In May 2008, when the Roper poll asked a random sample of Americans “If your medical records and personal health information, such as test results and doctor’s instructions, were available to you online, how likely do you think you would be to access those records and information?” Sixty-five percent said they were somewhat, very, or extremely likely to access their records. In the February 2009 stimulus bill, Congress asked the Health IT Policy Committee “to facilitate secure access by an individual to such individual’s protected health information” and “… to facilitate secure access to patient information by a family member, caregiver, or guardian acting on behalf of a patient…”
CMS now proposes that in 2014, hospitals receiving the billions of dollars of Stage 2 federal EHR incentive payments must provide patients with electronic access to their hospital discharge information within 36 hours of leaving the hospital. CMS is not only asking hospitals to give patients reasonable access to their own current and actionable health information, but it’s also trying to help patients and families address the wasteful and dangerous rates of hospital readmission and failures in continuity of care that haunt American healthcare. But the American Hospital Association is arguing that “Establishing a web portal or other mechanism to provide patients online access to this magnitude of data is unrealistic and premature.”
The employers I work with have many concerns about the state of US health care – but near the top is the persistent idea that hospitals and doctors own and control health care information. Employers are not allowed to find out the prices they are paying for care for their employees; they can’t find out which doctors get better outcomes; they can’t find out which ones use inappropriate treatments (like some of those recently cited in the Choosing Wisely campaign). Now their employees are told that they can’t expect to get information about their own diagnoses, test results, and discharge medications for 30 days after leaving the hospital – that’s after leaving a hospital with certified electronic health records paid for by taxpayer dollars.
If there are legitimate concerns about the types or amounts of data to be released, or a need to control highly sensitive information, then AHA should identify those and allow CMS to make technical corrections. But telling the tweeting, app-downloading, online banking, travelling, and prescription filling American consumer of 2014 – five years after Congress highlighted the need, eleven years after the Veterans Health Administration released my Health eVet (with a million users by 2010) – that she can’t see her medical records online?? That jeopardizes patient safety, limits patient engagement in their care, and is certainly not deserving of federal subsidy.
CMS Proposed Information to be Provided to Patients after Hospital Discharge:
·Admit and discharge date and location.
·Reason for hospitalization.
·Providers of care during hospitalization.
·Problem list maintained by the hospital on the patient (verified to be up to date)
·Relevant past diagnoses known by the hospital.
·Medication list maintained by the hospital on the patient (both current admission and historical, and verified to be up to date).
·Medication allergy list maintained by the hospital on the patient (both current admission and historical, and verified to be up to date).
·Vital signs at discharge.
·Laboratory test results (available at time of discharge).
·Care transition summary and plan for next provider of care (for transitions other than home).
·Discharge instructions for patient.
·Demographics maintained by hospital (gender, race, ethnicity, date of birth, preferred language and smoking status).
David Lansky, PhD is the CEO of the Pacific Business Group on Health