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 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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The great thing about data is if you play with it, it tells you stories.
Then the question is, are the stories true?
We know from several empirical studies that a digital divide exists between large and urban healthcare providers on one hand and small and rural providers on the other.
What we don't know quite yet—empirically—is whether the federal electronic health-record system incentive payment program has begun to bridge that divide. My somewhat educated guess would be, yes, but that's not good enough. We need to know for sure.
Last week, after downloading and analyzing data from the CMS and the Office of the National Coordinator for Health Information Technology about Medicare meaningful users and the EHRs they use, what jumped out at me was that Computer Programs and Systems Inc., or CPSI, had taken over the top spot from Epic Systems among all vendors to hospitals that have used complete EHRs to meet their meaningful-use targets. CPSI focuses on small hospitals.
Toss in No. 5 on the list, Healthland—another vendor serving small hospitals—and between the two of them they provide health IT systems to 382 hospitals, or 28% of the 1,381 hospitals that have become Medicare meaningful users with complete EHRs. Add in Meditech, which also markets to small hospitals, although not to the degree that CPSI or Healthland does, and you account for 574 hospitals and 42% of the complete EHR category.
Those numbers should not be surprising, given that a little more than half (2,561) of all non-federal community hospitals (4,985) have fewer than 100 beds, according to American Hospital Association statistics.
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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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