Slashdot Mirror


Patient Access To Electronic Medical Records Strengthened By New HHS Rules

dstates writes "The Department of Health and Human Services has released newly revised rules for the Health Information Privacy and Accountability Act (HIPAA) to ensure patient access to electronic copies of their electronic medical records. Several years ago, there was a great deal of excitement about personalized health information management (e.g. Microsoft HealthVault and Google Health). Unfortunately, patients found it difficult to obtain their medical records from providers in formats that could easily be imported. Personalized health records were time consuming and difficult to maintain, so these initiatives have not lived up to their expectations (e.g. Google Health has been discontinued). The new rules should address this directly and hopefully will revitalize interest in personal health information management. The new HIPAA rules also greatly strengthen patient privacy, the ability of patients to control who sees their medical information, and increases the penalties for leaking medical records information. 'Much has changed in health care since HIPAA was enacted over fifteen years ago,' said HHS Secretary Kathleen Sebelius. 'The new rule will help protect patient privacy and safeguard patients' health information in an ever expanding digital age.'"

10 of 53 comments (clear)

  1. About time but is it enough by Gim+Tom · · Score: 5, Interesting

    A recent experience in my family made me fully aware of how important immediate access to personal medical records can be and how difficult they can be to obtain at times.

    A family member had been hospitalized and surgery was indicated. However, the current CT image showed something that may contraindicate surgery if it was new, but would not do so if it was an artifact of a previous surgery many years before. The only way they could tell was to compare the current image with an image several years old, but after the prior surgery. There was such imaging done at a different hospital about 20 miles away about eight years prior and the doctor learned that they did have the image archived. However, the only way to get the image to him was for someone to drive to the hospital and bring a copy of it back on a CD. I made that trip and the CD showed that the suspicious object on the CT scan was an artifact from a surgery over a decade prior.

    This made me realize how important having one's own copy of complete medical records could be. It would be so easy to have them on even a small thumb drive and they could be encrypted for security. The real problem is getting the medical community to give the patient those records in electronic format, and that format should be an open and published format and not in any way proprietary.

    1. Re:About time but is it enough by Anonymous Coward · · Score: 4, Insightful

      As someone who develops medical records, let me tell you "good luck with that".

      As a newcomer to the field (with hundreds of competitors) fighting to carve a space for ourselves we're all for it, after all if you don't like your current system, an open record format makes it easy to import it into our system.

      Obviously, the established players aren't so happy with it, but there's one more party who's against it too: the doctors themselves. They don't realize it, but their own actions are fighting this tooth and nail. "Why can't I just dictate everything in a box?" "Why can't i just write it down and scan it in" "I don't want my chart to say Weight can't it just say W"?

      TL;DR: the format already exists, it's called PDF.

    2. Re:About time but is it enough by ColdWetDog · · Score: 4, Informative

      As a physician involved in this mess (and it's a mess), let me chime in and say that you're partially right and partially wrong (TL;DR - it's complicated).

      Yes, lots of health care providers (doctors, nurses and ancillary personell) absolutely hate change. There are doctors who are perfectly happy scribbling down a paragraph of acronyms and abbreviations and calling it a day. Then they get mad at the nurse because she can't figure out just what the hell the doc meant.

      Those people need to get put in a closet and only used in emergencies (fat chance). Then there are EHR providers that can't program anything harder than "hello world" without six months of testing. It should be fairly easy, for example, to input weights in pounds and convert it on the fly to kg (or stones or troy ounces for that matter). Instead you have input fields that are rigidly structured, and worse, fail in unspecified ways requiring you to re input the data. Those programmers need to be put in a closet an left there.

      The problem with patient data is that you don't know the level of understanding that you are shooting for. Do you dump everything out in Doctor Babble? Do you try to make it read at a 5th grade level? Do both? Something else?

      PDF is fine for data output that would be static - not so good if the patient wants the new provider to input it into another system. That's a difficult problem to solve. HL7 was supposed to be the standard that offered a solution to that, but, like most standards, it suffers from implementation problems.

      And the new gem:

      When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan.

      is going to really jam things up. Now you have to sort data on a whole new metric - who can see it. I predict this isn't going to work out well, although I understand the rationale behind it. I also understand how this is going to be abused - your doctor / healthplan doesn't see the fact that you paid for a script for 150 Vicodan. You'd like some more.... Whatcouldpossiblygowrong.

      --
      Faster! Faster! Faster would be better!
    3. Re:About time but is it enough by Gim+Tom · · Score: 2

      Thank you for your comments. I was aware of the multitude of problems that would have to be addressed to really do this effectively. Both of my parents had Alzheimer's, and prior to retirement in 2007 I was Network Engineer and Security Officer for a State Agency that handled PHI and was on a state wide HIPAA implementation team. A nightmare that still haunts me from time to time.

      I too was surprised that the image could not be transmitted electronically between the two hospitals. Some prior experiences with medical records may have influenced my opinion. When was in military service I hand carried my medical records when I moved permanently to a new base. That was back in the days of paper and film records. Latter, my employer had a large HMO (Kaiser) as the insurer for their employees and it was at the time that they were making the transition from paper to internal electronic records. Considering what I did I was very skeptical of how well it would work, but the transition was much smoother than expected and the advantages of every doctor in the network having immediate access to my complete medical record soon became very obvious.

      Earlier in my career I worked on design, implementation, and quality assurance of some large systems. I know that good systems can be built and can be designed to do what what the USER needs not what is easy for the designer or coder to make. However, this does not seem to be being done much any more. I suspect that part of the problem is that the developers never actually talk and work with the people who are going to use the system and don't really know what is needed.

    4. Re:About time but is it enough by ColdWetDog · · Score: 2

      There is some rational thinking behind parts of those policies:

      - In general, having a patient directly give a doctor records makes tampering with the record a real possibility. No real way to ensure that the record hasn't been modified or simply trimmed of data that the patient didn't want anyone to know or just simply thought wasn't relevant.

      - Some EHRs dump every cold and sniffle to the output. EHRs, especially on complex patients, suffer from a signal to noise problem. Unfortunately, the best way to deal with that is for a clinically trained person (doesn't have to be a physician) to review the chart and determine what's valuable. I can't see why you'd have to send the chart to each specialty to pull out the relevant data - that sounds like some committees got involved somewhere.

      - And, unfortunately, you're right. It's often easier / faster to just repeat the tests. This is seen by the Higher Powers as an unmitigated evil and the Source of All Financial Improprieties. It's likely that the feds are making a bigger deal about it than reality would indicate. It's a problem. It's not the Big Problem or even one of the Big Problems.

      --
      Faster! Faster! Faster would be better!
    5. Re:About time but is it enough by smpoole7 · · Score: 2

      As a patient involved in this mess, first, let me say that you sure are putting a lot of people in the closet. :)

      (And I heartily agree.)

      As a patient, what drives me crazy is that each health care provider wants you to fill out forms with the same questions. Each form is just different enough that I can't make a standard form and just take it with me. "Yes, I have high blood pressure (and you people are part of the reason, heh), yes, I've had surgery, my father had heart trouble and both parents have had cancer," and so on. Standardize the blooming form and let me fill it out once.

      This isn't an issue for some people, but my wife, just to name a good example, is one of terribly unlucky people who specializes in conditions that are uncommon. We often have to explain them, over and over again.

      Pseudo Tumor Cerebri, or Idiopathic Intracranial Hypertension -- hope I spelled that right -- is the best example, though she was also one of the youngest ever to need hip replacement because of avascular necrosis; in that case, Blue Cross insisted that she HAD to have been in an accident, because it just didn't happen to people her age. The form just said, "give the date of the accident and the name of the responsible party." I had to cram on that form: "NOT AN ACCIDENT."

      I have to be honest: I am NOT a fan of the Affordable Care Act, at all. I won't get into that here. But I'll agree that some form of standardization, and the availability of records, is badly needed.

      --
      Cogito, igitur comedam pizza.
    6. Re:About time but is it enough by dstates · · Score: 2

      And they will come back at you for a HIPAA privacy violation. Your scenario implies that to save IT complexity and expense, you are willing to risk patient confidentiality. You are not going to come across as a sympathetic defendant, especially when they say the only reason they were looking was to test the system security which they found wanting but were afraid to report to their greedy boss looking for an excuse to fire people.

      --
      Statesman
  2. What's not in the article by somarilnos · · Score: 4, Informative

    One thing it misses - the "Final Rule" part of it implies that this is it. It's not.

    The requirements from HITECH come in three stages - and this is the final rule for stage 2. There's an entire additional stage coming to further enhance what hospitals are doing to improve the quality of health care with technology.

    Of note, too, hospitals who meet these requirements get additional reimbursement from Medicare (Beaucoup bucks). Those that don't get reduced reimbursement from Medicare. So a lot of these rules aren't entirely mandates, but close enough.

  3. For what cost? by pubwvj · · Score: 3, Interesting

    A year or so ago our doctor switched over to electronic records. Now they want $75 per person for us to get a copy of our records as an administrative fee. All they need to do is print the records off of the computer. Minimal labor, minimal cost, not even very many pages. They're just using the fact that they're now electronic records as a means to collect more fees. It is greed on the doctor's part, plain and simple.

    1. Re:For what cost? by Trax · · Score: 3, Insightful

      I'm a doctor who is involved with the hospital's IT and EMR. The cost of switching over to electronic records is an already expensive proposition at the beginning and where the vendors get you is for maintaining the EMR on a yearly basis. Yes, it is minimal labor and not many pages but it is NOT minimal cost. Neither the private insurance nor medicare/medicaid reimburse the doctor for his or her use of the EMR and the patient is saddled with the cost.