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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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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Where's Epic?
In his keynote address Tuesday, cardiologist and healthcare information technology futurist Dr. Eric Topol asked that question.
The context was a much-ballyhooed consortium of five health IT vendors announced Monday at the Healthcare Information and Management Systems Society conference in New Orleans.
They joined hands to launch a not-for-profit consortium called the CommonWell Health Alliance, with the stated aim of improving health information interoperability. The founding members of the consortium are Allscripts Healthcare Solutions, Athenahealth, Cerner Corp., Greenway Medical Technologies, and McKesson Corp., along with its connectivity unit RelayHealth. At the launch, the founders said the consortium is open to everyone.
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Give RAND Corp. researchers Arthur Kellermann and Spencer Jones a gold star for integrity for pointing out the predictions in a totemic 2005 RAND report haven't quite panned out yet.
Their latest analysis of the value of health IT, published in the January edition of Health Affairs, notes that the billions of dollars in annual savings from the adoption of health IT systems projected by RAND peer Richard Hillestad in 2005 haven't materialized.
The Hillestad study was often cited by EHR advocates, including a few federal legislators, as an economic argument for promotion of health IT.
What seems to be getting lost in some recent news reports and follow-up discussions about both RAND reports, however, is that while the predictions of Hillestad and his team “have not yet come to pass,” it is not because their cost-savings projections were flawed, according to Kellermann and Jones, but rather because of “sluggish adoption of health IT systems,” EHRs that are “neither interoperable nor easy to use,” and providers who fail to re-engineer their care process to best leverage the IT systems they have.
Some analysts have interpreted Kellermann and Jones' report as RAND crawfishing.
Hillestad, now retired, says he has been keeping up on the controversy and is standing firm.
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We probably won't know until late January the full-year numbers for 2012 on the EHR incentive payment program, but with three quarters of the year reporting, 2012 already is shaping up to be a banner year in health information technology.
Here's what I mean.
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How can one respond to the news of four more Republicans writing another letter to HHS Secretary Kathleen Sebelius about the federal electronic health-record incentive payment program other than to invoke Ronald Reagan?
"There you go again."
In their Oct. 17 letter (PDF), Sens. Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Pat Roberts (R-Kan.) and John Thune (R-S.D.) weren't as lopsided in their argument or as inflammatory in their rhetoric questioning the program as were their House counterparts, who, in an Oct. 4 letter accused the feds of "padding the numbers" of EHR adopters while alleging the program will squander taxpayers' dollars.
The senators in their letter also did what those House members should have done—in claiming thatthey didn't understand what was happening with the ongoing federal health information technology initiative, they asked for a meeting with the pros at HHS to try and get some answers.
That said, it's at least worth noting that, like their House counterparts, none of these four senators voted for the American Recovery and Reinvestment Act of 2009, which created the EHR incentive payment program.
And, like their House colleagues, their approach—inadvertently or intentionally, if anyone takes it seriously—could cause serious damage to the program.
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A million and a half dollars here, a million and a half dollars there, and pretty soon, you're talking real money—even in the healthcare industry.
The Office for Civil Rights at HHS on Monday announced a settlement agreement for $1.5 million with a venerable Massachusetts healthcare organization, Boston-based Massachusetts Eye and Ear Infirmary and its affiliated medical group, Massachusetts Eye and Ear Associates, over alleged HIPAA security-rule violations. They involve the reported theft of an unencrypted laptop bearing the records of 3,621 individual patients back in 2010.
I did a quick check of the OCR's "wall of shame" website and found MEEI was getting whacked on its second trip to the rodeo.
The privacy and security enforcers at the OCR, after a long, long period of quiescence, appear to be stepping up their enforcement efforts and availing themselves of the stiffer penalties that Congress provided in the American Recovery and Reinvestment Act's revisions to the Health Insurance Portability and Accountability Act's privacy and security rules.
And while the OCR is allowing MEEI to pay the fine on the installment plan, even $500,000 a year is a lot of money—a point not lost on MEEI itself.
In a statement, MEEI said that because no one appears to have been harmed, it was "disappointed with the size of the fine, especially since the independent specialty hospital's annual revenue is very small compared to other much larger institutions that have received smaller fines."
I'll bet.
But it's hard to know what the government was supposed to do other than to take out its proverbial 2x4 and start whacking to get the healthcare industry's attention.
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