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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Sometime before the end of March, the Office of the National Coordinator for Health Information Technology will be releasing new tools to help providers wanting to digitize the process of obtaining patient consent before releasing their medical records to regional or statewide health information exchanges.
The tools, developed in a pilot project in western New York, include educational videos that can be shown to patients on tablet computers, which also run software that enables patients to digitally record their consent (or not). The videos were developed following a random survey of western New Yorkers and several focus group meetings, with the aim of ascertaining what patients might want to know before they commit to making their electronic records available to the exchange.
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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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Four high-ranking members of Congress wrote a letter to HHS Secretary Kathleen Sebelius (PDF) last week urging her to halt federal electronic health-record incentive payments to hospitals and office-based physicians because of an alleged lack of interoperability spawned by weak rulemaking.
At the $7.1 billion mark in an estimated $27 billion program, what's up with that?
How about an honest difference of opinion?
Nope.
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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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