Looking back on 2009 and changing perspectives:
Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons. Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.
I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient – prohibiting the real patient from examining his or her own health record. Although this is possible, the benefits of HIPAA outweigh the burden.
Reasons to Go Slow
Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products. He gives these reasons for the need to slow down in the rush for interoperability:
- Adding safety and records mitigation protocols ensures patient safety as an ongoing concept and practice.
- No industry would be allowed to operate, where the officials in charge of it stated that the market or other bodies would be responsible for creating safety procedures. Can you imagine if the auto industry stated, “We make cars, let the market figure out how to regulate safety”? I doubt that Congress or any other body would consider these people as remotely credible, yet I hear time and time again these statements being made in public and private forums by executives, lobbyists, and even so-called healthcare leaders.
- For the public and providers to embrace a product that has no regulation, no built-in safeguards and obviously no importance to safety from the makers of these products, why would Congress expect the American public or healthcare providers to embrace a product or concept that involves the unregulated risk of injury, death, or staggering liability opportunities, let alone without any hope of remedy or proper relief?
Provider Training Specialist
Blue Cross / Blue Shield, New Mexico
In rebuttal to these points, and considering 2022 hindsight:
- the Health Insurance Portability and Accountability Act that was passed by Congress in 1996
- subsequent electronic transaction standards were widely available by 2003 and underwent an extensive public rulemaking process
- therefore, the industry did not make up its own rules to regulate itself
- the ARRA HITECH Act of 2009 created a Standard known as Meaningful Use, with extensive vetting of Standards by the industry
- as a result of the HITECH Act, Certified Electronic Health Record Technology (CEHRT) provides additional patient safety features such as clinical decision support and medication alerts to avoid medication errors
- Insurance coverage data such as Medicare LCDs are embedded in some E.H.R. systems enabling decision making of both medically necessary care and insurance coverage standards in a single point of care decision making tool
One of the keys to improving life for payers as well as providers and patients will be process innovation. This is accomplished by clearly documenting the existing or
as is process as well as the
to be of the desired process. That can only be accomplished with combined disciplines of technicians who know business process modeling (BPM), facilitators who are professionals that can interact with all levels of stakeholders in the health care service chain, and “content” experts who understand legal, medical, and workflow implications of making changes to major functions such as provider management or claims adjudication.
No World Borders has been consulting with several health care payers on process improvement, and preparation of the conversion of systems for electronic health records.