Congress' passing of a federal medical privacy law in the 1990s was hailed as a new level of protection for patients nationwide. But even though the government has received about 34,000 complaints of privacy violations since in the last five years, only a handful of defendants have been criminally prosecuted. Critics say the government's approach may be too lenient, especially when medical records are increasingly being shifted from file folders to computers. The goverment's current approach focuses on getting providers to correct violations.
A recent essay in Health Affairs (Dec. 11, 2007), "The State of Regional Health Information Organizations: Current Activities and Financing," likely won't make it to CNN. Nevertheless, for IT proponents, this is essential reading. The report suggests that many--perhaps even most--data exchanges, or RHIOs, are not going to survive. Among 145 surveyed RHIOs, nearly one in four was defunct. Only 20 were exchanging clinical data.
Despite federal support for the idea, data exchanges face plenty of hurdles. The industry is pouring plenty of effort into them. Perhaps that's why, when the well-known Santa Barbara data exchange folded up shop last year, you could practically hear the collective sigh. After all, isn't data sharing the whole point of IT? And ultimately, if you can't make it work beyond the boundaries of one hospital, what's the point?
Well, for my money, many data exchanges are the cart before the horse. Local hospitals and medical groups need to get their own acts together first before they can even begin thinking about trading data with others. I've interviewed numerous industry leaders involved with data exchanges. They invariably point to politics, not technology, as the challenge. To be sure, they are intertwined. Take the cross-community master patient index. Before that hurdle can be approached, there needs to be a community consensus--at least on the need, if not the solution.
One IT industry group, the National Alliance for Health Information Technology, is attempting to spark that consensus. The group ended 2007 with a renewed call for a national patient identifier. "One of the biggest obstacles to progress in developing an interoperable national health information network remains reaching agreement on how to correctly match medical information to patients while guarding their privacy," says Scott Wallace, Alliance president and chief executive officer.
A national identifier may be a lofty goal, especially when you reflect back on the Health Insurance Portability and Accountability Act of 1996. The original law called for a national patient identifier, but the provision generated so much controversy it was scrapped. The need, however, has not disappeared. The patient identifier is just one of many political roadblocks that can block data sharing, regionally or nationally. It is one of many horses needed to pull the cart. Kudos to NAHIT for recognizing that.
P.S. This issue marks the completion of the first year of HealthLeaders IT. Thanks to the many people who have commented on my essays, contributed their own articles, and directed me to newsworthy stories. I look forward to serving you in the year ahead.
First I must confess that I’m a Gen-X’er through and through (I can hardly remember life without the Internet). I have grown up with it and through the years it has metastasized into every fiber of my being. Like anyone else, I have to ‘unplug’ every now and then but for the most part I have only positive things to say about it.
Not long ago, I went to Africa to tackle Mt. Kilimanjaro. Perhaps the most significant aspect of this trip is how it was planned--yep you guessed it--on the Internet. Although I live in Arkansas, I was joining up with a team out of Kentucky. You name it and we accomplished it online. We researched the route, booked our guide (who lives in Africa), booked hotels and plane tickets, paid for the trip, communicated with our ground transportation there, researched and bought gear, communicated responsibilities, and organized a visit with local friends. In short order, we accomplished virtually everything online. We didn’t have to worry about catching people on the phone. . .the asynchronous aspect of online communication was perfect for our on-the-go lifestyles.
As I was cruising at 39,000 feet crossing the ocean, I realized I forgot one important question--the medication Diamox. Facing the prospect of a climb to 19,340 feet (Kili’s summit), I had been on the fence of using Diamox to help combat potential altitude sickness. I simply forgot to make the decision before I left. No problem. I figured I still had plenty of time. Once I hit the ground in Amsterdam, I would send an e-mail to my primary care physician and get his response once I hit African soil. That would give me two days in Africa to track down some Diamox if he felt it was the right move for me. It was a great plan...except for one thing. My PCP is not accessible through e-mail. The only way to contact him is the phone and that is typically an exercise in futility even when we are on the same continent.
My Kilimanjaro trip gave me plenty of time to ponder this question: Why does my PCP seem to be so slow in adopting email and other forms of information technology? Although I’m a patient, it seems to me my physician and his nurses would be attracted to the asynchronous aspect of the secure e-mail. It could give him the ability to take care of simple, non-emergent questions on his time and in turn give great service to me, his patient. He would be able to provide me links to quality materials that can help give me the confidence to make good decisions. It could also serve to help me make more efficient use of clinic time--only going to see him when I truly need to be there (that could save me some co-pays). To take it a step further, I can only imagine having the ability to go online and request prescription refills, make appointments, download forms prior to a visit, review follow-materials, get lab results, and communicate with office staff. As a patient I would be very attracted to a physician office with such abilities and I imagine it would help his clinic be significantly more efficient. With services like these, I believe my PCP could easily attract new patients and perhaps a better set of patients.
Implementing information technology into an everyday medical practice obviously has its challenges. I certainly don’t pretend to have answers to all those hurdles. I’m just a lone consumer with one desire--good service. As time goes on, I will expect my PCP to move forward with the right approach. In my opinion one small technological step for my PCP would be a giant leap in service for his patients. Remember, I’m an aging Gen-X’er . I expect speedy, convenient answers to everything (thanks Google) and now I’m starting to have health questions. Good thing I didn’t need Diamox.
The American Health Information Management Association has published a book that probes issues surrounding medical identity theft. The book is targeted to health information management professionals, privacy and security officers, and risk managers. It covers preventive policies, internal and external threats, risk and exposure mitigation, HIPAA compliance, and best practices to resolve incidents.
Now in its 17th year, the Aesculapius Award honors excellence in health communication through World Wide Web sites and public service announcements.
The deadline for receipt of entries for the 2008 Aesculapius Award competition is September 5, 2008. Any WWW site or PSA that promotes public awareness, understanding or involvement in health, health care or health policy is eligible. Entries are judged by panels of communications and health professionals. Past honorees include the American Dietetic Association, the American Institute for Cancer Research, American Lung Association, and Texas Heart Institute. The contest is sponsored by the Health Improvement Institute. For information, visit www.hii.org.
Diagnosing heart disease in women is sometimes difficult, but molecular PET and SPECT imagin is beginning to contribute to resolving the problem, writes Johannes Czernin, MD, a professor of Molecular and Medical Pharmacology at UCLA. PET/CT's ability to correct for soft tissue attentuation, and its excellent spatial and temporal resolution allows it to quantify blood flow in the various regions of the heart. With SPECT/CT, appropriate soft-tissue attentuation is now possible, reducing the number of false positive findings, Czernin writes.