EHR's - Does this make sense?

chanel

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Jun 8, 2009
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Dr. David Blumenthal, the Obama administration's National Coordinator for Health Information Technology, said on Tuesday that patients can choose to omit procedures such as abortions and positive HIV tests from the electronic health records (EHR) that every American is supposed to have by 2014 under the terms of the economic stimulus law that President Barack Obama signed last year.

CNSNews.com - Obama's Electronic Health Records Czar: HIV Status and Abortions Need Not be Included

I read the article twice and still don't get it. He seems to be saying that the EHR only needs to contain the information that the patient wants in there - which is fine with me. However, if people choose not to disclose that info to the govt., what's the friggin point?
 
Dr. David Blumenthal, the Obama administration's National Coordinator for Health Information Technology, said on Tuesday that patients can choose to omit procedures such as abortions and positive HIV tests from the electronic health records (EHR) that every American is supposed to have by 2014 under the terms of the economic stimulus law that President Barack Obama signed last year.

CNSNews.com - Obama's Electronic Health Records Czar: HIV Status and Abortions Need Not be Included

I read the article twice and still don't get it. He seems to be saying that the EHR only needs to contain the information that the patient wants in there - which is fine with me. However, if people choose not to disclose that info to the govt., what's the friggin point?


I think the health records of anyone only really need to contain information that would effect them in the future....seems to me HIV status would be an essential piece of information, but abortion....not so much:

But I'm only an amature gynecologist.:redface:
 
What about smoking? BMI's? High cholesterol? If insurers are going to do risk assessments and charge accordingly, wouldn't unprotected sex - abortions; STD's, etc. be considered risky behavior?

I'm fairly certain that when this becomes reality that I will inform my docs that I want NOTHING in my health report except name, address and SS#.
 
What about smoking? BMI's? High cholesterol? If insurers are going to do risk assessments and charge accordingly, wouldn't unprotected sex - abortions; STD's, etc. be considered risky behavior?

I'm fairly certain that when this becomes reality that I will inform my docs that I want NOTHING in my health report except name, address and SS#.

What Insurers?

Why would Nationalized Healthcare be concerned with "risk assessments and charge accordingly?"
 
Dr. David Blumenthal, the Obama administration's National Coordinator for Health Information Technology, said on Tuesday that patients can choose to omit procedures such as abortions and positive HIV tests from the electronic health records (EHR) that every American is supposed to have by 2014 under the terms of the economic stimulus law that President Barack Obama signed last year.

CNSNews.com - Obama's Electronic Health Records Czar: HIV Status and Abortions Need Not be Included

I read the article twice and still don't get it. He seems to be saying that the EHR only needs to contain the information that the patient wants in there - which is fine with me. However, if people choose not to disclose that info to the govt., what's the friggin point?

“That is between the doctor and patient,” Garrett wrote. “The EHR incentive program is a voluntary program. If a physician chooses to participate, they are not required to record any specific type of health information and the physician needs the patient's consent in order to record any of their personal health information. As with all medical records, protecting the privacy of patients' heatlh information is a top priority and informational privacy will continue to be protected as EHRs become more widely used.”

The “incentive program" Garrett refers to is the system of bonus payments the government will make to health care providers that implement EHRs by 2014. Garrett did not mention the penalty system that diminishes a health-care provider's Medicare and Medicaid payments if it does not comply with the EHR mandate by 2014. As the January 13, 2010 edition of the Federal Register noted: "Section 1848(a)(7) of the Act provides that beginning in CY 2015, EPs who are not meaningful users of certified EHR technology will receive less than 100 percent of the fee schedule for their professional services."

According to CMS’s own regulations issued on July 13, doctors and hospitals must demonstrate “meaningful use” of EHRs to qualify for federal subsidies before 2014.

Among the regulations that Dr. Blumenthal issued last week for health-care providers seeking to demonstrate that they are engaging in “meaningful use” of EHRs is that they: “Maintain an up-to-date problem list of current and active diagnoses."

The regulations also require the EHRs to include a patient's "problem list" as well as "procedures."

What a "problem list" must entail is defined in separate federal regulations – referenced in those issued by Dr. Blumenthal on July 13. These regulations say such a list will include: “(i) Diseases. (ii) Injuries. (iii) Impairments. (iv) Other health problems and their manifestations. (v) Causes of injury, disease, impairment, or other health problems.”

"Procedures" are defined as actions taken with regard to: “(i) Prevention. (ii) Diagnosis. (iii) Treatment. (iv) Management,” of those things listed on the problems list.

I'm confused. It says the info in the EHR is between the patient and doctor, that they decide what is or isn't included. It says the EHR program is voluntary, no specific info is required to be included in the records and the doctor needs the patients permission. If the doctor chooses not to participate, they get penalized by less than 100% of Medicare/aid payments. Ok. But then it says that the EHR must include a patient's 'problem list'. No specific info is required . . . except for the specific info that is required? What if the doctor wants to list this but the patient doesn't?
 
Exactly zoom. I don't know if this is a poorly written article or the EHR component of the HC bill was poorly explained. I'm going to side with the latter.

And Samson - of course insurers (or the eventual govt. UHC) is going to use this info to set premiums. Why else would anyone need it except the doctor who already has it?
 
And Samson - of course insurers (or the eventual govt. UHC) is going to use this info to set premiums. Why else would anyone need it except the doctor who already has it?

I don't think there will be premiums with UHC....at least not for everyone.
 
UHC is probably ten years down the road, doncha think?

There are many people who argue that smokers and fat people should have to pay more. But I'm saying so should drug addicts and whores. Or are they a protected class now? Hard to keep up...
 
UHC is probably ten years down the road, doncha think?

There are many people who argue that smokers and fat people should have to pay more. But I'm saying so should drug addicts and whores. Or are they a protected class now? Hard to keep up...

Under UHC, of course addicts, whores, the mentally ill, and every sort of self-inflicted ailment will be covered.

Why else would we have UHC?
 
I know they'll be covered, but shouldn't their insurance cost more if that's the way they do it? In fact, doesn't it work that way now with "high risk policies" for people with HIV and cancer and what not?
 
I know they'll be covered, but shouldn't their insurance cost more if that's the way they do it? In fact, doesn't it work that way now with "high risk policies" for people with HIV and cancer and what not?

Yes, that is the way it works now....hence the real aggregate recipients for UHC: The stupid and irresponsible that cannot afford health insurance.

Of course, the facade is that poor families where little Johnny has Leukimia cannot afford healthcare. The fact that a Pregnant Crack Ho cannot afford healthcare doesn't sell UHC.
 
So true.

I may dig a little deeper on this. I still feel people should not disclose any info to the govt. that they don't need to . Especially those that are paying their own way.
 
I read the article twice and still don't get it. He seems to be saying that the EHR only needs to contain the information that the patient wants in there - which is fine with me. However, if people choose not to disclose that info to the govt., what's the friggin point?
So true.

I may dig a little deeper on this. I still feel people should not disclose any info to the govt. that they don't need to . Especially those that are paying their own way.

First, note that there's a thread on the meaningful use regulations directly below this one (well, before I bump this one by responding to it). It has additional information on this topic.

That said, it sounds like you're proceeding here on the assumption that the goal of EHR adoption is to give the government access to your information. It's not. The government (whether you're defining that as the federal government or state) doesn't see this information. An electronic record is subject to the same privacy rules as a paper record--partly those are set by federal law, though state law supercedes the federal privacy laws if the state law is stricter.

The point is to get providers using electronic records and exchanging information to improve quality of care and cut costs (e.g. by better coordinating care, reducing medical errors, substantially reducing time and transaction costs, etc).

What about smoking? BMI's? High cholesterol? If insurers are going to do risk assessments and charge accordingly, wouldn't unprotected sex - abortions; STD's, etc. be considered risky behavior?

That kind of rating won't be happening anymore starting in 2014 (with the exception of tobacco use, in which case your premiums for a given plan can be up to 50% higher than those of a non-smoker buying the plan).

I'm confused. It says the info in the EHR is between the patient and doctor, that they decide what is or isn't included. It says the EHR program is voluntary, no specific info is required to be included in the records and the doctor needs the patients permission. If the doctor chooses not to participate, they get penalized by less than 100% of Medicare/aid payments. Ok. But then it says that the EHR must include a patient's 'problem list'. No specific info is required . . . except for the specific info that is required? What if the doctor wants to list this but the patient doesn't?

Yes, the EHR incentive program is voluntary. It's a system of incentive payments to Medicare and Medicaid doctors and hospitals who start using high-functioning EHRs, it's not a mandate (the state of Minnesota, on the other hand, passed a law in 2008 requiring universal use of EHRs in the state by 2015). No doctor has to participate, though as you noted Medicare doctors will see small reductions in the physician fee schedule if they're still using paper in a few years.

The Stage 1 requirement for the problem list is: "More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data."

It doesn't require a problem list for every patient seen by a provider (though I don't know why you'd want an incomplete or inaccurate medical record), nor does it explicitly require comprehensiveness since it merely requires one item. Things like HIV status are generally have a special status as sensitive information in state law that grants them extra privacy protections.

Exactly zoom. I don't know if this is a poorly written article or the EHR component of the HC bill was poorly explained. I'm going to side with the latter.

Just as a sidenote, the EHR incentives aren't part of the health care bill. They're from the HITECH Act, which passed in February of 2009.

And Samson - of course insurers (or the eventual govt. UHC) is going to use this info to set premiums. Why else would anyone need it except the doctor who already has it?

Other doctors. One of the primary aims of health information exchange is to get your information to the person who needs it when they need it--be that in emergency situations or if you happen to go to someone other than your usual provider, if you're out of state, etc.


I know they'll be covered, but shouldn't their insurance cost more if that's the way they do it? In fact, doesn't it work that way now with "high risk policies" for people with HIV and cancer and what not?

Starting in 2014, insurers won't be able to price for risk, except in a very limited way based on age and tobacco use (with other rate variations allowed for family size and geography). What will happen instead is risk adjustment, administered by the states. Risk pools that have high-than-average risks will get a payment to offset the additional financial strain they're taking on.
 
First, note that there's a thread on the meaningful use regulations directly below this one (well, before I bump this one by responding to it). It has additional information on this topic.

That said, it sounds like you're proceeding here on the assumption that the goal of EHR adoption is to give the government access to your information. It's not. The government (whether you're defining that as the federal government or state) doesn't see this information. An electronic record is subject to the same privacy rules as a paper record--partly those are set by federal law, though state law supercedes the federal privacy laws if the state law is stricter.

And we all know the government never ever gets its hands on anything it is not supposed to because everyone who works for the government is not only scrupulously honest, they never make mistakes either.

The point is to get providers using electronic records and exchanging information to improve quality of care and cut costs (e.g. by better coordinating care, reducing medical errors, substantially reducing time and transaction costs, etc).

Then why make them contingent on a patients permission, and then not require them to have any information? I think you are arguing against yourself here, something supporters of government intervention almost always end up doing.

If someone can opt out of EHRs then the doctor will be required to keep paper records for that person, and for everyone else in case the electronic system fails at a crucial moment. He will, additionally, be required to keep EHRs on some patients, thus increasing his costs for those patients, hence the incentive program from the government to make EHRs more attractive in an attempt to offset those obvious extra expenses, unless you are a government employee who only sees what the government wants you to see.

The only possible way EHRs will decrease costs is if they totally replace paper, something this law claims will not happen. Go try to sell your snake-oil somewhere else, I am not buying.

That kind of rating won't be happening anymore starting in 2014 (with the exception of tobacco use, in which case your premiums for a given plan can be up to 50% higher than those of a non-smoker buying the plan).

Which will actually increase costs for healthy people to pay for the inability to actually charge the people that cost more more. How can that possibly be a bad idea?

Yes, the EHR incentive program is voluntary. It's a system of incentive payments to Medicare and Medicaid doctors and hospitals who start using high-functioning EHRs, it's not a mandate (the state of Minnesota, on the other hand, passed a law in 2008 requiring universal use of EHRs in the state by 2015). No doctor has to participate, though as you noted Medicare doctors will see small reductions in the physician fee schedule if they're still using paper in a few years.

Not a mandate at this point in time.

The Stage 1 requirement for the problem list is: "More than 80% of all unique patients seen by the EP or admitted to the eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) have at least one entry or an indication that no problems are known for the patient recorded as structured data."

It doesn't require a problem list for every patient seen by a provider (though I don't know why you'd want an incomplete or inaccurate medical record), nor does it explicitly require comprehensiveness since it merely requires one item. Things like HIV status are generally have a special status as sensitive information in state law that grants them extra privacy protections.

I thought you said it wasn't mandated. How can it require that doctors have 80% patient participation and still not be mandated?

Just as a sidenote, the EHR incentives aren't part of the health care bill. They're from the HITECH Act, which passed in February of 2009.

Does that make them a good idea, or a bad one?

Other doctors. One of the primary aims of health information exchange is to get your information to the person who needs it when they need it--be that in emergency situations or if you happen to go to someone other than your usual provider, if you're out of state, etc.

Yet they are not required to have any information at all. Kind of defeats the entire purpose of the things, doesn't it? And just wait for the first lawsuit that comes about because someone grabbed an EHR form someone else, and the doctors give the wrong treatment as a result. My guess is that without massive tort reform EHRs will be dead before they start because hospitals will not want to deal with the liability incurred as a result of relying on them.

Starting in 2014, insurers won't be able to price for risk, except in a very limited way based on age and tobacco use (with other rate variations allowed for family size and geography). What will happen instead is risk adjustment, administered by the states. Risk pools that have high-than-average risks will get a payment to offset the additional financial strain they're taking on.

If they cannot price for risk at all, why will we need high risk pools? Looks to me like someone did not think out all the implications of what they were saying, again.

Nothing to see here, move along.
 
Then why make them contingent on a patients permission, and then not require them to have any information? I think you are arguing against yourself here, something supporters of government intervention almost always end up doing.

What are you referring to? Where did I say patients had to opt in to having a medical record of any kind (electronic or paper)?

Not a mandate at this point in time.

That's right, it's not a mandate. Very good.

I thought you said it wasn't mandated. How can it require that doctors have 80% patient participation and still not be mandated?

Are you reading these threads or what? This is an incentives program. If you're a provider and don't meet the criteria, you don't get bonus money. If there weren't requirements, it would be a pretty useless incentives program.

My guess is that without massive tort reform EHRs will be dead before they start because hospitals will not want to deal with the liability incurred as a result of relying on them.

Safe harbor laws are being designed in every state in country. See the other thread regarding HIE cooperative grants to states to plan for HIE infrastructure development (the requirements of the grants include addressing legal and policy issues).

If they cannot price for risk at all, why will we need high risk pools? Looks to me like someone did not think out all the implications of what they were saying, again.

The high risk pools only exist until 2014, at which point the health insurance exchanges open and the high risk pools terminate. Looks like someone has no idea what he's talking about, again.

Nothing to see here, move along.

Please do.
 
What are you referring to? Where did I say patients had to opt in to having a medical record of any kind (electronic or paper)?

I didn't say you said that, the OP article did, and you did not refute it.

That's right, it's not a mandate. Very good.

At this time. If you look at history I can point to a "temporary" income tax that is not only still around, but more complicated. Care to bet on how this is going to end up?

Are you reading these threads or what? This is an incentives program. If you're a provider and don't meet the criteria, you don't get bonus money. If there weren't requirements, it would be a pretty useless incentives program.

Are you reading my replies?

What do you think is going to happen when doctors fail to meet these requirements because patients refuse to opt in and doctors complain because they cannot get those patients to see the light? Would it be possible to change the law to require them to opt out? Or even just eliminate their options altogether in the name of saving money?

Safe harbor laws are being designed in every state in country. See the other thread regarding HIE cooperative grants to states to plan for HIE infrastructure development (the requirements of the grants include addressing legal and policy issues).

That makes me feel better.

I have two words for you, Murphy's Law.

The high risk pools only exist until 2014, at which point the health insurance exchanges open and the high risk pools terminate. Looks like someone has no idea what he's talking about, again.

Or possibly someone is failing to earn his money and properly explain things.

Let me see if I understand this. Insurance exchanges are specifically designed to target high risk groups, yet pricing for those risks is going to be illegal, or are you failing to explain your boss's position again?
 
I didn't say you said that, the OP article did, and you did not refute it.

The OP says you can choose to omit sensitive information if you choose to (which is the case now with paper records). It doesn't say you have to opt in to having a health record.

Are you reading my replies?

Unfortunately yes.

What do you think is going to happen when doctors fail to meet these requirements because patients refuse to opt in and doctors complain because they cannot get those patients to see the light? Would it be possible to change the law to require them to opt out? Or even just eliminate their options altogether in the name of saving money?

See above, regarding patients not having to opt into a health record.

That makes me feel better.

I have two words for you, Murphy's Law.

Did you not just specifically say states should change liability laws to accommodate HIE? Oh right, that was when you didn't know they are doing that.

Now it's baaad.

Insurance exchanges are specifically designed to target high risk groups

No. Jesus Christ, what did people talk about in this forum for the past year and a half? Did this whole health reform thing just slip through the cracks or what? This thread explains what an insurance exchange is. For the love of God read it or at least never discuss the issue again.
 
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The OP says you can choose to omit sensitive information if you choose to (which is the case now with paper records). It doesn't say you have to opt in to having a health record.

Again, you seem to have a problem with understanding English.

If I can refuse to permit my doctor to include any information about me in an EHR, and the doctor is required to ask my permission to even have an EHR for me, that means I have to opt in to those records. Look up the definition of opt in if you have further problems with that concept.

Did you not just specifically say states should change liability laws to accommodate HIE? Oh right, that was when you didn't know they are doing that.

Now it's baaad.

No, I specifically said the the federal government needs to change liability laws, states doing it will not work. this health care abomination is being done by the federal government, they need to deal with the potential problems they are foisting off on the states.

Better yet, they should just got out of this totally, and let the states make their own decisions.

This thread[/URL] explains what an insurance exchange is. For the love of God read it or at least never discuss the issue again.

So then, an exchange is just a more expensive way to shop around for health insurance that will enable individuals who cannot otherwise get insurance to foist their costs off on everyone.

Got it. Thanks.
 
... and the doctor is required to ask my permission to even have an EHR for me...

Full stop.

No, I specifically said the the federal government needs to change liability laws, states doing it will not work.

Liability laws are state laws.

this health care abomination is being done by the federal government, they need to deal with the potential problems they are foisting off on the states.

You're confusing HITECH with the PPACA. HITECH is a program of providing states funds and guidance to develop their own HIE system in accordance with the conditions and infrastructure that already exists in those states. For example, Colorado is deferring to CORHIO (a private organization) to do most of its planning, while Florida is relying on its state's Medicaid agency because its state HIT work was already headquartered within it. Their HIE governance structures are going to be very different.

Better yet, they should just got out of this totally, and let the states make their own decisions.

Sort of like what they're doing.

So then, an exchange is just a more expensive way to shop around for health insurance that will enable individuals who cannot otherwise get insurance to foist their costs off on everyone.

"More expensive" implies a point of comparison.
 

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