. laws specifically require patient consent before “sensitive” information can be shared, even between doctors and hospitals, whereas, under the 2002 HHS-revised HIPAA privacy rule, patient consent is no longer required for most data sharing of other health data types.
So, it was refreshing to visit with Dr. David Levin last week at a health IT leadership forum here in Chicago hosted by Microsoft.
“I'm a little bit of a contrarian,” said Levin, a board certified family practitioner and full-fledged geek doc. He is the chief medical information officer at the Cleveland Clinic.
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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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Dear Jon Stewart,
I'm a huge fan of your “Daily Show,” but last week, with your segment, “The Red Tape Diaries,” you and your staff waded into the swamps of health information technology, made more dense and impenetrable by the Defense and Veterans Affairs bureaucracies.
By the sound of it, your hearts were in the right place, but you made a hash of a couple of things.
One topic covered by your segment was the alleged lack of interoperability between the VistA and AHLTA electronic health-record systems at the VA and DoD.
The other was the backlog of disability benefits claims at the VA, currently in excess of 900,000 claims and growing. A backlog, I might point out, that's exacerbated by the time it takes the Defense Department to round up and deliver to the VA all the medical records needed to document a service-related injury. It's a broken element that you didn't mention.
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