Two News Items That Tie Together

So I have been looking at this Harris Poll Report that states "4% or an estimated 9M American adults believe that they or a family member have had confidential personal medical information either lost or stolen", and trying to figure out if I know of anyone who this has happened to and if this is a low or high number.

The second round of figures: "about 7 in 10 (69%) of adults have either read or heard about medical records with personal health information being lost or stolen from doctor's offcies, clinics, hospitals, health insurers, employers or government agencies".

I definitely fit into this category, and it was even further reinforced with this article in the Atlanta Journal-Constitution about BCBS of Georgia sending out "an estimated 202,000 benefits letters containing personal and health information to the wrong addresses last week." That seems like a big screw-up.

So what do people really think about privacy, health records and the advent of EHRs? I am going to pull a few quotes from each piece to state my point. HPR: when asked which medical records, computerized or paper may be lost or stolen more often, 47% state computerized records, with 16% for paper, and 23% think the same.

My conclusion, Americans do not trust electronic records. Further support: of the 69% who had heard about medical records being lost or stolen, 54% believed it was from electronic records.

Recent medical "breaches" have included Wellpoint, U of Miami, NIH, the Cleveland Clinic, CVS, - with over 50 breached from healthcare providers reported to the Identity Theft Resource Center in the first 6 months of 2008. I have heard of these companies. Aren't they supposed to be the biggest and most secure in their fields?

BCBS of Georgia said the recent mix-up was caused by a change in the computer system that was not properly tested. Why would they implement a computer system without testing it, considering they are a HIPAA covered entity? Isn't there a law and governmental regulations in place to protect this data? Oh yeah, that's right, there is. Since HIPAA was fully implemented in 2003, very few fines have been assessed.

AJC: "This is very, very serious," [state Insurance Commissioner John] Oxendine said. A person with knowledge of medicine or billing, for example, could determine if the patient was treated for cancer, HIV or fertility problems, he said....

...Rhonda Bloschock, a registered nurse in Atlanta, said Monday that she discovered EOB forms from nine other patients in a large envelope she received Friday from Blue Cross. "This is a serious privacy breach," Bloschock said. Nurses and other hospital staff "jump through all sorts of hoops protecting people's privacy," she said....

...consumers have become more attuned to privacy issues, said Anne Adams, chief privacy officer for Emory Healthcare. "There is an expectation that their personal information is protected and not used inappropriately," Adams said. But with the movement toward keeping health records electronically, there's more potential for breaches to happen, Adams said."

So going back to Google Health, Microsoft Health Vault and EMR, PHR vendors - will the American people trust their records online to these companies, GOOG and MSN not being HIPAA covered, when other companies cannot protect this data already? And those that can protect it, still have mechanical errors?

Logicalis Top Ten HIT List

I found this list in a Logicalis press release from July 7th. They have revenues of over $1B annually, so I guess they know what they are talking about. Glad to hear that though only 8% of patients have access to EHRs or EMRs, it is #1 on this HIT list.

Logicalis Top Ten HIT List
1. Electronic Health/Medical Records (EHR or EMR)
2. Disaster Recovery/Business Continuity
3. Medical Archiving Systems (MAS)
4. Storage Consolidation and Virtualization
5. Backup (disk-based and online storage)
6. Business Intelligence
7. Picture Archiving and Communication System (PACS)
8. Infrastructure for Health Information Systems
9. Compliance
10. Securing Electronic Protected Health Information (ePHI)

Good Blog about Google Health

I have been playing around a bit on Google Health and have some issues, which I will discuss in a later post. I found this post from FutureHIT and thought it was a good summation of how GH might be used by all in the healthcare spectrum.

Hard Definitions for EMR, EHR and PHR

Hat tip to Ted Eytan for this information from Healthcare Informatics.

To me, PHR has always been the Revolution Health and now Google model of a Personal Health Record. The confusion between the EMR, and EHR is now clear.

The Chicago-based National Alliance for Health Information Technology (Alliance) released its final report, “Defining Key Health Information Technology Terms,” defining six important HIT terms.

The definitions, which will be presented to the Washington-based American Health Information Community (AHIC) on June 3 for final approval, are:

· Electronic Medical Record

An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

· Electronic Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization.

· Personal Health Record

An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

· Health Information Exchange Health Information Organization

The electronic movement of health-related information among organizations according to nationally recognized standards.

· Regional Health Information Organization

An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards. A health information organization that brings together health care stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community.

ePrescribing in Mississippi

You don't really think of Mississippi as being an early adopter of technology, but this article on FCW.com, states otherwise. My comments are below.

E-prescribing PDAs save millions for Mississippi Medicaid BY Nancy Ferris

Mississippi’s Medicaid program is saving about $1.2 million per month in prescription costs as a result of equipping 225 doctors with handheld e-prescribing devices.

State officials say the system not only reduces medication costs, it also increases the quality of care for patients. That's because doctors have access to patients’ recent medication histories and can avoid prescribing medicines that would interact with ones they are already taking.

In addition, doctors can find out whether patients are filling and refilling their prescriptions. This allows them to detect when patients’ continued poor health is due to noncompliance with the doctors’ treatment plans.

Prescribers who use the handheld devices write fewer prescriptions on average, state officials said, and those prescriptions are likely to cost the state less.

After 18 months of steady savings, the Mississippi Division of Medicaid is negotiating with its contractor to expand the e-prescribing program, officials said.

Besides cutting drug costs, the state is saving nearly $27,000 a month on hospitalizations avoided because the doctors are getting real-time alerts about drug interactions, they said.

The program costs the state about $35,000 per month, so the hospitalization savings come close to covering the cost of the handheld devices from Informed Decisions, based in Tampa, Fla.

Florida has launched a similar program, with comparable results.

Asked whether there was any negative aspect to the program, Mississippi officials said they knew of none.

“I can see which medications patients are taking regardless of who prescribed them. As a result, we are now able to keep comprehensive, up-to-date medication lists for all our patients,” said Dr. Kurt Bruckmeier, who cares for about 200 Medicaid beneficiaries through Pacific Physicians Services in Hattiesburg, Miss. “It has also helped identify drug abusers who would very likely have gone undetected were it not for our ability to evaluate the full scope of prescriptions they were taking.”

COMMENTS:
I think this is a fantastic program that will pay for itself over a very short time. ePrescribing and medication adherence go hand in hand - especially when it comes to refills. I am not familiar with pharmacy policy, but do they tell the MD when you do not refill a script? I don't think so. With all scripts and patient information linked up via these PDAs or hand tablets, MDs have all the info at their fingertips - as well as drug-drug interaction information to reduce ADRs.

The problems arise however when the technology fails and the MDs have no idea what is going on with the patient. I'm sure there are back-ups and colocation servers, but in Ol' Miss there could be flooding, hurricanes, fires, etc.... Also, as we have seen with Pfizer of the last couple of weeks, what happens when someone hacks into the system? Not that medical records of the elderly have that much value (no offense) but it is protected information that anyone can blast out over the internet or use to for blackmail (that might not happen but it could!).

This works into the EHRs that many tech companies, MDs and healthcare providers are trying to adopt. I like the idea, and use one on Revolution Health but at the same time I am wary about that information out there. Not that I have anything to hide, but I do not know who is looking at that information. Some techie who is performing a system analysis? They also capture what you are interested in, what medications you are on, etc.... which they can then use to market your "eyes" to advertisers.

Also health social networking sites which encourage you to sign up for chat groups and the like - all that information goes somewhere and is monetized somehow. Sorry for that little rant. These are all opt-in websites and have strict privacy policies and terms of use.

This of course would not happen with the proper EHRs and ePrescribing tools since they are covered under HIPPA and would be gross misconduct if that information was shared. So I encourage the technological advances - if you are heli-skiing in Canada and break your leg, the mountain MD with a handheld internet browser can see what meds you are on and your history of broken bones, your allergies, etc... And this makes for safe practices. Scuba diving in the Maldives and black-out from NO2 poisoning - same thing. When all medical records are computerized and on servers, it will be safer to get into an accident /life threatening situation!

Go forth Ol' Miss and show us the benefits of ePrescribing and adopt that new technology!