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FORT LAUDERDALE, Fla. — What a crazy, busy but productive week this has been here at the TEPR conference. I will post some highlights later today or over the weekend once I am back home in Chicago, but I just wanted to note that I will have a column published today (Friday) in iHealthBeat. Look for it around midday EDT.

This is the first of two columns I will be writing for iHB between now and July.

I also had some TEPR coverage in Thursday’s Health-IT World News.

Your comments on these stories and any other IT/patient safety issues are welcome. I will post comments only with your permission.

May 21, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

FORT LAUDERDALE, Fla.—Maybe some people are starting to “get it.”

Blue Cross of California says it has invested $2 million to bring e-prescribing and “paperwork reduction” technology to more than 1,000 physicians who care for low-income and uninsured patients, according to a report in Health-IT World News last week.

While Blue Cross and Blue Shield plans elsewhere—Massachusetts and New Jersey come to mind—are rewarding medical practices for writing electronic prescriptions, the California program may mark the first time a major payer has helped financially strapped practices pay for information technology.

(I’m making the assumption that those who care for the poor and uninsured do struggle to make ends meet, unless California somehow solved its budget crisis and suddenly bumped up Medicaid reimbursements. I think I’m safe here.)

WellPoint Health Networks, the for-profit parent of Blue Cross and Blue Shield plans in California, Georgia, Missouri and Wisconsin, now has helped nearly 20,000 physicians in those states automate their prescribing, billing, receivables and communications processes since the beginning of the year by purchasing hardware and software for doctors in its provider networks, according to the HITW story.

This gesture helps remove a key argument against investing in IT, that the efficiency and financial gains accrue to health plans, hospitals, pharmacy benefit managers and pretty much everybody else other than physicians themselves.

It’s a good start, but removing some of the paperwork associated with one payer is a rather small gesture as long as the HIPAA transaction regulations remain toothless. Even though CMS has said it really will start rejecting nonstandard claims, the fact remains that true standardization is impossible as long as each payer is permitted to add its own extensions to HIPAA-mandated code sets.

Plus, the WellPoint plan barely begins to address the general lack of technology in the U.S. healthcare system.

A recent poll of CIOs and other health IT professionals conducted by the Healthcare Information and Management Systems Society suggests that it may take a lot more money than even the $100 million President Bush wants in fiscal year 2005 to promote clinical IT. Only 22 percent of the 246 respondents say that $100 million from Washington will significantly boost the utilization of health IT.

Other results from the HIMSS survey send mixed signals. A majority of CIOs indicate that a national health IT infrastructure would be the most effective means of providing health information when and where it is needed.

Some strange political bedfellows, including Bush and Sen. Hillary Clinton, have come together to promote such a vision, but that’s another subject for another time.

However, only 38 percent of the survey pool want federal money to support the development of standards for data interchange, compared to the 42 percent who just want the government to give them the cash to subsidize technology purchases.

A quick glance at the program for this week’s TEPR conference here in Fort Lauderdale does bring some heartening news on the standards front: At least 27 vendors are participating in a demonstration project for the recently adopted Continuity of Care Record industry standard.

The registration goodie bag contains a USB drive loaded with hypothetical patient data in the CCR format. Attendees can take the drive to each vendor’s booth for a demonstration of interoperability when patients move between care settings.

Making the CCR work in a room full of health IT types is one thing. Getting medical practices to save patient records in standard format is another. Then there is the issue of convincing patients to carry USB drives, CD-ROMs, smart cards or even printouts of their medical histories when they switch doctors or get picked up by an ambulance.

At least doctors appear to be paying attention. I am writing this while sitting in on a seminar about implementing EMRs in small practices. Half the people in the room identified themselves as physicians.

That is about five times the number of docs who would have been here two or three years ago.

May 17, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Following is a piece I submitted to the Chicago Tribune as an op-ed in response to an article on the first anniversary of the HIPAA privacy rule. It has been two weeks since I wrote it and I have not heard from the Trib, so I figured I would publish it here. Sorry, but i do not have the Trib article that prompted this letter.

Your comments are welcome at nversel@rcn.com. – NV

By Neil Versel

Judith Graham’s story on the first anniversary of the medical privacy regulations under the Health Insurance Portability and Accountability Act, or HIPAA (“Privacy law a bitter pill,” April 13), leads the public to believe that the rules are hampering the ability of doctors and hospitals to provide proper care.

In reality, the article highlights a glaring lack of education among a large segment of the health care community, shows just how antiquated health care information management truly is and illustrates how simple misunderstandings can have dire consequences.

The survey Graham cited by the Council of State and Territorial Epidemiologists suggesting that more than a third of the nation’s public health officers label HIPAA a “major obstruction” in accessing information on publicly reportable diseases is a case in point. HIPAA itself is not preventing these public health professionals from doing their jobs; the greater culprit is serious case of ignorance among a sizable portion of the health care community.

As Graham correctly points out, each of the horror stories outlined in the article was entirely preventable.

The report in Graham’s story of a Department of Veterans Affairs doctor in San Francisco not being able to get information on a one of his own patients who had recently visited a hospital emergency room illustrates the lack of education — and perhaps unnecessary fear — about the HIPAA privacy regulations.

In August 2002 — eight months before the privacy safeguards took effect — the Department of Health and Human Services responded to criticisms that the rules were overly restrictive by explicitly stating that health care providers, insurance companies, pharmacists and others covered by HIPAA can share individual patient information for the purposes of treatment, payment and other operations related to care delivery.

These modifications also defined a “limited data set” of protected health information that can be disclosed without patient permission for the purpose of research, public health or healthcare operations.

According to the HHS ruling, it is perfectly legal for doctors and hospitals to report signs of certain diseases as long as health providers withhold patient-specific identifiers such as street addresses (city and state are OK), telephone numbers, full-face photos and vehicle license numbers. Indeed, common sense — not to mention ethical duty — pretty much requires care providers to inform public health officials of potential outbreaks.

Of course, we are not always dealing in common sense, as demonstrated by the tragic news of the suicide death of Charlie Blumberg after he was discharged from a Denver hospital into the care of a person not related to him. There seems to be an epidemic of fear within the health care community that some sort of HIPAA police force will start hauling doctors away in handcuffs should any hint of a medical record leak through a hospital’s walls.

Contrary to a widely held belief, the HHS Office of Civil Rights, which is charged with enforcing the privacy regulations, will not be going out of its way to hunt down and penalize healthcare organizations. The office’s director, Richard Campanelli, said so in March 2003 at a national, public conference in Rosemont on the HIPAA privacy rule.

“OCR’s goal is not to maximize enforcement. Our goal is to protect personal health information,” Campanelli said to a gathering of nearly 1,200 health care professionals.

Or as OCR privacy program policy specialist Christina Heide said at the same conference, “The privacy rule is not intended to impede treatment.”

The people from Carle Foundation Hospital in Urbana know this. A compliance officer from the affiliated Carle Clinic Association sat next to me at lunch that day. Unfortunately, the nearby hospital that, according to the April 13 Tribune story, would not release laboratory results did not get the message.

Unfortunately, the Carle physician who had to perform emergency heart surgery with an incomplete picture of his patient’s health is far from alone. Thousands of times every day across America, conditions are misdiagnosed, patients are given drugs they may be allergic to and pricey diagnostic tests are repeated simply because health care providers are missing major pieces of patient records.

HIPAA, for the first time, makes clear that patients, not hospitals, health insurers or physician offices, own their medical records. This represents a sea change from the doctor-centric view of health care that had long been the custom.

A select few in the rarified world of medical informatics understand that electronic connectivity and interoperability — backed up by the proper network security — would solve this serious problem of physicians practicing with incomplete patient information, while simultaneously ensuring privacy.

For example, Crusader Clinic in Rockford, or any other medical practice, for that matter, could do away with the inconvenience of requiring patients to come in to view lab results by adopting online clinical messaging. More secure than regular e-mail because users must enter a unique ID and password at an Internet portal, clinical messaging facilitates the safe exchange of sensitive personal medical information.

Technology such as this not only helps medical facilities comply with HIPAA requirements, it helps improve customer service by letting patients see their lab results at their leisure. And, as an added bonus, it gets doctors and nurses off the phone and back in the exam rooms so they actually can care for patients rather than shuffling paper.

If only the health care community would open its collective eyes, they would see that the year-old HIPAA privacy safeguards present not an insurmountable roadblock, but truly a wonderful opportunity to improve care by encouraging the adoption of information technology.

Neil Versel is a health care journalist in Chicago.

May 6, 2004 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Welcome to my healthcare blog

Welcome to my healthcare blog. Since I no longer have a regular outlet for my work, I would like to use this space to relay my thoughts on the subjects of clinical information technology, patient safety and healthcare quality improvement.

Some of my postings will be factual, some will be the opinions that to this point I, as a responsible journalist, have kept largely to myself. Other postings may just be random thoughts thrown out for public discussion.

I welcome your questions, comments, suggestions, news tips and, especially, your job leads. :-) Feel free to write me at nversel@rcn.com.

I hope that this can become a forum for intelligent discussion of issues that may have a profound effect on the delivery of care and the health of millions.

Neil Versel

Chicago, Illinois

May 6, 2004

I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.