EHR's - Does this make sense?

[chanel]

Well that clears things up.

Whenever I read legal mumbo jumbo, I try to figure out how it's going to work in the real world. If I am to accept that EHRs will simply be used by physicians and hospitals to reduce paperwork, then we can expect never to have to fill out another form in the doctor's office? Yeah right.

And if that is not the point - WHAT IS?????

Also - do insurance companies currently have access to medical records? How would an insurer know if someone has AIDs or smokes?

 

[Greenbeard]

Whenever I read legal mumbo jumbo, I try to figure out how it's going to work in the real world. If I am to accept that EHRs will simply be used by physicians and hospitals to reduce paperwork, ...

EHRs aren't just about reducing paperwork, although some people do want to take that sort of minimalist view of how they should be used. The reality is that they can do quite a bit more than that. Already, with the somewhat limited use of EHRs that's occurred in the U.S., we've seen quality improvements by helping doctors keep to a protocol (for example, the EHR can be used to send automatic reminders on screenings, procedures, etc), better clinical monitoring, and reducing medical errors (this involves things like an EHR instantly warning your doctor if a prescribed medication will interact negatively with something else you're on).

But it's more than just that, even. Information--data--has tremendous potential. If you think about it, medicine is still in many ways as much art as science. We don't often know the best way to tackle an illness or treat or condition. But if you think about the amount of raw data locked up in health records, it's staggering. You've got a record of what you had, how they treated it, and what the outcome was. Now aggregate that a couple tens of millions of times and you've got a boatload of scientific data. But it's locked up in paper records where 1) you can't easily de-identify the data to protect your privacy and 2) you can't get to it, physically. With EHRs, eventually that's a possibility, although obviously there's a lot to work out there, both technically and legally.

More generally, it's best to think of EHRs (and the electronic exchange of health information more generally) as a means, not an end. Converting from paper to EHRs just for the sake of doing it isn't really all that helpful, even if it saves a few trees, if you're not using them in meaningful way (that's why these meaningful use regulations are coming out for doctors who want to collect incentive payments--they need to show that they're using EHRs to their full--or at least near-full--potential). Every state has health goals it's pursuing to find ways to better coordinate care, reduce errors, fight fraud, cut back on administrative efficiency, etc. Health information technology--like EHRs--can be a tremendous resource for achieving those kinds of goals. It's a tool and a powerful one and we haven't even scratched the surface of its potential. This money from the stimulus package is aimed at starting to change that.

then we can expect never to have to fill out another form in the doctor's office? Yeah right.

Speaking in very general terms, there's two kinds of papers in your doctors office and it splits along the fundamental dichotomy that defines our health care system: payers and providers, money and medicine. The medicine part is your health record, which is what we're talking about here. But you probably don't interact with that very much, although one of the goals of EHRs is to turn health records more into personal health records that you have control over (i.e. control over who has access to it and what's in it).

But the other part of it is payer (insurer) related. When your doctor does virtually anything for you, he fills out a claims form that he submits to your insurer so that eventually he gets paid for services rendered. I imagine a lot of what you fill out is insurer-related, verifying that you have Insurer X and that somebody's going to be paying for your visit. In the long-run, that part of the paper load will probably be reduced by EHRs, too. Some forward-thinking folks are talking about the possibility of eventually eliminating claims entirely and basically just pulling the relevant information for reimbursement right out of EHRs--but again, that's an idea that's not very well-developed at this point and it would have a lot of implications to work through. But Medicaid agencies right now have electronic claims systems (their information systems are known as MMIS) that they're trying to integrate with EHRs--if you recall, the EHR incentives program this thread is about is aimed entirely at Medicare and Medicaid doctors. State Medicaid agencies are going into overdrive right now figuring how to make that work. But you're probably not on Medicaid so that's not immediately relevant to you, though Medicaid often pioneers the path that private insurers later follow.

That said, there was a provision in the original House health care reform bill last year (a bill that didn't end up becoming law) that would've allowed your doctor's office to communicate instantaneously with your insurance company to determine if you're covered and what kind of co-insurance, etc you're responsible for paying--no forms. Someone in another thread here thought that means the government would have access to your bank account, which of course is nonsensical on multiple levels. But that's the kind of hysteria this topic generates.

Also - do insurance companies currently have access to medical records? How would an insurer know if someone has AIDs or smokes?

I've never bought insurance in the individual market but I can say that if you were to go sign up for it you'd have to reveal your medical history to them voluntarily (because, at present, in most states they can change your rates to reflect things like gender and medical history--again, once the new health insurance exchanges are operating in 2014 that will no longer be the case), which may involve voluntarily allowing them access to your medical record. But in general, no, they can't just go in and thumb through your record any time they want. However, they'll probably figure out what you've got when your doctor bills them for the treatment.

And I realize I've rambled a bit here--apologies for the length of this post. I just think this is a very exciting topic.

 

[chanel]

No apologies necessary. That was very informative. Thank you.

 

[Quantum Windbag]

Liability laws are state laws.

And the health care law specifically sets up funding for pilot programs and studies. If Congress is going to force an abomination on us in the name of lowering costs then they should actually implement something that has been proven to work, instead of guessing and lying to everyone.

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.

How am I confusing them? You are the one talking about them.

Sort of like what they're doing.

If they were doing that this law would not exist, would it?

"More expensive" implies a point of comparison.

If you don't get it now you will later, trust me.

 

[Quantum Windbag]

EHRs aren't just about reducing paperwork, although some people do want to take that sort of minimalist view of how they should be used. The reality is that they can do quite a bit more than that. Already, with the somewhat limited use of EHRs that's occurred in the U.S., we've seen quality improvements by helping doctors keep to a protocol (for example, the EHR can be used to send automatic reminders on screenings, procedures, etc), better clinical monitoring, and reducing medical errors (this involves things like an EHR instantly warning your doctor if a prescribed medication will interact negatively with something else you're on).

But it's more than just that, even. Information--data--has tremendous potential. If you think about it, medicine is still in many ways as much art as science. We don't often know the best way to tackle an illness or treat or condition. But if you think about the amount of raw data locked up in health records, it's staggering. You've got a record of what you had, how they treated it, and what the outcome was. Now aggregate that a couple tens of millions of times and you've got a boatload of scientific data. But it's locked up in paper records where 1) you can't easily de-identify the data to protect your privacy and 2) you can't get to it, physically. With EHRs, eventually that's a possibility, although obviously there's a lot to work out there, both technically and legally.

More generally, it's best to think of EHRs (and the electronic exchange of health information more generally) as a means, not an end. Converting from paper to EHRs just for the sake of doing it isn't really all that helpful, even if it saves a few trees, if you're not using them in meaningful way (that's why these meaningful use regulations are coming out for doctors who want to collect incentive payments--they need to show that they're using EHRs to their full--or at least near-full--potential). Every state has health goals it's pursuing to find ways to better coordinate care, reduce errors, fight fraud, cut back on administrative efficiency, etc. Health information technology--like EHRs--can be a tremendous resource for achieving those kinds of goals. It's a tool and a powerful one and we haven't even scratched the surface of its potential. This money from the stimulus package is aimed at starting to change that.

And all governments should stay out of it and let the market determine what information is worth tracking, and how to make them functional. They will do it much more efficiently and effectively than regulating an industry no one understands in the hope of getting it right. If the government gets it wrong it will take years to untangle the mess, unlike the private sector which can fix things much quicker.

 

[Greenbeard]

And the health care law specifically sets up funding for pilot programs and studies. If Congress is going to force an abomination on us in the name of lowering costs then they should actually implement something that has been proven to work, instead of guessing and lying to everyone.

And those pilots in the reform law include federal money for states to reform their own liability laws.

If they were doing that this law would not exist, would it?

The HITECH Act provides federal money for states to design their own HIE infrastructures. Which is why they're all doing something different, unique to their state's situation.

And all governments should stay out of it and let the market determine what information is worth tracking, and how to make them functional.

The market for what?