Transition to electronic medical records gradually taking hold

Greenbeard

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Jun 20, 2010
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A generally good--and short--introduction to/overview of the HITECH Act, the law that's using a series of carrots to push doctors and hospitals toward using electronic health records and to help states develop the information pathways needed to move those records between providers in the state: "Transition to electronic medical records gradually taking hold"

The $19 billion medical records law — which pays doctors to switch to an electronic system or upgrade one they’re already using — is having an impact on the entire health care industry. And small primary care practices that treat Medicaid patients are no exception.

As of last week, the U.S. Department of Health and Human Services reported, more than 100,000 primary care doctors across the country had taken advantage of federal incentives to adopt a certified electronic medical record system. Half of the doctors were members of small practices that serve Medicaid and Medicare patients, and the rest worked in community health centers, public hospitals, rural health clinics and other public settings.

In the meantime, states are developing what is known as a health information exchange that will allow doctors who convert to electronic systems to access patient records within the state through secure portals, and ultimately transfer records across the country.

In general, states are setting their own schedules for developing in-state networks and going national. South Carolina, for example, is already connecting doctors to a national health exchange, though its statewide network is not fully implemented.

In addition to primary care doctors, Alabama’s regional extension team is helping independent pharmacies, small laboratories, and public clinics and hospitals get electronic health systems up and running. “Rural providers may not be ahead of the curve,” says Dr. Daniel Roach III, Alabama’s state health information coordinator. “But they won't be left behind.”
 
Electronic Medical Records are a great idea because electronic information has never been lost or stolen before. I'm certain that all my personal medical records are completely safe in a computer. Somewhere.
 
A generally good--and short--introduction to/overview of the HITECH Act, the law that's using a series of carrots to push doctors and hospitals toward using electronic health records and to help states develop the information pathways needed to move those records between providers in the state: "Transition to electronic medical records gradually taking hold"

The $19 billion medical records law — which pays doctors to switch to an electronic system or upgrade one they’re already using — is having an impact on the entire health care industry. And small primary care practices that treat Medicaid patients are no exception.

As of last week, the U.S. Department of Health and Human Services reported, more than 100,000 primary care doctors across the country had taken advantage of federal incentives to adopt a certified electronic medical record system. Half of the doctors were members of small practices that serve Medicaid and Medicare patients, and the rest worked in community health centers, public hospitals, rural health clinics and other public settings.

In the meantime, states are developing what is known as a health information exchange that will allow doctors who convert to electronic systems to access patient records within the state through secure portals, and ultimately transfer records across the country.

In general, states are setting their own schedules for developing in-state networks and going national. South Carolina, for example, is already connecting doctors to a national health exchange, though its statewide network is not fully implemented.

In addition to primary care doctors, Alabama’s regional extension team is helping independent pharmacies, small laboratories, and public clinics and hospitals get electronic health systems up and running. “Rural providers may not be ahead of the curve,” says Dr. Daniel Roach III, Alabama’s state health information coordinator. “But they won't be left behind.”

It's a good idea, but it will have to be monitored more closely. Right now, anyone with a login (medical students to nurses to attending physicians) have access to the medical records of anyone that comes to our hospital. HIPAA prevents you from accessing patient information willy nilly, but the potential for abuse is still there.

Imagine the temptation if a person could access the medical records of anyone in the country.

At any rate, I am glad for this to happen if for no other reason then the drug seekers are going to be fucking screwed.

That alone makes it worth it.
 
HITECH updated the existing HIPAA Privacy Rule a bit to ease it further into the digital age, but the real policies governing those kinds of security issues (e.g. patient consent models) are being made on a lower level. Historically they've been determined within individual networks linking information--at most, this has been on a regional scale and you can look at different existing examples of private regional health information organizations that have adopted different models.

Now that we're moving into the era of statewide networks--health information exchanges--we're seeing that policy being considered and made at the state level. That's part of what goes into this work:

In the meantime, states are developing what is known as a health information exchange that will allow doctors who convert to electronic systems to access patient records within the state through secure portals, and ultimately transfer records across the country.

Anyway, there's some news today on the electronic health record front. In order to actually take advantage of the incentives for adopting electronic health records, doctors and hospitals have to demonstrate they're actually using them in a meaningful way. Hence the name of the criteria for getting a payment: "meaningful use." Those criteria are rolling out progressively in three stages that require more sophisticated use as time goes on.

Despite the widespread interest in participating in the digital shift, there's been some question of whether meeting meaningful use criteria is feasible for many doctors and hospitals. Today, apparently in an effort to encourage and facilitate participation, it's getting a little more feasible.

Sebelius Announces Changes to Timeline for Meaningful Use - iHealthBeat
On Wednesday, HHS Secretary Kathleen Sebelius announced policy changes designed to make it easier for health care providers and hospitals to qualify for meaningful use incentive payments, Modern Healthcare reports.

Sebelius announced the changes during an event at Cuyahoga Community College in Cleveland (Modern Healthcare, 11/30).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

Under current regulations, eligible health care providers that attest to Stage 1 of the Medicare EHR incentive program this year would need to meet Stage 2 requirements in 2013. However, health care providers who attest to Stage 1 in 2012 would not need to meet Stage 2 requirements until 2014, but they still would be eligible for the same total incentive payment amount (DeParle, "White House Blog," 11/30).

To encourage greater participation in the meaningful use program, Sebelius said that health care providers who meet Stage 1 requirements this year would not need to meet the Stage 2 standards until 2014. According to an HHS statement, "Doctors who act quickly can also qualify for incentive payments in 2011 as well as 2012" (Modern Healthcare, 11/30)
 
Long overdue

Your medical records should be available to any doctor or pharmacist who needs access. Transferring hard copies is cumbersome and risky
 
Long overdue

In many ways.

A timely development this week: CMS has launched a new section of its website to allow easier access to data on the electronic health records incentives programs. With maps!

A map of state-by-state totals for the amount of payments made to electronic health record-adopting doctors and hospitals participating in the Medicare or Medicaid incentive programs:
10062011.jpg


A map of state-by-state totals of the number of providers signed up to participate in the program:
092011MM.jpg
 
There is something about electronic records being accessed by anyone who can hack that I don't like. Just don't.

My personal experience is this:

My doctor uses only electronic record keeping. Part of my file is my picture. When my file was opened my photo became part of the file. Everything he did and medication prescribed was scanned with a barcoder.

I went to the hospital for an emergency procedure. Gave them my doctor's name. In seconds his records were accessed, there was my picture verifying my identity, what was done, medications prescribed. I got stitches and pain medication all put into my electronic record. When I saw him to get the stitches out, he had full access to my hospital records. I didn't even have to give a history.

I can see the potential for abuse, but I can also see how much of a benefit it can be.
 
I will always be confused with the US healthcare system, here in NZ all operations are free. We pay less in terms of percentage of gdp than the US when it comes to healthcare, which I think shows the inefficiency in the US healthcare system aka 10% in NZ vs 17% in the US. The private sector and private medical insurance takes up the rest, and those that can't wait for treatment. Though admitidly in comparison to the US we have low rates of prescription of drugs, which reduces medical costs.

Obamacare doesn't seem to give a choice between private and public treatment, and public treatment is worse quality than private treatment in US and run with inferior equipment to the private sector, rather than simply full of patients (as it is here in NZ), if people can't wait they just go to the private sector, problem solved.

However I know that doctors/gps and the health sector here in general keep electronic records on their patients, and share that information electronically. You don't have to fill out forms to get an appointment, besides name, address and phone numbers, and they get the rest from your medical records. But I really just hate lots of forms, there are enough things you have fill out already.
 

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