California health regulators have connected 14 more people affiliated with UCLA Medical Center to the improper viewing of celebrity medical records, bringing the number of current and former workers apparently implicated in the snooping scandal to 68. Each of the employees had signed a confidentiality agreement after being hired promising to access patient information "only in the performance of assigned duties and where required or permitted by law," according to investigators. UCLA officials have appointed a committee to review privacy policies and have pledged to retrain staff and improve computer systems to increase security.
The Illinois Department of Healthcare and Family Services has launched the Medical Electronic Data Interchange, which keeps data such as medication and immunization histories, lab orders and hospitalizations for Medicaid patients. In addition to keeping track of Medicaid patient data, officials say the database also helps reduce redundant care, especially when someone is seeing more than one doctors.
The Georgia Department of Community Health has awarded a $5.2 million contract to the IBM Corp. to build a Web site for state consumers in an effort to help them make more informed healthcare decisions. The Web site, scheduled to go online in October, will offer information about hospitals and where various procedures are performed. The Web site will also permit the comparison of hospitals in terms of cost, quality, customer service scores, and other related information.
Identity thieves are using different methods to steal patient information from doctors' offices, clinics and hospitals, lawyers and privacy experts say. Legal experts say the thieves use medical information to get credit card numbers, drain bank accounts or falsely bill Medicare and other insurers. Although hospitals and other medical settings often encrypt data and take other steps to protect privacy, people are acting with increasing sophistication to steal information, attorneys say.
Kaiser Permanente has announced that all of its 8.7 million enrollees in nine states and the District of Columbia have access to an outpatient electronic health record Kaiser says is the world's largest privately funded EHR. All of Kaiser's 13,000 physicians nationwide now have electronic access to patients' medical records in the system's 421 medical offices and clinics, said Kaiser officials. Kaiser's overall costs for the EHR installation are approximately $4 billion, including $1 billion for maintenance.
The U.S. is facing a crisis with the quality, disparity and cost of our healthcare services. We have a fragmented healthcare delivery system that functions with silos of data.
Creating a cohesive healthcare system is exactly what we need to meet the common objective of delivering high-quality, cost-effective, and timely patient care. Luckily, we have a model to follow directly to our north: Canada.
In Canada, the 14 federal, provincial and territorial Deputy Ministers of Health—as well as regional healthcare authorities and other healthcare organizations and information technology vendors and suppliers—are all working together toward a common goal: to provide 50% of Canadians with access to a secure electronic health record by 2010.
How does a country with more than 33 million people come to an agreement and move forward with a country-wide healthcare IT system? Easy—in Canada, the healthcare IT infrastructure functions like a business unit. To move forward with EHR adoption, this representative group did research, made a decision, secured funding, and began implementation.
Here in the U.S. we don’t make decisions nearly this quickly. We’ve been churning over patient identification, for example, for more than a decade. Churn costs money; churn costs development time and effectiveness; ultimately, churn costs lives. Let’s take a lesson from our northern neighbors and get the job done.
Following Canada’s lead
Spearheading the initiative is Canada Health Infoway, Inc., an independent not-for-profit organization that invests with public partners across Canada to implement and reuse compatible health information systems.
One of the first steps in implementing this nationwide project—and one of the most pivotal aspects of its success—was to create a common blueprint, or electronic health record “info-structure.”
This blueprint includes:
Client registry systems, similar to enterprise master person indexes and record locator services that commonly support regional health information organizations (RHIOs) in the U.S. domain repositories
A longitudinal record service, to coordinate data across multiple domains and registries
Standardized common services and communication services to sustain privacy, security and overall interoperability
Standardized information and message structures and standardized business transactions to support information exchange
In this model, each info-structure interoperates with others in a peer-to-peer manner through the Health Information Access Layer (HIAL). The data-sharing journey begins and ends with the HIAL.
Watch and learn
Let’s learn from Canada’s success and follow a business-model approach.
First, of course, let’s have a blueprint. Second, let’s invest wisely and strategically—and measure results to monitor that investment. The Canadian government invested $1.6 billion in the initiative. The government entities knew they needed to see value from their investment, so they funded a small number of targeted areas rather than spreading their investment across a range of initiatives.
The Canadian government also demands results. Each year, Infoway is accountable for reporting status and success metrics. Again, this mirrors the way a business unit would operate.
Third, no churning. Period. Let’s make decisions and start to move.
Ron G. Parker, Director of Architecture within the Solution Architecture Group at Infoway, added this advice: “It is important to invest in a structured collaboration model that ensures all key stakeholder communities are represented in the process of standardization.”
He explains that standardization of business processes in any industry requires a three-level simultaneous “sell”: To the executive decision makers/sponsors, to the people with the industry domain expertise, and to the people that implement the business processes directly.
“Only if everybody in this ‘stack’ knows the other groups are good-to-go, can you have success,” he says.
I love Canada. I just don’t want to move there. (In fact, I’d like to retire in Montana.) My hope is that we’ve got a nationwide healthcare IT system in place by that time. Needless to say, the clock is ticking. Can’t we follow someone else’s lead?
Lorraine Fernandes is VP, Healthcare Industry Ambassador at Initiate Systems. She frequently on topics such as RHIOs, health data exchange, patient identification issues, and best practices for master person index (MPI) cleanup. She serves on committees and workgroups for HIMSS, AHIMA, and Health Initiatives. She can be reached atlfernandes@initiatesystems.com.
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