Haven’t we heard this one before?

As many of you know, I am an occasional contributor to a British publication called E-Health Insider.

A story published today in EHI’s newsletter for primary care mentioned that a development board for electronic medical records in England is wrestling with what constitutes a “summary record” of patient information in a national database and a “local record” for a patient’s general practitioner.

Hmm, questions over what data elements to put into an EMR? Issues of data ownership and access? Apparently, turf battles and lack of standards in health IT are not a uniquely American problem.

HIPAA myths, ad nauseum

I fired off a long e-mail Thursday night to the listserv of the Association of Health Care Journalists, of which I am a member. I got tired of reading about people discussing why an editor for medical publishing company Elsevier had a hospital deny permission to print a clinical photo of a small portion of an unidentified patient’s body, even though a physician at the same hospital was willing to hand over the image.

Nothing in healthcare frosts my biscuits more than HIPAA-related paranoia.

This is how I responded:

Yes. there is a lot of paranoia about HIPAA, mostly because it’s badly misunderstood. For example, HHS has said it is perfectly fine for staff to call out patient names in waiting rooms. Click this link to go to the HHS privacy FAQ page and click on Subject #5.

From all the other comments on this listserv, it sounds like the hospital’s refusal to ask for consent had more to do with money (from sale of the rights to such photos) and potential malpractice liability. The potential criminal penalties notwithstanding, I am not aware of the feds prosecuting anybody under the privacy regs to date. The HHS Office for Civil Rights, which enforces the civil part of the privacy regs, has been clear in saying that enforcement will be driven by complaints only. There is no “HIPAA police” out there trying to catch anyone in the act.

One interesting provision in the privacy rules is that covered entities (e.g., hospitals, docs, labs, health plans) have permission share a “limited data set” of de-identified information with public health agencies to identify or respond to a public health outbreak, but news media are expressly excluded from this right. Read it yourself at http://www.hhs.gov/ocr/hipaa/privrulepd.pdf, page 57, final comment at the bottom of the right-hand column and the response that follows on page 58.

The HHS press office is at (202) 690-6343. Someone there should be able to explain the minutiae of the regs. E-mail me directly if you want the name of a HIPAA consultant or lawyer.

If you think the rules are too restrictive, get in touch with the National Committee on Vital and Health Statistics, which must report to the HHS secretary each year on the status of HIPAA regulations and recommend any necessary changes. The Radio-Television News Directors Association submitted testimony last year. See http://www.ncvhs.hhs.gov/040714p3.htm.

I took the trouble of carefully researching this information because I think it’s important to explode some of the myths. Whoever is planning next year’s AHCJ meeting, I think this subject might need to be on the agenda.

EHRs and other health IT on the national radar screen

The Associated Press had a rather lengthy feature today on electronic health records and personal health records, including the new iHealthRecord service from a group led by Medem.

Read the story here, via Yahoo!, which tends to keep news stories online longer than a lot of newspapers.

And now back to more pressing issues for a beautiful Sunday afternoon, like today’s Cubs–White Sox game.

TEPR notes

Here are some interesting tidbits from the annual TEPR conference, which concluded Wednesday:

• NextGen Healthcare Information Systems announced a partnership with British clinical decision support developer Isabel Healthcare. Isabel co-founder Jason Maude says that the deal creates the first direct link of diagnostic decision support to an ambulatory EMR product.Maude started the company with Joseph Britto, M.D., who was the attending physician when a misdiagnosis by a resident at a London hospital nearly took the life of Maude’s daughter, Isabel, at age 3. I wrote about Isabel Healthcare a couple of years back when I was on staff at a certain magazine that’s now dying a slow, painful death.

  The way Maude and NextGen CMO John Dulcey, M.D., described the diagnostic support engine this week reminded me of the misdiagnosis detailed in Atul Gawande, M.D.’s book, Complications: A Surgeon’s Notes on an Imperfect Science. Turns out that Gawande’s patient at Brigham and Women’s Hospital in Boston and the young Isabel both had necrotizing fasciitis, aka flesh-eating bacteria.

  Maude says that Isabel, now 9, is mostly healthy, though she requires a series of skin grafts as she grows.

  After our discussion, Maude said he would get back in touch with Sorrel King, who founded the Josie King Foundation in memory of her own daughter, who did not survive a medical error at Johns Hopkins University. The Josie King Foundation is participating in the Institute for Healthcare Improvement’s 100,000 Lives Campaign.

• Allscripts Healthcare Solutions is publishing a book entitled The Electronic Physician: Guidelines for Implementing a Paperless Practice. Allscripts product management VP Stuart Scholly calls it a collection of best practices for EMR implementation compiled from company experts and customers.Allscripts itself, and not any specific individual, gets the author credit, though Scholly says the book does not even mention the company after the first chapter, so as not to have others take it as a sales tool.

  The book should be available on Amazon within a couple of weeks. It lists for $29.95, or $41.95 if you’ve got Canadian currency.

• Speaking of books, David Classen, M.D., of First Consulting Group and the University of Utah School of Medicine, called the 2003 Institute of Medicine report on patient safety “the greatest compendium of patient safety and quality ever published.”Classen, of course, is a member of the IOM committee that produced that volume, but the more people know about patient safety, the better.

• Of all the renowned healthcare institutions in New England—think Mass. General, Dartmouth-Hitchcock, Lahey Clinic—it is MaineHealth that is the first in the region to buy the ever-popular Visicu eICU remote intensivist technology.

Small oops

Check what I said earlier about Bill Yasnoff possibly being a replacement for David Brailer at TEPR. I have just been informed that Yasnoff no longer works for the federal government.

Brailer to miss TEPR

SALT LAKE CITY—It’s always a surprise these days when national health information technology coordinator David Brailer, M.D., is not a featured speaker at a conference dealing with electronic health records. But that is exactly what is happening at the annual TEPR conference here this week.

TEPR organizers said that Brailer’s office informed them over the weekend that Brailer had to cancel his planned Tuesday appearance here because the White House called him to some sort of urgent meeting.

My best guess is that the replacement speaker the government will provide will be Bill Yasnoff, M.D., director of the National Health Information Infrastructure project within HHS.

The bigger question I want answered is the reason for the White House meeting. Again, making an educated guess, someone in the administration decided that Brailer’s speech was not ready for public consumption. I believe—though I could be wrong—that Brailer was to begin laying out an action plan based on last winter’s public request for information.

Stay tuned. This could be interesting.