Report: HIEs failing at true interoperability

See a summary of the report by Mike Miliard at GovHeathITHIEs failing at true interoperability

· Healthcare organizations “must unlock the patient data in EHR silos of hospitals and affiliates to better coordinate and improve quality of care delivered. Health Information Exchange technology is the enabler.”

· Until EHR vendors incorporate a shared set of standards, HIEs will remain in a state of stunted development, said Moore: “Across the board, legacy systems fail to support true interoperability, and vendors are doing little to remedy this situation.”

· The report will also look to the future as to how this [Health Information Exchange or HIE] market will grow and evolve over the next several years as meaningful use requirements take hold, healthcare reform brings forth changes in reimbursement models, access to health data moves to mobile platforms and the consumer takes on a larger role.”
The quotes above show that the health technology industry and the government are beginning to face key facts:

· Data silos endanger patient health and safety: obviously we need our doctors to see relevant parts of our medical records held by other doctors/hospitals.

Electronic Health Records companies, hospitals, and the many other corporations that hold our electronic health information want to continue to “own”, control, and sell our personal health data. They built this system of “silos” that PREVENT data exchange (also called “interoperability”).  Corporations fiduciary duties to make profits for shareholders trump exchanging health information to save patients’ lives and reduce costs!

· Consumers = patients. If we say so, our health records must be shared with our physicians or other health professionals. This is matter of law.

No matter which corporations or health professionals hold our electronic health data, we are entitled to electronic copies. If you say your health data should be sent to another physician or health professional, the data holder must send it. ONLY individual patients or “consumers” have clear rights to control personal health information and have it sent to the other physicians and health professionals who are treating them.

· HIEs, data exchanges where patients have no meaningful control over who can copy and use their health information, are not the answer.

How “Direct” exchange works (via the “Direct Project”): a participant (like our physicians) can send secure, encrypted health information directly to a known, trusted recipient over the Internet. Unlike the case with HIEs, personal health information can’t be “pulled” from the 10, 20, or 100 places that hold our health records. Using the “Direct” method, someone has to decide to send one patient’s data to another person.

We [“consumers”] are the ONLY ones who can quickly, easily, and legally get and “exchange” our own health records at will. Hippocrates Oath, the foundation of the physician-patient relationship, states that sensitive health information should ONLY be shared with the patient’s consent.  Data exchanges like the Direct Project

The only way electronic health systems can work and earn the public’s trust is if data flows are controlled by patients, with very rare legal exceptions.

Proposed Rules Prevent Patient Control Over Sensitive Information in Electronic Health Records (EHRs)

The proposed federal rules will require physicians and hospitals to use Electronic Health Records (EHRs) that prevent patient control over who can see and use sensitive personal health information.

This is the second time the federal government has proposed the use of technology that violates Americans’ strong rights to control the use and sale of their most sensitive personal information, from DNA to prescription records to diagnoses.

The proposed rules require EHRs to be able to show “meaningful use” (MU) and exchange of personal health data. PPR and other consumer and privacy advocacy groups submitted similar comments for the Stage 1 MU rules. These newly proposed rules are known as “Stage 2 MU” requirements for EHRs.

The most important function patients expect from electronic health systems is the power to control who can see and use their most sensitive personal information. Technologies that empower patients to decide who can see and use selected parts of their records have been working for 4 million people for over 10 years in 8 states with mental illness or addiction diagnoses. Today we do not have any way to know where our data flows, or who is using and selling it.

Even if we had a ‘chain of custody’ to prove who saw, used, or sold our personal health data—which we do not—it is still essential to restore patient control over personal health data so we can trust electronic health systems.

Technologies that require patient consent before data flows are cheap, effective, and should be required in all EHRs.

See Patient Privacy Rights’ formal comments on the Stage 2 MU proposed requirements submitted to the Centers for Medicare and Medicaid and the Office of the National Coordinator for Health IT at: http://patientprivacyrights.org/wp-content/uploads/2012/05/PPR-Comments-for-Stage-2MU-5-7-12.pdf

The Depressing State of HIEs

See the full article at Hospital EMR and EHR: The Depressing State of HIEs

Yes, the state of Health Information Exchanges (HIEs) in the US is depressing, because many don’t work well for patients or doctors. They enable hundreds or thousands of strangers who work for hospitals, insurers, health IT companies, etc to exchange, use, or sell our sensitive medical records without our consent.

The safe way to exchange health information is to use secure email and patient consent, this is called the “Direct Project”. See: http://directproject.org/ . It enables us to share our health information between two health professionals and email physicians. The Direct Project enables “participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.”

Patient Privacy Rights (PPR) endorses the “Direct Project” as the ONLY legal, ethical, and secure way for sensitive patient information to be exchanged.  The public will not trust HIEs or national data exchange models unless patients control the disclosures of their sensitive health records.

A quote from the story below shows financial interests of Accountable Care Organizations (ACOs) can trump patients’ interests: “Some ACO providers are now blocking access to their data so competitors can’t get to it”—-that means doctors who are not part of the ACO but who treat ACO patients can’t see their test results and treatment records–even when these patients want them to have that information.

Some ACOs and other businesses view HIEs as vehicles to get more patient data, rather than as a means to serve patients’ needs for care coordination, to avoid duplicate tests, to ensure better treatment, or enable them to give consent for research use of their data.

Many corporations and businesses that HOLD patient data imagine they own it, so they use and sell it without patient consent. US law and medical ethics still require meaningful, informed patient consent before physicians or data holders can disclose anyone’s health information. “HIPAA compliance” actually does NOT get data holders off the hook for asking patients for consent before disclosing data. According to the HIPAA Privacy Rule, it’s “the floor” for data privacy protection, not the ceiling. 67 Fed. Reg. at 53,212 (August 14, 2002).  HIEs designed to further business interests over patients’ interests will continue to fail, because the public will not support them.

It turns out that the only person who can easily, cheaply, and legally make patient data flow for all the right reasons (treatment, research), to all the right all the people (a specific doctor or researcher) at the right time is YOU.

Only you can tell an ACO to send your data to an outside clinician —- and the ACO must send it, whether it gives competitors an advantage or not. Only you can make your data “fluid”, because patients are the only people with clear, longstanding Constitutional, legal, and ethical rights to disclose personal health information.

In PPR’s recent comments about building a Nationwide Health Information Network (NwHIN), we urged the Office of the National Coordinator for Health IT (ONC) to address the fatal privacy and security flaws in current systems and state and federal data exchanges. We urged ONC to certify that HIEs and data exchanges protect privacy by verifying that only patients decide when/where personal data flows.  “Multi-stakeholder” public-private governance at the state and federal level has failed to gain public trust.  Public-private governance assures that industry, research, and government interests trump the public’s rights to health information privacy. See: http://tiny.cc/e1v0gw for more information.

Health records lost, stolen or revealed online

From the Chicago Tribune Article: Health records lost, stolen or revealed online

“Almost a decade after a new law went into effect to strengthen health privacy protections, the number of breaches of patient records and databases across the U.S. suggests that personal health information is not as private or secure as many consumers might want or expect.

Since fall 2009, more than 400 large health care breaches affecting at least 500 people and more than 50,000 smaller breaches have been reported to the federal government.

One of the largest unauthorized disclosures in recent history of medical records and other private information happened in September, when computer tapes were stolen that contained data on almost 5 million people enrolled in TRICARE, the nation’s health program for military members, their families and retirees.

Some breaches have resulted in personal information being revealed online. The names and diagnosis codes of almost 20,000 emergency room patients at Stanford Hospital in Palo Alto, Calif., were posted on a commercial website for nearly a year before it was discovered in September and taken down…

Dr. Deborah Peel, founder and chair of Patient Privacy Rights, a consumer group, would like to see more help for those whose information is breached and tougher punishment for those responsible. The BlueCross BlueShield of Tennessee settlement amounted to “roughly a dollar per breach record, which is nothing,” she said.

Harvard’s Data Privacy Lab launching health record bank

Read the full article at: http://www.nhinwatch.com/perspective/harvard’s-data-privacy-lab-launching-health-record-bank

Some key points from the story:

“In a major new development in the world of health IT, the Data Privacy Lab in the Institute of Quantitative Social Science at Harvard University will soon unveil a health record bank (HRB) that allows anyone to own and manage a complete, secure, digital copy of their health records and wellness information with a free account. This is the first time that a prominent academic institution is hosting an HRB for use by the general public and communities nationwide.”

“This launch is important for health IT because an HRB can provide and sustain all the capabilities of a fully functional health information infrastructure (HII):
1. It allows access to comprehensive individual electronic patient records, aggregation of population information for public health and medical research, and record searching to facilitate patient-specific notifications;
2. Privacy is protected since each patient determines who can access which portions of their own health records;
3. Collecting patient information is assured – since patients request their records, all providers must supply them (under HIPAA and for Stage 2 Meaningful Use);
4. It is inexpensive to operate since it obviates the need for the complex and costly real-time record locator services necessary when each patient’s records from all sources are not centrally stored;
5. Patient consent enables innovative applications linked to HRB accounts, providing compelling value to consumers and other stakeholders (e.g., reminders and alerts), thereby ensuring more than enough revenue for financial sustainability. HRBs could even fund permanent, ongoing EHR incentives to office-based providers to help further promote widespread adoption and standards compliance. The HRB at Harvard therefore represents a feasible and readily achievable HII paradigm that can be utilized by individuals and communities nationwide.”

Health privacy issues can be resolved without obstructing care

See the full article at FierceHealthIT.com

“At times, it seems like concerns about the security and privacy of healthcare data have catapulted into overdrive: For instance, it recently was predicted that healthcare spending on security would hit $70 billion a year by 2015–enough to cover the majority of the uninsured. Sure, there are plenty of security breaches–some of them serious enough to attract public attention. But as a few recent cases show, universal encryption of data (some forms of which may soon be required under the latest HIPAA rules) could eliminate the biggest source of security breaches. Also, with the advent of virtual desktop infrastructure, there’s no reason to store any personal health information on end-user devices…

…Another challenge in the security arena is giving consumers the ability to control who sees their records. While most physicians now have their patients sign HIPAA forms so that they can share data with other providers, the advent of electronic health information exchange (HIE) has greatly increased access to a wide range of individually identifiable data from a variety of sources. And patients may not want everyone who treats them to know, for example, that they have seen a psychiatrist.

A study recently published in Health Affairs documents the extent to which five California healthcare organizations follow principles for protection of patient information that were developed by consumer groups and other stakeholders. Although the healthcare providers took privacy and security seriously, the report said, “none of the organizations did much to educate consumers about the data available about them or to enable them to control their data.””

Doctors order more X-rays, not fewer, with computer access

This excerpt is taken from Lena H. Sun’s article in the Washington Post National: Doctors order more X-rays, not fewer, with computer access.

“In the debate over the high cost of health care, federal policymakers have always claimed that one way to cut costs is for doctors to use electronic medical records and other information technology. Doing so, they say, avoids duplication and saves money.

But new research suggests that may not be the case.

Doctors who have easy computer access to results of X-rays, CT scans and MRIs are 40 to 70 percent more likely to order those kinds of tests than doctors without electronic access, according to a study to be published in the March issue of the journal Health Affairs.

“On average, this is comparing doctors who had electronic medical records and those who didn’t,” said lead author Danny McCormick, a physician and assistant professor of medicine at Harvard Medical School.

Researchers say the findings challenge a key premise of the nation’s multibillion-dollar effort to promote the widespread adoption of health information technology.

“This should give pause to those making the argument,” McCormick said. Instead of saving money, that effort could drive costs higher, he said.”

PPR in the Wall Street Journal

The Journal Report of The Wall Street Journal featured Patient Privacy Rights’ founder in a debate about Unique Patient Identifiers (UPIs). Deborah C. Peel, MD, founder & chair of Patient Privacy Rights, opposes UPIs, pointing out there are better electronic records systems that allow patients to control data exchanges for treatment and other approved uses.

You can read both sides of the debate at this link: “Should Every Patient Have a Unique ID Number for All Medical Records?”

While voting remains open, the scores have remained fairly static over the past month showing a clear victory. Deborah Peel, MD has won the debate for Patient Privacy Rights, exposing the dangers of UPIs in electronic health record systems. If you have not already, you can still vote “No” to UPIs, and help protect patients, privacy, and progress toward patient-controlled electronic health records. If you are in the main article, voting takes place on the left side of the screen below the picture of Michael Collins. You can also use this direct link to vote after reviewing the full debate.

To dispel the myths of UPIs:

  • Trying to separate UPIs from financial records would be like trying to separate SSNs from everything they have been linked to, including medical records!
  • UPIs will give government, industry, data miners, and others greater ability to collect all health information on individuals. Imagine giving everyone a unique financial identifier that they would use for all credit cards, banks, retailers, and other financial institutions. Would you feel your money was secure?
  • A surprising amount of patients already do not trust a paper-based system, and fear for their privacy even more with expanding Health IT. Having a UPI takes away the idea of patient control and consent, creating one very easy and obvious way for anyone with the means necessary to look up a patient’s full health record. Patients will only accept a system they can control.

We do our work to improve health care by protecting patient privacy. We encourage you to protect your own privacy rights by voting now.

National experts to meet at HIMSS to promote health record banks

See the full article at: http://www.nhinwatch.com/perspective/national-experts-meet-himss-promote-health-record-banks

Experts are planning to meet at HIMSS to discuss “strategies to promote and accelerate development and adoption of HRBs – community-based personally controlled repositories of electronic health records.”

Some key points:

  • -“HRBs can provide effective and efficient health information infrastructure (HII) in communities by simultaneously addressing the interdependent requirements of privacy, stakeholder participation and financial sustainability.”
  • -“HRB allows patients to readily and conveniently manage their access permissions in one place. In addition to being an effective approach to privacy, patient control also ensures that stakeholders make information available.”

The article goes on to list the cost and efficiency revenue advantages of HRBs as well as the privacy implications.

Re: Study shows privacy of medical records is weaker in the U.S.

A study of US and EU health data protections in the Journal of Science & Technology Law concluded Americans “have no real control over the collection of sensitive medical information if they want to be treated.”

Wow! It’s great to see legal scholars second the message that Americans’ rights to health privacy were eliminated.

You can see the article on the study in The Epoch Times here, written by Mary Silver.

For years, Patient Privacy Rights and the bipartisan Coalition for Patient Privacy were the lone voices carrying this message to Congress and the public.

Public and expert support to restore control over sensitive health data will only build. Soon, no one will buy the argument that privacy is an obstacle to electronic health systems.

Here are some other key quotes from the story:

  • “EU countries have adopted electronic health records and systems, or EHRs, and legally protected privacy at the same time.”
  • “The 1950 Council of Europe Convention identified individual privacy as a fundamental value”
  • “the good aspects of EHRs can be undermined by the bad consequences of poor privacy practices and the ugly effects of inadequate security”
  • “patient privacy is much better protected in Europe”
  • “European patients are able to encapsulate particularly sensitive medical information, and an individual has far greater access to and control over his records in Europe than in America.”

So, again why is the US government rushing to spend $29 billion on health IT systems that offer neither privacy nor security?