HIT Blawg

HIT Blawg Named a Top 50 Blog for Health Administration

2010-01-13T13:49:00.000-06:00

The folks over at Health Hut have come out with a list of the Top 50 Blogs to learn about health administration. I am proud and honored to have this blog among those selected for inclusion.

Congrats to the others selected as well.

HIPAA Holidays!

2009-12-22T11:37:00.000-06:00

Susan Ziel and I got together recently to prepare a short video on HIPAA updates. You can view the video here.

The 30-minute briefing reviews some of the significant amendments to HIPAA that were enacted under Title XIII of the American Recovery and Reinvestment Act, also known as the Health Information Technology for Economic and Clinical Health ("HITECH") Act. This HIPAA briefing is one of our "first efforts" to bring you useful compliance information that can be accessed online, anytime, at no cost to you. You can access our briefing by viewing this email as a web page (or by clicking here). We also encourage you to make this "user friendly" briefing available to your professionals and staff as part of your ongoing HIPAA compliance program. We wish you and your organization "HIPAA Holidays" and a very successful 2010!

PHR Report Card

2009-12-14T16:27:00.000-06:00

Patient Privacy Rights has released its report card on Personal Health Records ("PHRs") and which PHRs protect patient privacy. So which PHRs scored best? No More Clipboard scored an "A" while Google Health scored a "D/F", Microsoft Healthvault a "B/F", WebMD and CapMed's ICEPHR each scored a "C" and PHRs offered by employers and insurers scored a flat "F".

I have to extend my thanks to Dr. Kari Harno of Helsinki (Finland) University Central Hospital for bringing the report card to my attention.

CCHIT Certifies First Group of EHRs

2009-12-01T15:17:00.000-06:00

CHICAGO – The Certification Commission for Health Information Technology announced today the first group of products certified for use with the proposed American Recovery and Reinvestment Act ("ARRA") incentive requirements.

None of the offerings appear to be from major EHR vendors. The products announced Tuesday as certified in the Preliminary ARRA 2011 program are:

eHealth Made EASY, version 3, by eHealth Made EASY, LLC, supporting two of 27 meaningful use objectives for eligible providers and two of 24 objectives for hospitals.
KIS Track, version 5.1, by Kaulkin Information Systems, supporting two of 27 objectives for eligible providers.
Medios, version 4.5, by IOS Health Systems, supporting all 27 objectives for eligible providers.

Engage with Grace Blog Rally

2009-11-24T13:22:00.000-06:00

At the request of my good friend, Bob Coffield, I am joining the Engage with Grace blog rally to spread the word about end of life planning. Unfortunately, I had personal experience with this topic due to the death of my father a few months ago. It is a difficult discussion but one for which I admire my Dad a great deal. He made a decision and we all respected his choice. May you and your loved ones have such a thoughtful and dignified discussion when the time comes.

Happy Thanksgiving.

EHR and Legal Liability Task Force

2009-11-20T15:35:00.000-06:00

I have the good fortune of co-leading an American Health Lawyers Association Task Force on Electronic Health Records and Legal Liability. For those of you who might be interested in this topic and/or participation, please let me know. The Task Force will seek to address the issues and concerns relating to EHRs, Personal Health Records, and Health Information Exchange.

This is a tremendously interesting area of the law. The developments in EHR adoption and implementation are on the cutting edge of legal liability and sometimes beyond that.

AHIMA Lobbying Aggressively Against Red Flag Exemption

2009-11-19T02:47:00.001-06:00

AHIMA Recently sent a letter to Senator Chris Dodd (D-CT) and the Senate Committee on Banking, Housing and Urban Affairs to oppose any consideration of HR 3763, legislation that would exempt certain businesses, including healthcare practices with 20 or fewer employees, from the requirements of the Red Flags Rule. AHIMA is asking members to send a letter to their Senators opposing this legislation.

Interesting position by AHIMA in seeking to have the Red Flag Rules apply to these smaller practices and one that is certain not to win them any fans among physician groups.

ABA Wins - Red Flag Rules Do Not Apply to Lawyers - What About Doctors?

2009-11-16T09:55:00.000-06:00

The American Bar Association succeeded in obtaining an Order for Summary Judgment holding that the FTC's Red Flag Rules do not apply to lawyers. The Order granted the ABA an injunction and summary judgment on its claim that the Rules should not apply to lawyers and concluded the FTC acted arbitrarily and capriciously.

No word yet on the application of the Rules to physicians and other medical professionals. It would appear at first blush that the same argument exempting legal professionals would apply equally to medical professionals.

Breach Notification and Employment Law

2009-11-12T13:28:00.000-06:00

I just finished presenting a teleconference with my colleague, Linda Cooley. The subject was the intersection of the new Breach Notification Rule, Interim Enforcement Rule, and Employment Law. Linda's presentation on the HR implications was absolutely fascinating and a tremendous resource for covered entity employers. There is a lot to be considered in addition to compliance with the new HITECH Act requirements.

AHIMA Opposes Limitation on Red Flag Rules

2009-11-11T22:49:00.000-06:00

AHIMA has continued its effort to oppose any consideration and passage of HR 3763 in the Senate. HR 3763 would exempt certain businesses, including healthcare practices with 20 or fewer employees, from the requirements of the Red Flags Rule.

The Benefits of HIT - Felt Immediately

2009-11-02T10:26:00.000-06:00

Out of an abundance of caution, my doctor originally diagnosed me with H1N1. While at the office, I underwent the nasal swab test. Unfortunately, those test results are not available for two days and my visit was on Friday.

My family, friends, and co-workers were informed of the tentative diagnosis. Of course, as a parent I worried tremendously about my children contracting the flu. Thankfully, my physician utilized an EHR system with a PHR and patient communication component. So, as of Sunday evening I got my test results back along with a message from my doctor. It was not H1N1. I could quickly tell my office and family and decrease their worries.

I am still sick but the concern of H1N1 is off my mind, for now.

House Healthcare Bill Creates Health Insurance Cooperatives

2009-10-30T13:02:00.000-05:00

The House Bill introduced recently creates Consumer Operated and Oriented Plan programs ("CO-OP") which are nonprofit health insurance insurance cooperatives which are to be member-owned. The CO-OPs are a new type of health insurance which are not to be affiliated or the successor to an existing health insurance plan. Each CO-OP must be licensed in each state it plans to operate. There will be grants and loans available for the creation of these new entities.

The creation of the CO-OPs will be a new aspect to healthcare reimbursement. CO-OPs will need to rely upon professionals with the skills and expertise in health law to navigate the state and federal requirements which are applicable. Those firms which have historically represented health insurance plans and payors will no longer be able to provide assistance; either due to lack of experience and expertise or due to conflicts of interest in representing plans and payors and CO-OPs. However, those professionals who have counseled nonprofits and providers will be well-suited to advise on the creation and governance of these new entities.

As more details emerge on CO-OPs, additional considerations will doubtless be raised. Stay tuned.

HIT Policy Committee Discusses "Meaningful Use"

2009-10-29T10:17:00.001-05:00

At a recent meeting of the HIT Policy Committee , small practice and solo physicians, community health providers, behavioral health providers, doctors who treat minorities testified that "meaningful use " may be a good idea in theory, but there are many problems. The providers said they don't see many doctors adopting HIT, while others say collection of data could be used to punish them in the future.

Many of the complaints focused on financial and time barriers. Physicians have asked ONC and CMS to consider expanding and clarifying the requirements for "meaningful use." CMS, with counsel from ONC, is currently writing a proposed rule on meaningful use, to come out by the end of the year, according to David Blumenthal, head of ONC.

Seventh Circuit "Finally" Develops Electronic Discovery Program

2009-10-28T10:04:00.000-05:00

The Seventh Circuit Court of Appeals has launched its Electronic Discovery Pilot Program, commencing October 1, 2009. The program is meant to address the e-discovery issues triggered by the changes to the Rules of Civil Procedure relating to discovery of electronically-stored information.

Draft Criteria for HIE Accreditation Program

2009-10-28T09:39:00.001-05:00

The Electronic Healthcare Network Accreditation Commission has released its draft criteria for a Health Information Exchange Accreditation Program.

The criteria mirrors the HIPAA Privacy and Security Rule requirements. This can offer an easy form of checklist for HIE's looking to ensure their compliance but should be viewed as only a starting point for overall compliance.

The target release date is April 2010.

'Little Buddy' GPS device keeps tabs on your kid :: CHICAGO SUN-TIMES :: Technology

2009-10-27T12:43:00.002-05:00

'Little Buddy' GPS device keeps tabs on your kid :: CHICAGO SUN-TIMES :: Technology

Secondary Usage of Health Data

2009-10-23T11:05:00.000-05:00

Another report has been released touting the benefits of secondary usage of health information. PriceWaterhouseCooper's report highlights the benefits of utilizing this data for a variety of purposes. It also notes that a majority of companies already utilize health information secondarily. For example, half of pharma companies have access to clinical informatics contained in EHRs. However, the access that was available was seen as limited or difficult to obtain and use in a meaningful way.

The report does cite the need for stringent privacy and security protocols. A majority of those surveyed were concerned with legal and public relations incidents from usage of the data. Another area of the report calls for increased collaboration among providers, payers, pharma, and IT vendors. This recommendation seems to be based on common sense. However, it does not fully address Stark, Anti-Kickback, and Anti-Trust considerations.

All in all it appears that the veil is being lifted and the real reason underlying adoption of EHRs is being brought to light. The business rationale for secondary usage is convincing. However, the privacy and security concerns will be difficult to adequately resolve.

Health Care Bill - Final

2009-10-19T18:13:00.002-05:00

The Final Health Care Bill has been released. Here is the Committee Report. More details to come.

Nurse Accused of Using Internet to Encourage Suicides

2009-10-19T09:01:00.000-05:00

A Minnesota nurse is accused of accessing online chat rooms and encouraging depressed participants to take their own lives. Investigators said the nurse, William Melchert-Dinkel, 47, feigned compassion for those he chatted with, while offering step-by-step instructions on how to take their lives.

Legal experts said prosecuting such a case would be difficult because Mr. Melchert-Dinkel did not physically help kill anyone. In the meantime, his nursing license has been revoked.

2009-10-18T09:45:00.001-05:00

Data-mining component of EHRs expected to generate substantial revenues:

From the NY Times

-By 2020, a majority of American health providers are expected to have electronic health systems, the data mining component alone could generate sales of up to $5 billion

Mayo to Limit Medicare and Medicaid Patients

2009-10-13T15:21:00.000-05:00

Mayo announced late last week that its flagship facility in Rochester, MN, will no longer accept Medicaid patients from Nebraska and Montana. The clinic draws patients from across the Midwest and West, but it will now accept Medicaid recipients only from Minnesota and the four states that border it. As it is, only 5% of Mayo's patients in Rochester are on Medicaid, well below the average for other big teaching hospitals, and below the 29% rate at the other Rochester hospital.

In addition, Mayo's facility in Glendale will no longer accept Medicare patients. The skeptics also question Mayo's argument that it needs to cut back on Medicare and Medicaid patients because those payments are so far below its costs. While Mayo is adept at limiting unnecessary procedures, they note, the costs of the procedures it does provide are high. By extracting such high rates from insurers and private payers, it can pay for top talent and facilities, thus raising its budget and its per-procedure costs.

2009-10-12T15:16:00.001-05:00

Well, a few days before going to get my flu shot I have come down with flu-like symptoms. It serves me right for being a procrastinator. I will keep you updated with any interesting details.

Congressman Waxman Takes Issue with HHS Breach Notification Standards

2009-10-05T15:27:00.000-05:00

Henry Waxman sent a letter to Secretary of Health and Human Services Kathleen Sebelius outlining Congressional disagreement with the standard HHS had proposed for breach notification without "harm" to the individual. Waxman, joined by other members of the Committee on Energy and Commerce, along with Pete Stark, stated that

"Section 13402 of ARRA requires health care entities to notify individuals if there is an "unauthorized acquisition, access, use, or disclosure of protected health information which compromises the security or privacy of such information." In its interim final rule, HHS interpreted the term "compromises" to include a substantial harm standard. If the breaching entity decides there is no significant risk of financial, reputational or other harm to the individual, that provider or health insurer never has to notify their patients that their sensitive health information was used or disclosed in violation of the federal privacy rule. ARRA's statutory language does not imply a harm standard."

Waxman concludes that Congress expressly rejected a harm standard in its drafting of the legislation and that HITECH/ARRA implemented a "black and white standard" for breach notification, without leaving it to healthcare providers to determine if "harm" has or will occur.

HHS Position on Revisions to Existing Business Associate Agreements

2009-09-18T11:26:00.000-05:00

Sue McAndrew, of HHS Office for Civil Rights, on the requirement that business associate agreements be modified to include the new HITECH Act requirements:

“we are still on track for an 'omnibus' HITECH Act NPRM in the fall. It will include the business associate changes, along with most of the other privacy changes, except for accounting for disclosures which awaits the ONC standard setting process to work through first. We hope to get the final rulemaking done in early 2010. We are not likely to issue revisions to the sample BA contract provisions until the final rule stage. We are also still looking to have the usual compliance period time following a modification to the privacy rules apply here and are revisiting the extended compliance period allowed under the original regulations for conforming existing contracts to BA requirements to see if the same need exists this go round. Hope that helps with your planning."

A big shout out to Ed Shay for passing this valuable information along.

Child Health Corporation of America Risk Management Forum

2009-09-14T15:54:00.000-05:00

I have been invited to speak at the upcoming Child Health Corporation of America Risk Management Forum in Baltimore, MD. My topic will be "Caselaw Update and Other Tips, Trends, and Tidbits." I look forward to addressing the audience on recent caselaw on EHRs and also engaging in a discussion on PHRs and related issues. Those in attendance will be from pediatric facilities across the country.