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EHRs and Multi-Provider Use: Lessons from the VA

By AUSTIN FRAKTDurham VA Medical Center

With billions of dollars of stimulus funds available and the President and state governors promoting them, electronic health records (EHRs) are likely to become commonplace in the U.S. health care system. To be sure the transition will be complex and costly, but incentives provided by insurers and the federal government for quality improvement tied to EHR use will encourage providers to enter the brave new electronic world and bring their patients with them. While EHRs are praised for their promise to increase efficiency and safety, it is still an open question how much of those benefits will be realized or when.

There is one clear threat to the fruition of EHRs’ potential for quality improvement: the inability of various EHR systems to share information with one another. This potential limitation is highlighted prominently in a new Congressional Budget Office (CBO) report Quality Initiatives Undertaken by the Veterans Health Administration (August 2009), principally authored by Allison Percy of CBO’s National Security Division.

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Medical Data in the Internet “cloud” (part 2) – Data security

By ROBERT ROWLEY, MD

Robert.rowley

This is the second of a 3-part series, where we dig a little deeper into the questions of medical data in the Internet “cloud.” In the first part, we reviewed issues of data safety – how to guard against loss of data. In this second part, we will review data security – how to guard against data theft. The third part will focus on privacy and ensuring that only the right people can access the right data. 


DATA SECURITY

A review of issues around medical records ownership and protection shows that medical records are the property of those who prepare them (medical professionals), and not the property of those about whom they are concerned (patients), although patients generally have a right to review them, demand copies of them and demand their confidentiality. With limited and specific exceptions, consent is required in order to disclose such information to others. So, how does one create a framework of security that protects the confidentiality of such records against unauthorized breach?

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Why Standards Matter (1): The True Meaning of Interoperability

By DAVID C. KIBBE and BRIAN KLEPPER

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Americans are generally skeptical of words that otherwise intelligent and articulate people can’t pronounce.  “Interoperability,” like nu-cu-lar, is one of these. After a while, these words can take on a mystique all their own.

But interoperability is a hugely important word in the context of today’s ongoing debate about the use of EHR technology by physicians, hospitals, and patients too. The federal government is going to provide billions of dollars to encourage today’s fragmented health care providers to convert from mostly paper to mostly computerized information systems. It is critically important for these systems to talk with one another. We want health data to flow between and among these systems and to be, well, interoperable.  And it isn’t now.

So how can this word be so difficult to put into action?  Here’s a clue: a lot of people are confused about its meaning.

Continue reading “Why Standards Matter (1): The True Meaning of Interoperability”

Enthoven’s ABCDs and why that socialist Gingrich is wrong on standardized benefits

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By Matthew Holt

Here's Alain Enthoven's four part plan for fixing healthcare. As THCB regulars might guess, it's familiar and very sensible stuff. (Here’s the PDF)

A. Create an exchange with standardized plans, make individuals buy through the exchange and limit outside subsidies to the value of the lowest cost plan.

B. Tax health benefits (starting with those over the value of the cheapest plan)

C. Phase in the same system for Medicare

D. Phase out employer based insurance, giving everyone a voucher for the lowest cost plan based on a dedicated tax like a VAT.

Meanwhile in the LA Times, Newt Gingrich, who continues to smell blood in the Palin-infested waters, spouts BS that would destroy any sensible Enthoven-style reform. Apparently in Newt-world a regulated insurance package of standardized benefits is government bureaucracy run amok.

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Will Hospital Stocks’ Rally Continue?

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By DON JOHNSON

Since early July, most hospital companies’ stocks have been rallying in anticipation of relief from uncompensated care costs under proposed health insurance reform bills. On Wednesday, however, profit taking hit the stocks in a small way.

The rally got an added boost in the last week from positive earnings reports and guidance by Community Health Systems (CYH) and Universal Health Services (UHS).

Tenet Health Care (THC) Tuesday reported a small loss on increased revenues. Lifepoint Hospitals (LPNT) reported Friday. (After this post was originally published.)

In its conference call with securities analysts, Tenet said the health care reform bills before Congress would relieve it of the cost of uncompensated care of the uninsured and of the cost of charity care. Tenet didn’t say any more about the health insurance reform debate and how the legislation would affect the company.

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Shocking Google Health Back to Life

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By SCOTT SHREEVE, MD

I hope to use this post to motivate my good friends at Google Health into taking a much more public, visible, and proactive role in the health conversation. More importantly, it is a call to Google HQ to wake up to the opportunity within health care to leverage their current tools and technology to create a platform that others can use to enable the creation of a next generation health system.

The scene was familiar, but it didn’t take away the tragedy. A young motor vehicle accident victim was involved in a head on collision with a drunk driver. The blunt trauma to the chest had created a literal mish-mash of complex internal injuries. The ambulance crew had attempted multiple times enroute to obtain a pulse and the monitors were all flatlined from the field. They intubated the patient in the field, performed CPR enroute, and initiated a ATLS protocol which included shocking the patient en route. In the face of asystole (lack of heart movement) after blunt trauma to the chest, the indication is to literally crack the chest open (called a anterolateral thoracotomy), a serious medieval last ditch rescue effort to save a life.

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Medical Data in the Internet “Cloud” (part 1) – Data Safety

By ROBERT ROWLEY, MD

The question of data security
in a “brave new world” of cloud-based Electronic Health Records (EHRs),
Personal Health Records, and iPhone and other smartphone apps that
could transmit personal health information, has attracted the attention
of many. Web-based services – so-called “cloud computing” – are not inherently secure.
Such technology is focused more on widespread reach and
interconnectedness rather than on making sure that the connections and
the data are foolproof. Yet much of our personal information, such as
banking information, is housed electronically and accessed through the
web – we have become so accustomed to it that we seldom think very much
about it. Personal health information, moreover, is protected by law:
HIPAA, which is focused around physician and hospital-centered
recordkeeping, and now ARRA, which extends HIPAA-like protection to
patient-centered Personal Health Records as well.In a previous blog post,
we reviewed (at a high level) the ways in which special attention to
security and privacy can create what is needed to house personal health
information in a hosted, “cloud”-based setting. In this series of
posts, we will dig a little deeper into these questions. This first
part addresses the issues of data safety, and protection against loss
and “down-time.” The second part will address the question of security
between connections (making sure “the pipes don’t leak”). The third
part will focus on privacy and ensuring that only the right people can
access the right data.

Continue reading "Medical Data in the Internet "Cloud" (part 1) – Data Safety"

KP lawsuit doesn’t sniff quite right

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By Matthew Holt

It’s about time we had a fun Kaiser Permanente scandal, as it’s been a while, and it appears that they’re having some influence on the side of the angels in DC these days. And tracking vis HISTalk apparently there is one. You can wonder over to this blog to get the full rhetoric but basically it comes down to KP being sued by a former relatively senior techie in the Northern California region who has had a big time falling out with his boss.He has three main accusations.

1. KP kept a registry of dementia patients on an open internal network2. KP employees were dumping personally identified data in the trash3. KP was and is not tracking deductibles and was forcing their members to count up to them—presumably costing their members money for those who were paying cash when they’d already met their deductible.

So let’s parse these apart.

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Is “Cloud Computing” Right for Health IT?

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By ROBERT ROWLEY, MD

Robert.rowley

The announcement of Salesforce.com investing and coordinating development efforts with Practice Fusion has brought talk of “cloud computing” to the fore. Salesforce has been known as a leader in cloud computing, and moving healthcare IT to that “cloud” has raised questions by a number of observers. What, exactly, is “cloud computing?” Is it appropriate for health IT? What are the security issues and risks?

“Cloud computing” is a term described as a style of computing in which on-demand resources are provided as a service over the Internet. Software-as-a-service (SaaS) is a type of cloud computing, where users do not need to install or maintain any software themselves – simple Internet access and a browser are all that is needed.  Users do not need to have knowledge of, expertise in, or control over the technology infrastructure in the “cloud” that supports them – the Internet site (e.g. Practice Fusion) provides a unified dashboard to the user, and works out the technical issues of presenting that data in the background.Continue reading…

Shaking my fist at Jon Cohn

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By Matthew Holt

Today Stephen Hawking gets the Presidential Medal of Freedom. Not bad for a guy the British NHS had its “death panel” kill off in the 1960s.  Meanwhile the real star of the day is not the guy who was on Canadian TV yesterday, but instead it’s The New Republic health care guru (and blogger at The Treatment) Jon Cohn who was just great on the Colbert —even revealing to Colbert that his insurance policy included death panels too. Colbert of course thought that this meant he could have his staff put to death.

The Colbert Report Mon – Thurs 11:30pm / 10:30c
Jonathan Cohn
www.colbertnation.com
assetto corsa mods