Enabling the Health Care Locavore

Here’s a great article written by PPR’s Chief Technical Officer, Dr. Adrian Gropper about “why hip replacement surgery costs 5-10 times as much in the US as in Belgium even though it’s the same implant… JAMA publish[ing] research and a superb editorial on the Views of US Physicians About Controlling Health Care Costs and CMS put[ting] out a request for public comment on whether physicians’ Medicare pay should be made public.”

To view the full article, please visit Enabling the Health Care Locavore on The Health Care Blog.

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

PPR on article: What ‘Patient-Centered’ Should Mean…

It is extremely helpful that the nominee to head of one of the largest federal agencies, the Centers for Medicare and Medicaid (CMS), stated he believes medical records should belong to patients.

You will be intrigued by Don Berwick’s terrific and very personal article titled “What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist, A seasoned clinician and expert fears the loss of his humanity if he should become a patient.” He is a highly respected physician and scholar. Key quotes:

  • “Medical records would belong to patients. Clinicians, rather than patients, would need to have permission to gain access to them.”
  • “My proposed definition of “patient-centered care” is this: The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care . . .”

Discussion on Targeting in the UK using the National Health Service

UK patients are outraged over whether the government NHS (National Health Service) data base was used to find individual cancer patients and pressure them to vote for the Labour party.  See article here.

Even if NHS data was not used, CLEARLY there is enough commercial data for sale in both Britain and the US for cancer victims’ addresses to be found and re-identified.

Allowing the secret US data mining industries that steal, collect, aggregate, and sell all Americans’ sensitive personal health information, health-related searches, health-related posts on social websites, email about health, and health-related purchases to continue doing business-as-usual is a prescription for disaster.

It’s a key reason we are seeking 500,000 people to sign the Do Not Disclose list. If Congress gets 500,000 signatures, they will pass a law to restore our control over our digital health records and set up the list.

Don Berwick MD, President Obama’s nominee to lead the Centers for Medicare and Medicaid, agrees that health information should belong to patients—and doctors should have to ask us to see it. See his article on patient empowerment: What ‘Patient-Centered’ Should Mean.

Yes, it’s illegal for employers and banks to use health information—but if they have it, they can use it—and there is no way to stop them.

We should be able to stop anyone from getting our health information. A national Do Not Disclose list would ensure we decide who sees our health information and who doesn’t.

It’s time to prevent corporations and government from being able to get our sensitive health information without consent. Sign the Do Not Disclose list!


  • “The Conservatives and the Liberal Democrats have attacked the Labour Party for sending “alarmist” literature to cancer patients, and called for an inquiry into whether NHS databases had been used to identify recipients. The row erupted after Labour sent cancer patients mailshots saying that their lives may be at risk under a Conservative government.”
  • “Experian, the data management company, confirmed that both Labour and the Conservatives use its Mosaic database, which divides voters into 67 groups. The databases can use anonymised hospital statistics, including postcodes and the diagnoses of patients, to identify the likely addresses of those with particular illnesses.”

Study: Online Care May Reduce Healthcare Costs

Results of a study released today found that the use of online care for certain prescribed circumstances may result in first-dollar financial savings for employer-sponsored health plans.

The Milliman study was authored by Arthur L. Wilmes, FSA, MAAA, principal & actuary at Milliman, an actuarial firm with a leading presence in the healthcare market. The analysis demonstrated potential medical savings of $3.36 and $6.95 per-member-per-month (PMPM) for commercial and Medicare plans, respectively. The study investigated the use of online care services similar to those in American Well’s Online Healthcare Marketplace System, which became commercially available earlier this year.

Writing is on the wall for doctors’ e-prescriptions

The move to get doctors to file prescriptions electronically is gathering steam and may get a further boost from new Medicare rules that give doctors money to go electronic — and take it away if they don’t.

From 2004 to 2007, e-prescriptions increased from 700,000 to 35 million, according to the company that routes e-prescriptions from doctors’ offices to pharmacies, Pharmacy Health Information Exchange operated by SureScripts. Still that only amounts to about 6% of U.S. doctors who regularly sent e-prescriptions in 2007.

The government is hoping to change that…

…But privacy advocates warn of problems.

Transforming prescriptions from scrawl into a standardized electronic format can make them even easier for pharmacies to sell and trade, violating patient privacy, says Tim Sparapani, senior legislative counsel for the American Civil Liberties Union. “Any time you put something in a digital format and standardize it, it becomes much more profitable and easy to move those records,” he says.

Industry Concerns About Privacy Restrictions Stall Senate’s Health IT Bill

A bill aimed at pushing the health care industry toward conversion to electronic records seemed to gain new life three weeks ago, after a compromise between key senators, but now the legislation is knotted up again over the same issue that has weighed it down for years: privacy.

The bill (S 1693) would provide grants and loans to hospitals and other health providers to help them purchase what is known as health information technology, or health IT. The legislation would also require the federal government to settle on software and hardware standards for its own health functions, like Medicare, in hopes that such standard-setting would help bring the private sector along.

Records of up to 71,000 Georgians made available on Internet

The state Department of Community Health said it has notified state and federal agencies that a Florida company mistakenly put the private records of up to 71,000 Georgians on the Internet.
The records were made available on the Internet for several days by WellCare Health Plans Inc. of Tampa, Fla., and some may have been viewed by unauthorized people, company officials said.
The problem was caused by human error, the Department of Community Health said.
The department said Wednesday it has informed the federal Department of Health and Human Services and its Office of Civil Rights; the Centers for Medicare and Medicaid; the Governor’s Office of Consumer Affairs; and the Georgia Attorney General’s office about the data breach.
Any exposure of private health information is a potential violation of HIPAA, the Health Insurance Portability and Accountability Act.
The Department of Community Health said the families whose data may have been accessed are members of the federal Medicaid health program for the poor, and the federal-state PeachCare for Kids program for children of the working poor.

HHS urges Congress to include IT adoption in physician payment fix bill

Secretary of Health and Human Services Michael Leavitt urged Congress yesterday to include a requirement for doctors to use electronic health records as part of any proposed Medicare physician payment bill.

On Nov. 1, the Centers for Medicare and Medicaid Services issued a final rule calling for a 10.1 percent reduction in payment rates for physicians beginning Jan. 1, 2008.

Physician groups hope to have this reversed by last minute legislation before Congress breaks for the holidays, and for the last five years, Congress has intervened to temporarily suspend requirements the would require decreases.

Despite Leavitt’s call for healthcare IT adoption, a physician payment fix bill already faces strain. Congress’ last-minute deferral of a 5 percent cut to Medicare reimbursements last year puts extra pressure on retaining the cut this year.

Lawmakers: Medicare’s cost crisis starving health IT

The prognosis is simple for a health care system that is hemorrhaging money: Submit to rehabilitation in the form of widespread adoption of information technology or stand by as the condition worsens. That was the overall message delivered June 21 at the Capitol Hill Health Information Technology Showcase in Washington.

“We are headed for the cliff,” said Sen. Kent Conrad, (D-N.D.). He cited projections that, without meaningful intervention, expenditures on Medicare and Medicaid could rise to 20 percent of the gross domestic product over coming decades.

Sen. Sheldon Whitehouse (D-R.I.), said failure to fix the systems guarantees that Congress “will be forced to make savage cuts” later.

However, implementing necessary IT solutions amounts to major surgery. Among the challenges are an absence of interoperability among different  health IT applications, a lack of universal broadband access, insufficient political will at the national level and misalignment of the financial incentives needed to propel rapid adoption of health IT.

{Quotes from Rep Patrick Kennedy: “The public’s concerns aren’t misplaced, said Rep. Patrick Kennedy (D-R.I.), who predicted that failure to secure patients’ electronic records would invite misuse of the data by life insurance companies, big pharmaceutical companies and other corporate interests. “To move forward with IT, it needs to have as its cornerstone privacy,” Kennedy said.”}