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HHS Proposes Patient Privacy Rules

Department of Health and Human Services regulations would expand patients' rights to control their personal health data.

By Nicole Lewis - InformationWeek  - July 9, 2010 09:53 AM

The Department of Health and Human Services has announced new rules that expand patients' rights to make decisions regarding their health records, including giving patients the ability to restrict the use of information for marketing purposes, and granting them greater control over the sale of their health information.
The proposed rules are seen as a crucial step as the Obama administration promotes the adoption of electronic health information exchange, and has set the goal of providing every citizen with an electronic medical record (EMR) by 2014.

Announced on Thursday, the policies would strengthen and expand enforcement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy, security, and enforcement rules in several ways.
The rules call for the expansion of individuals' rights to access their information and to restrict certain types of disclosures of protected health information to health plans. It also requires business associates of HIPAA-covered entities to be under most of the same rules as the covered entities.
 

The proposed modifications to the HIPAA privacy & security rules also establish new limitations on the use and disclosure of protected health information for marketing and fundraising, and prohibits the sale of protected health information without a patient's consent.

"To improve the health of individuals and communities, health information must be available to those making critical decisions, including individuals and their caregivers," HHS secretary Kathleen Sebelius said in a statement. "While health information technology will help America move its healthcare system forward, the privacy and security of personal health data is at the core of all our work."

Through the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, current health information privacy and security rules will now include broader individual rights and stronger protections when third parties handle individually identifiable health information.

"Giving more Americans the ability to access their health information wherever, whenever, and in whatever form is a critical first step toward improving our healthcare system," David Blumenthal, HHS national coordinator for health information technology, said in a statement. "Empowering Americans with real-time and secure access to the information they need to live healthier lives is paramount."

HHS has also launched a privacy website to help the public easily access information about existing HHS privacy efforts and the policies supporting them.

Led by the Office of the National Coordinator for Health Information Technology and the HHS Office for Civil Rights, HHS is working with public and private partners to ensure that patients' health information is protected and secure.

Once the rule is published in the Federal Register on July 14, a 60-day comment period will begin during which time the public is invited to give their feedback and suggestions concerning the proposed rules.
  

Top 10 Meaningful Use Challenges Faced By Docs

Posted by Marianne Kolbasuk McGee on April 19, 2010 03:48 PM

Doctors and other eligible healthcare providers, such as dentists and nurse practitioners, who meet the federal government's upcoming meaningful use criteria for health IT could earn up to $44,000 or $63,000 each in incentives depending on the patients (Medicare or Medicaid) they treat. But meeting those criteria won't be easy. A new CSC report lists the top ten challenges healthcare providers face in cashing in on the incentives.

Meaningful use criteria will come into effect in three incremental stages. Stage one starts in 2011, followed by stage two in 2013, and stage three in 2015. Healthcare providers have until end of 2014 to achieve any of the stages, but the more stages they achieve before 2015 the bigger the payout in meaningful use bonuses they'll get. (By 2015, penalties will begin kicking in for non-compliance.)

Right now, it's estimated that fewer than 6% of the nation's healthcare providers have health IT--such as e-health records and computerized physician order entry systems--in place to meet even stage-one meaningful use requirements, said Walt Zywiak, a CSC principal researcher in an interview with InformationWeek.

"Many healthcare providers are still trying to figure it out," in terms of the basics, like picking out the software and other technology they'll need in their practices, let alone the workflow and other issues they'll also need to tackle, said Zywiak, who is also a co-author of the new CSC report, Meaningful Use For Eligible Providers: The Top Ten Challenges."

With so few healthcare providers on track right now for stage-one compliance, there will also be a scramble for health IT talent to help implement these systems, said Zywiak. The government's HITECH program creating dozens of "regional extension centers" across the country to help assist doctor practices and hospitals should help some, "at least that's the plan," he said.

In the meantime, CSC has pinpointed the top challenges eligible healthcare providers face in meeting stage-one meaningful use requirements. Here you go:

1. Capture the data--that includes collecting and entering data in a structured formats so that data can be sorted and selected for reporting purposes, said Zwiak.

2. Establish effective workflows to reinforce data entry, including medication reconciliation. For instance, "often, an organization's workflow needs to be modified to make sure data is entered," while patients are being cared for, whether it's vital signs like blood pressure or allergy updates, said Zywiak.

3. Drive provider involvement in adoption of the EHR. "The primary users of these systems need a say" in what's selected, said Zwiak.

4. Computer-based provider order entry (CPOE). "In ambulatory settings, 80% of orders, including tests, referrals and medication prescriptions, will need to be entered electronically," he said.

5. Start e-prescribing. "Do this as soon as possible," he said.

6. Develop a process for managing clinical decision support. This could include different clinical reminders for individual doctors in the same multi-specialty practice. For instance, a primary care doctor might need different alerts than a dermatologist caring for the same diabetic patient.

7. Implement patient health information exchange workflows. As a healthcare provider, "you've got to provide patients access with information--but will you do this via a patient portal or through a [third party] personal-health record" site, such as Google Health, said Zwiak.

8. Formulate a provider health information exchange strategy. "How will you exchange patient summary data with hospitals, specialists?," he said.

9. Ensure privacy and security compliance. "Most primary care organizations haven't been on an EHR, so they think of HIPAA in terms of protecting paper-based information," he said.

10. Initiate EHR-based quality performance measurement support. "You'll need to report quality measures to Medicare and Medicaid," he said.

What's your biggest meaningful use headache so far? Tell us how you're planning to tackle these challenges, and what tips you suggest to others.

Telehealth Lets Patients 'See' Specialists Sooner

Posted by Marianne Kolbasuk McGee on April 13, 2010 05:30 PM

It a common frustration for patients: During an office visit with your primary care physician, the doc advices you to see a specialist. But then you're forced to wait weeks for the appointment to see the specialist. A new telehealth service available to patients in Hawaii could have patients elsewhere envious.

Hawaii Medical Service Association--the Blue Cross Blue Shield plan of Hawaii--is the first health plan in the U.S. planning to deploy a new telehealth program unveiled by American Well, a provider of online health care services.

By using American Well's new web-based, VoIP-enabled Online Care Team Edition, primary care physicians caring for patients in their exam rooms can on-demand access consults with remote medical specialists, such as dermatologists, cardiologists, and others for whom patients frequently have long waits for appointments.

So, if that primary care doctor is suspicious that a patient's complaints could indicate a more serious issue that needs further evaluation by a specialist, the primary care doc could enlist help immediately by connecting with a remote expert who can take a look at the patient's lab and imaging results, as well as help evaluate physical findings.

Another new related service--Online Medical Home--also allows primary care doctors to take on the role of care coordinator for a patient with more complex needs. The primary care physician can use the American Well telehealth services to enlist the consultations of multiple specialists from their remote locations.

The telehealth services that are being supported for by Hawaii's Blue Cross Blue Shield members are surely something that can help patients who might otherwise be forced to wait a long time for office appointments with scarce specialists in the region.

These latest specialist telehealth services supported by HMSA are in addition to other virtual medical consultations from American Well that HMSA began offering to its members more than a year ago.

In case you're wondering how doctors are reimbursed for these new services--American Well says the primary care physician bills the payer for an office visit, since the patient is with doc in the exam room.

The consulting specialist gets paid for the Online Care visit according to the reimbursement set by the health plan.

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