Posted on Mon, Jan. 25, 2010 11:03 PM
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closeRace to share your medical info is on
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No matter what happens with health care reform, an electronic network to share your medical records is being stitched together.
Health practitioners, information tech experts, lawyers, ethicists and government officials are racing to implement a national system by 2014.
“We don’t want to just have the equipment in place. We want to have a meaningful use of electronic health records that will help consumers and health care providers,” said Helen Connors, director of the University of Kansas Center for Health Informatics.
You may already have seen your physician typing exam notes into a laptop. And you can already picture the day when you don’t have to hand-carry your X-rays from an imaging center to a hospital. Or when you show up in an emergency room and a click of a mouse presents an immediate health history.
But all that’s just a glimpse of what electronic file sharing is about. The big picture involves what’s called “comparative effectiveness research.”
The phrase describes the idea that if a Kansas City, Kan., hospital is getting outstanding results by treating an ailment in a specific way, a hospital in Goodland, Kan., ought to know about it, use it and be financially rewarded by Medicare, Medicaid and insurers. Eventually, such information will be shared nationwide.
“Don’t lose sight of why we’re doing this,” said Ronald Levy, director or the Missouri Department of Social Services, who is overseeing medical records digitization in Missouri. “We’re doing this to lower the cost and improve the quality of health care.”
There are concerns. Such a system must be careful about individual health privacy so that personal information is accessible only to authorized and intended users.
And talk about “comparative effectiveness research” generates a fear factor connected to health care reform.
The concept of getting the government involved in “best practices” gave birth to rage about “death panels” that would intrude into private decision-making.
“Winning the public relations campaign is a stiff challenge,” admitted Robert St. Peter, who heads the Kansas Health Institute, one of several organizations involved in the digital transition.
“Privacy is a sensitive issue, but a lot of people are under the false impression that this sort of information isn’t being exchanged right now, which, of course, it is,” St. Peter said. “Insurance companies already are exchanging a lot of information to determine eligibility of coverage. But the challenge is to convey the privacy safeguards in place.”
That in itself is a huge challenge. The Connecticut attorney general this month sued Health Net, alleging the insurer failed to protect the patient records of 446,000 members and failed to notify them of a security breach.
Also this month, Blue Cross and Blue Shield of Tennessee said personal information of about 500,000 members was on 57 stolen hard drives.
Last year, a highly publicized case involved a medical researcher at UCLA Health System who looked at and leaked medical records of celebrities.
“As a state, we’ve been working on the privacy issue for four years,” said Connors, who is leading the E-Health Advisory Council in Kansas, a coalition charged with organizing a secure online health records system in the state.
“We have a team of 26 health care lawyers working on aligning state laws with the Health Insurance Portability and Accountability Act … where to put the firewalls, who’s in charge of your information, how you’re notified when your information is put into the health information system, how you can opt out if you don’t want to be in it.”
In the states
The digital call to arms reaches far beyond putting firewalls or opt-out policies in the right places. In many doctors’ offices and hospitals, the first challenge is getting them computerized.
The Kansas Foundation for Medical Care Inc. is in the second year of a four-year project to provide direct technical help to primary care providers.
Call it a medical geek squad. They’re information technology specialists set up to help about 1,200 individual doctors and small group practices in the state adopt digital records.
Oversight for that and other elements of the large-scale “health information exchange” project in Kansas comes from the Kansas Department of Health and Environment.
Under the department’s auspices, the E-Health Advisory Council is regularly convening representatives from nearly three dozen health-care-related organizations in the state.
Similarly, the University of Missouri is leading a Missouri-side grant application effort that will help set up regional extension centers to provide information technology training and support to primary care physicians who lack the expertise or equipment to participate in a digital network.
Missouri already has applied for a federal planning grant, which Levy said is expected to total $13.8 million for planning, design and implementation over the next four years.
So far, every other week the state is convening committees concerned with governance, technical infrastructure, business and operations, legal policy and privacy, finance and consumer engagement.
Kansas last fall submitted a $9 million Healthcare Information Exchange grant application to finance its planning and preparation for digitization, and similar committees are meeting.
For the nation
Digitization of health records got a big push nationally with the American Recovery and Reinvestment Act of 2009. It created a Federal Coordinating Council for Comparative Effectiveness Research and allocated $1.1 billion for research.
The act authorized $35 billion in incentives for doctors’ offices and hospitals to computerize patient health records. Only about one in 10 U.S. hospitals and one in five doctors’ offices is digitized now.
Doctors who start computerizing records by 2011 will get about $44,000 each in stimulus act money — about the cost estimated to set up an average digital records system in a doctor’s office.
Hospitals that digitize will get a one-time $2 million grant, plus ongoing higher reimbursements for Medicare and Medicaid patients.
But national standards were needed. It won’t help to punch individual health facts into a computer if the computers aren’t linked compatibly.
The federal government has supplied “meaningful use” standards — a 576-page document published a few weeks ago. That guidance tells what kind of health information is expected to be a part of the electronic system.
Federal “interoperability” standards also have been distributed. The guidelines will allow technology providers, such as Cerner, and coordinating councils, such as the e-health group in Kansas, to proceed on a common platform.
David Blumenthal, national coordinator for health information technology, explained the motive behind the digital flurry.
“Information should follow the patient, and artificial obstacles — technical, business-related, bureaucratic — should not get in the way,” Blumenthal said on the federal Health and Human Services Web site.
“As a doctor, I have many times wanted access to data that I knew were buried in the computers or paper records of another health system across town. Neither my care nor my patients were well served in those instances. That is what we must get beyond.”
To reach Diane Stafford, call 816-234-4359 or send e-mail to stafford@kcstar.com.
Posted on Mon, Jan. 25, 2010 11:03 PM
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