By: Andis Robeznieks / HITS staff writer Story posted: May 21, 2007 – 10:56 am EDT

Part one of a two-part series

Like a recurring dream about having to take a test they didn’t study for, some physicians view the idea of patients with electronic personal-health records as their own personal nightmare.

Visions of patients handing over a computer disk containing years’ worth of blood-pressure readings taken every four hours along with random recollections of rashes and muscle strains that physicians are required to somehow make sense of and memorize are followed by thoughts of being sued because there was a kernel of important information missed in the deluge.

“That’s why folks like me are terrified of personal health records and what patients will bring to us,” internist Michael Zaroukian said earlier this year during a panel discussion at the Integrating the Healthcare Enterprise Connectathon, an event that brings electronic medical-record vendors together to solve interoperability problems (and sponsored by the Healthcare Information and Management Systems Society, the Radiological Society of North America and the American College of Cardiology).

While Zaroukian, who is chief medical information officer at Michigan State University, is now backing away from the word “terrified,” he still maintains “there are certainly lots of reasons to be concerned.”

The reasons for concern that Zaroukian cites include: the accuracy, completeness, usefulness and volume of the records physicians receive from patients; the hours of uncompensated work it will take to slog through them; and the potential for a misdiagnosis if something important was overlooked.

“In some ways, it’s simply an electronic extrapolation of what we’ve seen in the paper world,” Zaroukian says. “The greater the volume, the more likely it is that relevant data will be lost.”

Zaroukian certainly isn’t the only physician who feels this way.

“He has every reason to be frightened by that, and I don’t see what he is describing as an improvement over someone bringing in an entire paper chart,” says Joseph Heyman, a gynecologist and an American Medical Association trustee. “I don’t blame a physician for worrying about that. I think the beauty of a personal health record is if it’s a snapshot of a patient and their most important demographics—like their current condition, allergies and medications—that’s entirely different from their entire medical history for their entire life.”

Peter Basch, medical director for e-health at MedStar Health in Washington, says “physicians love a (hospital) discharge summary” that gives one to two pages of key points. What they may get from a PHR, however, could be something that has no resemblance to a discharge summary at all.

“Electronic records make it easier to share more information and images, so often what could be included on one page is now included on 10 and 12 pages,” says Basch, an internist who serves on the medical informatics subcommittee of the American College of Physicians.

He says, though imperfect, a quick two- to three-minute oral history taken during an office visit can be more helpful than an extensive PHR.

“It’s like saying to a patient: ‘Tell me about the rash,’ ” Basch says. “Don’t give me a seven-hour history of every rash you’ve had in your life.”

Zaroukian says that while things like patient-recorded blood-pressure readings can be useful, the value is not in each particular entry, but in the average and the range of high and low readings.

He says diabetic patients often give him diaries of insulin doses and pre-breakfast blood-sugar levels recorded in meticulously arranged rows and columns, but—despite their neat appearance—the numbers are not distilled into a useable format.

“You have to skip between rows and try to average the numbers somehow, but it’s impossible,” Zaroukian says. “The data is so poorly organized that it not only does not improve quality, it could contribute to making a bad decision.”

Nevertheless, he says that PHRs could be an important tool in developing a partnership with patients, so he “gently forces” them to use the spreadsheets—either paper or electronic—that he has developed.

“Over time, patients see how their own self-management can be improved, so over time they become more interested in doing so,” Zaroukian says. He adds that the key is to make it easy to record the information in a usable format so the patient-maintained record is not “just a few jewels of data floating in a sea of debris.”

Organization and quality of the data are paramount to making the PHRs useful, says Heyman, who has a solo practice in Amesbury, Mass.

“I think at the AMA, we believe there can be great value to PHRs and they can save physicians and patients a great deal of time, while helping to avoid medication errors and duplicate laboratory tests,” he says. “But there is a risk of ‘garbage in, garbage out,’ and if the record is populated by the patient, there are errors of understanding that can be inputted by the patient.”

Basch says it’s not the PHR alone that will create savings or improvements in care or efficiency, but it could be the tool that helps a motivated patient achieve those results. In fact, all the information included in the popular physician-provided PHR iHealthRecord from Medem, a San Francisco company founded by the AMA and several other medical societies, is entered by the patient (although if patients choose they can have data automatically flow into their PHR as it is entered in their physician’s EMR system).

“Some patients will rise to the occasion, and some won’t,” he says. “But for patients with diabetes, hypertension or congestive heart failure, daily or weekly recordings of blood pressure and weight could result in useful information that could stem chronic conditions from going bad and save a lot of ER visits.”

And, for these patients with chronic conditions, Basch cites key barriers to primary-care physician involvement in helping develop and maintain a patient’s PHR: a lack of reimbursement for coordination of care among specialists; uncertainty over the legal responsibilities of helping a patient maintain a PHR; and knowing what the record contains.

“With personal health records, one of the issues is the core problem of financing healthcare where information management and discussions with patients are poorly reimbursable in the context of an office visit,” he says. “Those are currently seen as an uncompensated burden on physicians.”

Making sense of complicated and unorganized records can require four to five hours of work—whether the records are on paper or in an electronic format—Basch says, but this is accepted in most sectors because “there’s an unwritten rule that a primary-care physician’s time is not relevant and that information management isn’t really work.”

“There’s no payer who will say: ‘Sure, I’ll pay you for your time’; they’ll say ‘Too bad, learn how to do it in 60 seconds,’ ” Basch says.

Steven Waldren, director of the American Academy of Family Physicians’ Center for Health Information Technology, says PHRs haven’t caught the attention of most doctors yet. But for the relatively small portion of physicians who have implemented electronic records, PHRs are known entities and these doctors’ main concern is on workflow.

Establishing PHR data standards—what information to include and in what format—will be important to solving workflow and data-management problems, Waldren says, adding that it’s time for physicians to get familiar with PHRs.

“PHRs are here and will continue to be,” Waldren says. “If the healthcare consumer empowerment trend continues to move in the direction it’s moving, we’ll continue to see growth in the tools available for patients.”

Waldren mentions healthcare decision-support applications as one of the tools patients are going to be using soon, and this prediction is already coming true. Earlier this month, Verizon Communications announced it was offering PHRs to 900,000 of its employees, retirees and their family members, and the system would include alerts that would inform users when their care “may not be consistent with evidence-based medicine.”

See article here: http://www.modernhealthcare.com

Joe Vanden Plas • 04/23/07

Madison, Wis. – Is America rushing into the adoption of electronic medical records and patient data exchange without enough concern for data security?

The question has been raised on many fronts, including the Congress, where some bills seek to provide incentives to encourage the adoption of interactive personal health records, and others that raise privacy concerns are construed as a barrier to the adoption of EMRs.

Moreover, headline-grabbing data breaches in both the public and private sector are still fresh in the public’s mind.

As healthcare institutions in both Madison and metropolitan Milwaukee try to develop a framework for patient data exchange, we put the “rushing into” question to attorneys who practice in the healthcare sphere.

Attorney David Hanson, a partner in Michael Best & Friedrich and chairman of its healthcare practice group, noted there are people in the health field who think the industry already is spending too much time and money on patient data security – thanks to regulations like the Health Insurance Portability and Accountability Act.

In addition to HIPAA, most states, including Wisconsin, already have patient confidentiality regulations in place.

“That backdrop doesn’t change with the advent of shared medical records,” Hanson stated.

Carrie Killoran, a partner in Michael Best’s healthcare practice group, where one of her areas of emphasis is patient confidentiality, said healthcare providers are mindful of security concerns and regulations. The issue boils down to the context in which they are willing to share patient data, and which data sets should be shared.

Rather than a rush to adoption, Killoran said privacy concerns have delayed the implementation of EMRs. “They aren’t rolling them out as fast as clinicians would like,” she said.

Before any additional laws and regulations are adopted, she said health providers would like to see the HIPAA framework fully implemented and get a sense of how it’s working.

Continue article here: http://wistechnology.com/article.php?id=3868 

By CATHERINE DOLINSKI The Tampa Tribune Published: Apr 9, 2007

TALLAHASSEE – Your doctor in Tampa knows you’re allergic to penicillin. What about the hospital in Miami, where you’re headed for a two-week vacation?

Soon, doctors and hospitals throughout the state may obtain such information via the Internet instead of relying on patients and their families to provide it.

Bills advancing through the state Legislature would expand local electronic medical record-sharing programs into a single, statewide network.

“We live in a day of ATMs, BlackBerries and instant messaging,” said Rep. Denise Grimsley, R-Lake Placid, who is sponsoring the proposal in the House. “But when we step into the health care arena, we step back in time to a paper-based system that’s often unsafe and inefficient.”

Grimsley’s bills, which provide the first $5 million to establish the online network, heads to the full House on Tuesday. A Senate committee will hear similar bills the same day.

However, the push for electronic records has detractors sounding alarms about patient confidentiality.

“The states are racing ahead to build these systems,” psychiatrist Deborah Peel said. “I think it’s dangerous to opt in, until Congress fixes what’s wrong.”

Former Gov. Jeb Bush initiated Florida’s move toward electronic medical records in 2004, following President George W. Bush’s executive order to expedite the process. Since then, several pilot projects have launched across the state, including in the Tampa Bay area.

This year’s legislation would create the statewide Florida Health Information Network, available to authorized doctors, hospitals and other providers. The estimated $51 million project could eliminate the repetitive paperwork that patients face every time they seek medical treatment, lower health care costs, reduce medical errors and provide lifesaving information in an emergency.

Such record-sharing would minimize duplication and errors in treating patients who move around or who need treatments from distant specialists, Ronald Burns, an osteopathic physician from Orlando, told the House Health Quality Committee last month. “I have many patients that come to Orlando for treatment that reside in Lakeland, that also receive cancer treatment in Tampa.”

It could also play a critical role in medical responses during hurricanes, he said.

But, Rep. Gayle Harrell asked, how can patients be sure their data are protected from the prying eyes of government, businesses or others?

“The one question that keeps coming up – an issue that is out there, no doubt about it – is the privacy issue,” said Harrell, Health Quality Committee chairwoman.

Internet Is ‘Very Secure’

Electronic records are subject to the same federal and state privacy laws that guard paper records, said Michael Heekin, chairman of the Governor’s Health Information Infrastructure Advisory Board.

A public-private partnership would authorize the network’s users and decide how best to secure it, he said. Options for accessing records could range from a password to a retinal scan; different kinds of users could be granted different levels of access. Meanwhile, banking and other data-sensitive industries have paved the way for encrypting online records.

“The Internet today is a very secure place to do business,” said Sen. Jeremy Ring, D-Fort Lauderdale, an Internet entrepreneur who is co-sponsoring the proposal. “There’s a much stronger perception than there is a real application of true hacking that goes on.”

It’s not hacking that worries Deborah Peel most about electronic records.

Insurers, pharmacists, even hospitals have aggregated and sold sensitive patient data over the years, said Peel, who founded the Texas-based Patients Privacy Rights Foundation in 2004. Moving to electronic records, she said, vastly increases the potential for collecting and selling such data.

Last year, New Hampshire enacted legislation banning pharmacies, insurers and other companies from selling medical prescription data. Vermont is considering similar legislation.

Read complete article here: http://www.tbo.com/news/metro/MGBVKMUDA0F.html 

Harris Poll also finds most adults comfortable with existing state and federal health privacy laws

Heather Havenstein March 26, 2007 (ComputerWorld) — Electronic health records can be recorded and shared without jeopardizing privacy, according to a Harris Interactive Inc. survey of 2,337 adults that was released today.

In the survey, 63% of respondents said that a move to electronic health records could be done without endangering their privacy, while 25% disagreed. In addition, 60% of those surveyed said that existing state and federal health privacy laws provide a “reasonable level” of privacy.

The survey, which was done in January, was designed with Alan Westin, a professor of public law and government at Columbia University who studies electronic health records.

The survey showed “about a two-thirds majority are ready to accept the potential benefits of electronic health records systems if solid privacy and security rules are applied,” Westin said. “However, about one quarter of the public remains skeptical and worried about such systemic computerization, and it will take highly robust and transparent new privacy and security programs to overcome these fears.”

The survey also found that seven in 10 U.S. adults are generally satisfied with the way doctors and hospitals handle and protect personal health information. However, 50% noted that they believe patients have lost control over how organizations like insurance companies, employers and government health agencies use their personal health data.

The survey comes at a time when privacy concerns are at the forefront of federal government and health care providers’ efforts to help spur the adoption of electronic medical records and the creation of nationwide networks to share them.

Last month, the U.S. Government Accountability Office released a report  that said the federal government has not yet come up with a way to tie together the various ongoing initiatives it has to tackle privacy concerns associated with electronic medical records.

In addition, one of the country’s oldest regional health information organizations was shuttered  late last year, citing privacy as one of the challenges to continuing its operations.

Find article here:  www.computerworld.com

Group practice leaders responding to the 17th annual Modern Healthcare/Modern Physician Survey of Executive Opinions on Key Information Technology Issues are looking to spend more on healthcare IT in the near term than they are currently spending, but how much more is widely variable.

This story initially appeared in this week’s edition of Modern Physician.

Article: www.modernhealthcare.com

BY Brian Robinson Governmenthealthit.com March 16, 2007

Start-up electronic health record vendor Practice Fusion has struck a deal with Web search giant Google to provide a full-featured EHR for free, the first time such a product has been available to physicians at no cost as an on-demand Web service.

Advertising sold through Google’s system will finance the service, said Ryan Howard, chief executive officer of Practice Fusion. The company will also provide the EHR through a standard for-pay model, he said, but focus groups have indicated a greater potential acceptance of the free EHR.

“In this case the physician is the standard consumer for the ads,” Howard said. “When they realize this will allow them to offset the $50,000 per seat it could cost them with traditional EHRs, physicians tell us this will be no big deal.”

The San Francisco-based company was officially launched in August 2006. Its original software-as-a-service subscription model allows physicians to use as much or as little of the service as they need and to pay only for the amount they use.

Howard said the service was designed from the ground up to compete with established vendors EHRs sold. The service is separate from Google, which drives the application to the user, and Google will not handle any of the patient data exchanged through it.

A central repository owned and controlled by Practice Fusion will hold the data, and the service natively incorporates strong security and is compliant with the Health Insurance Portability and Accountability Act and Health Level 7. It also includes an integration layer using a well-defined application-programming interface that will enable it to access and share records with other existing systems.

The EHR, which is still in beta development now, should be available within the next four months, Howard said. The company has seed funding from a number of venture capitalists, he said, and is currently looking for other funding to allow it to scale its operations.

Article here: San Francisco Chronicle 

By ROBERT PEAR New York Times February 18, 2007

WASHINGTON, Feb. 17 — The Bush administration has no clear strategy to protect the privacy of patients as it promotes the use of electronic medical records throughout the nation’s health care system, federal investigators say in a new report.

In the report, the Government Accountability Office, an investigative arm of Congress, said the administration had a jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers.

President Bush has repeatedly called for the creation of such networks, through which health care providers could share information on patients. In 2004, Mr. Bush declared that every American should have a “personal electronic medical record” within 10 years — by 2014. With computerized records, he said, “we can avoid dangerous medical mistakes, reduce costs and improve care.”

In response to the president’s plea, federal officials have developed elaborate plans for what they describe as “a nationwide health information network.” Mr. Bush has said: “One of the things I’ve insisted upon is that it’s got to be secure and private. There’s nothing more private than your own health records.”

But in the report, issued this month, the G.A.O. said the administration had taken only rudimentary steps to safeguard sensitive personal data that would be exchanged over the network.

Senator Daniel K. Akaka, Democrat of Hawaii, who requested the investigation, said it showed that “the Bush administration is not doing enough to protect the privacy of confidential health information.” As a result, Mr. Akaka said, “more and more companies, health care providers and carriers are moving forward with health information technology without the necessary protections.”

In written comments on the report, Jim Nicholson, the secretary of veterans affairs, who supervises one of the nation’s largest health care systems, said, “I concur with the G.A.O. findings.”

But Dr. Robert M. Kolodner, who coordinates work on information technology at the Department of Health and Human Services, disputed the findings. Dr. Kolodner said his department was “very committed to privacy and security as it works toward the president’s goal” of switching medical records from paper to electronic files.

Read full article here:  www.nytimes.com