ADVANCE Perspective: HIM

Weigh In

2008-07-08T19:07:00Z

After some new software, my first ever Webinars and a little TLC, I'm proud to say that we have a brand new salary survey for your viewing pleasure. I think you'll find that the new survey is a bit more scientific, easier to access and use and all around an improvement over our former survey. No longer will cancer registrars be forced to select the rather unflattering job title of "Cancer/Tumor," as in our past salary calculator.

There is the sad little fact, however, that if you already took the survey via our old calculator and you want to participate, you'll have to take it again through our new one. I promise that it will only take a few minutes of your time, and the new survey will provide us with a more accurate picture of just what you HIM professionals are up to (and what your salaries look like, of course).

All in all, the survey works a lot like public television, but without the Suze Orman specials or the myriad membership/pledge drives. We truly do depend on "viewers like you" to help us out with this. Our survey results (here are last year's) are looked to by the industry, and the story about the results typically ranks as our most read story of the year on our Web site. If you enjoy seeing how you measure up when our survey story comes out at the end of the year, you should participate and be part of the results we garner.

Unlike public TV, we don't ask for your dollars (just information about your dollars), and we actually give out some money--$100 cash to a randomly chosen participant. That 100 bucks could help ease the "pain at the pump" I keep hearing about on the news (and um, experiencing), or, if you're like me, it could buy you some new shoes or half an iPhone or lots and lots of yard sale finds.

After you take the new survey, come back here and let us know what you think, and feel free to e-mail me at ljusinski@advanceweb.com if you run into any troubles along the way.

You can access the new survey here or at this address: http://research.zarca.com/k/SsUWRWsSsPsPsP

Utah Records Breach

2008-07-07T16:37:00Z

It's the unfortunate but frequent way that a facility experiences a medical records breach. Someone leaves medical records information in a vehicle, said vehicle is broken into and the information is out there, compromised.

In this case, the University of Utah Hospitals and Clinics experienced the breach. A courier for an offsite records storage company violated policy and put a tape containing the medical billing records of 1.5 million patients in the back of his sport-utility vehicle, and drove to his home. There, thieves broke into the SUV and stole the cash box that contained the records.

The breach cost the University more than $2 million, which was spent notifying affected patients and letting them know their options. It doesn't seem likely, according to www.ksl.com, that the somewhat bumbling thieves knew how to access the information on the tapes they were in possession of, as according to the authorities, the pair were "definitely not techies," and authorities also questioned whether the thieves "could find their rear ends with both hands," which I believe is possibly some sort of official police talk.

The University still plans to work with the FBI to determine if the patients' records are at risk, and two class-action lawsuits have been filed.

Why Is Corky Romano No. 16?

2008-07-03T19:52:00Z

This has little to nothing to do with HIM, but hey, it’s approaching a holiday weekend, and I’m in the midst of putting together a spanking new Salary Survey for this year (any suggestions?), and I just came across an article that actually made me smile after an incredibly hectic week of moving, lots of work and little sleep.

I’ve just discovered Google Trends, thanks to this article in the Washington Post, via msnbc.com. I’m not sure how long this has been around, but it’s a Google tool that puts together a list of the day’s top searches.

I immediately thought back to some of the searches I’ve done. I truly believe that Google makes life less fun at times, because when I’m struggling to come up with the title or artist of a song, or I can’t place what that guy in the movie I’m watching was in before, I can simply pull my computer on my lap and type in snippets of song lyrics or “scary guy from No Country for Old Men,” and I’ll have my answer in under a second. Google takes the guesswork out of life. It’s settled countless arguments that I’ve had with friends and family members, and having the answers at my fingertips gives me a great opportunity to access the page, print out the information and tape it to the forehead of whoever’s arguing with me (as long as I’m right, of course).

When I think of all the random things I’ve Googled over the years, I must say that I’m hoping that I’m not what I Google. I tend to get rather wordy in my searches when I can’t find what I want. This morning, I was looking for information on the South Carolina economy to see how many health care jobs there are in the state (this is for a supplement we do in ADVANCE), and I became more and more frustrated as I couldn’t find what I wanted. My final (unsuccessful) search was “south carolina economy health care jobs employment industry medical records.” My word! What does that say about me? And don’t even get me started on some of the other searches I’ve done: “pin up girl light switch cover” (I’m decorating the new apartment), “landlord makes you have a certain move-out time” (at least mine did, and I wanted to see if others could sympathize), and “sugaring hair how to make the wax” (answer: don’t. It hurts.).

So it made me feel worlds better to see what others are typing into the famous search engine, and to see that people are hilarious, curious and interested in some strange stuff. I couldn’t help cracking up at some of the things that people searched. And when I finished reading the top 50 searches of today, July 3, I really, really wanted to go to the Naperville Rib Fest, whatever that is. I also found myself wondering what the heck a butler bag is, and also questioning why so many people chose to search the term “faceless aliens.”

All in all, Google Trends is a lot like cracking open the collective skull of America and taking a peek inside (even the president Googles, after all). What’s in there is humorous at times (the dual spellings of “samuel clemens” and “samuel clemmons” ranked Nos. 1 and 3, respectively, on June 30), slightly disturbing (“world of death” ranks No. 74 on July 2 and “cherry bomb” was No. 63 on June 29), slightly disappointing (“tila tequila shot at love 2” and “who won tila tequila” on two separate days—and OK, I admit that I watched the first season), and slightly confusing (“giant killer snakes” was No. 1 on June 25).

Besides confirming that no one, not anyone, uses capital letters in Internet searches, the Google Trends site is definitely good for a few laughs, and it’s a good peek into what’s going on in the brains of Americans.

Outtakes

2008-07-01T15:39:00Z

After every single story I write, I end up a mess. My hairstyle flops. My desk is piled up with papers. I can't find my right shoe. I accidentally don my interview transcribing headphones in the lunchroom (and let me tell you, the headphones are large).

The June 30 cover story on physician liaisons, practicing physicians who work between the HIM department and the physician team, was certainly no exception. After much struggle, the story is finally filed. As always happens, I am absolutely amazed at the amount of material I didn't get to use in the article. I interviewed six people, and I ended up with 22 pages of transcribed notes from the interviews, all in 12-point Times New Roman font (with 1-inch margins, if you're wondering), and that may not seem like much, but trust me, it is when you're trying to pare it down to fit on a few print pages.

I didn't get to use some of my favorite quotes because there's only so much room in the magazine, so I figured I'd do that here. The physicians I spoke to were fantastic, and I'm not just saying that because they might read this. I told my dad how cool they were--so they really were great to work with.

With their permission (which I haven't gotten as of writing this, but which I will get before it's posted, so if you're reading this, yay, they said it was OK!), I am posting some "outtakes" from my sources. (And I have even more backstory posted here.)

First up is William Haik, MD, of DRG Review, and since this is a blog I won't go into the huge formal title thing here, but you can look at the article for more information. He has a pretty great story about how he got involved with coding (that's in my sidebar), and he even worked on the editorial advisory board of Coding Clinic, and worked alongside the late Faye Brown, RHIA.

His local paper published results that didn't make him look too flattering--and while he admits that some of the problem was due to his own documentation, much of it was because there was no code for certain conditions, like gram-negative bacterial pneumonia, or COPD with asthma, common conditions that Dr. Haik, a pulmonologist, deals with (all of this is explained better in my sidebar--I am more eloquent in print than on the computer screen, I promise). He joked that he "did what most doctors do--I went down to medical records and bawled them out, and they explained to me that a lot of it was my documentation, but at the time there was actually no code for gram-negative bacterial pneumonias, and there were some other issues, too."

Dr. Haik also talked about the risks of training physicians to be physician DRG advisers. "You train them, and you give them all sorts of information, and then all of a sudden you've got experts," Dr. Haik kidded. "That's part of the DNA for doctors. Some people would call that obnoxious ... You kind of create a monster sometimes."

I also loved this quote from Norman Ward, MD, medical director for case management at Fletcher Allen Health Care. He gave this answer when asked what qualities an ideal physician liaison should have. "I think that any physician like myself who does this basically has to have an inquisitive mind for trying to make sense out of what is often a senseless system," Dr. Ward said.

Overall, I found myself very impressed with every single source I spoke to for the article. They were each humorous in their own ways, and each had a unique way of expressing their thoughts. It's sometimes frustrating for me to let things slip out of articles and onto the cutting room floor, but as I said, there's only so much room in print.

I'll try to do more of these outtakes columns (as long as it's cool with my sources), and I'll be sure to name each blog post something horribly cliché, like "Behind the Music," or "Unplugged," or "The Director's Cut Special Edition DVD." Feel free to ask any questions you might have on the article here as well by posting below, and as always, if you've really got a beef or a compliment (guess which I prefer), you can send a letter to editor Lisa Algeo at lalgeo@advanceweb.com. Thanks for reading!

Concerns Raised Over NY Medical Records Acts

2008-07-01T15:23:00Z

This morning, the Association of Health Information Outsourcing Services (AHOIS) issued the following press release regarding its concerns about the pending New York medical record legislation.

There are three bills pending in the New York legislature, A. 9501, S. 6626, and S. 1970, that seek to limit the fees that may be charged for the often intricate and time-consuming process of medical record retrieval, review and preparation for the purpose of litigation. If signed into law, these measures would curtail the ability of health care providers and their partners to produce records in a confidential, secure and economically sustainable manner. AHIOS, an organization committed to promoting excellence in the handling and dissemination of confidential patient information, believes that these Acts would unfairly shift the financial burden of preparing materials for litigation from the legal parties to the State's hospitals, and ultimately to patients, and public and private insurers.

"If hospitals are not allowed to seek appropriate compensation for the time and effort it takes to properly prepare confidential health records for release, it is ultimately the patients and taxpayers who suffer," said Jan McDavid, legislative chair at AHIOS and general counsel and compliance officer at HealthPort Technologies. "When the State sets the rate that hospitals can charge to produce an accurate record in a secure and confidential manner well below what it actually costs to provide that service, it is forcing hospitals to cover costs that should be borne by the requestor. Because hospitals are often not-for-profit and serve communities that include large numbers of under-insured or state-insured patients, those costs ultimately land on the taxpayer's plate."

Proposed acts A. 9501 and S.6626 seek to set $5 as the maximum rate a health care provider may charge for reproducing records electronically, such as on a compact disk. Proposed act S. 1970 seeks to ensure that adverse parties in litigation can access records at the same rates enjoyed by patients seeking their own records.

The major problem AHIOS sees with each of the bills is the lack of understanding or acknowledgement of the effort involved in ensuring patient confidentiality, and the privacy risks faced by the general public if such confidentiality cannot be attained. When a hospital or one of its partners prepares a medical record for litigation purposes, it must complete a meticulous and extensive process involving retrieval of information (sometimes from multiple sites), a detailed review of the record to select just the information associated with specific dates or conditions, careful culling of any sensitive data (e.g., HIV-related data) that legally cannot be released, and duplication of the appropriate materials into the requested format.

"This legislation exposes a fundamental misunderstanding of the process. We are not talking about simply photocopying paper here, nor are we talking about just giving a patient a copy of his or her file - this is a detailed, prescribed set of procedures that is required as part of the legal discovery process," said Joe Fournier, co-legislative chair at AHIOS and vice president for legal affairs and administration at ChartOne Inc. "The elements of these Acts pertaining to electronic record formats are particularly telling, because they illustrate the perception that the process is simple; however, the steps involved with moving records to a CD are actually even slightly more burdensome than the steps needed to produce paper records. These bills seem to assume that the fees we have historically charged were just for the copier ink and paper, rather than for the services involved in making sure we have the correct patient information and that we are disclosing only what was authorized."

Fournier added, "Additionally, the majority of requests we receive are for purposes of personal injury litigation, so this legislation would essentially subsidize personal injury litigation at the potential expense of patient privacy."

AHIOS will continue to support any legislation that makes it easier for health care organizations to produce information efficiently and cost-effectively. It also encourages state legislators who are considering similar legislation to become fully educated about the process of releasing confidential patient information before passing new laws and offers its support in this endeavor. Interested parties are encouraged to contact Bonnie Coffey at 800-688-9644 or bonnie@cminfospec.com.

Take Our HIM Director/CIO Survey

2008-06-25T16:04:00Z

These days, a chief information officer (CIO) is much more than a department manager; he or she is an important part of the executive team. Similarly, the HIM director is more than just a medical record custodian. He or she is a bridge between the day-to-day realities of paper records and the long-term strategy for e-enablement of the entire organization. As hospitals transition from paper-based medical record keeping to electronic information, the two domains must come together - for the betterment of the entire organization.

When the two departments work in harmony and maintain mutual respect, the benefits are widespread. Not only is each party more productive (and most likely, happier); but the organization's technology and information management is better planned, managed and synchronized.

With nearly 30 percent of organizations reporting a fully electronic medical record, perhaps the time has come for HIM and IT (or health information services) to work closer together. In fact, many are already doing so.

We want to know how closely the HIM director and CIO are working together. We've created a survey that will provide an industry snapshot of reporting relationships between HIM and IT. With the move to electronic medical records, are these two departments working closer together and if so, how has the relationship kept pace with technology?

Go take our survey here and then come back and comment on the HIM director and CIO relationship at your facility.

Cost Prohibits EHR Adoption

2008-06-19T20:23:00Z

The news is not really shocking to HIM professionals who've seen EHR adoption up close and personal, especially if those HIM professionals had any dealings with the CFO while working toward implementing an electronic record.

The New England Journal of Medicine published a study on the adoption of EHRs by ambulatory physicians. Only 4 percent have an "extensive, fully functional electronic system," while 13 percent have implemented some sort of an EHR.

I liked the Wall Street Journal Health Blog's take on it, and the comments that follow are worth a read, too, particularly the ones from frustrated physicians. At any rate, the study had EHRs in the spotlight today, and was covered by many of the major news outlets.

I think it's important to clear up a misconception I've been hearing lately, too. President Bush didn't mandate EHRs by 2014; he simply said that most Americans should have them. There's no requirement in place; it was more like a goal to work toward, and yes, some balls did get rolling to make this a reality, as with any goal. Just type in "Bush EHR mandate" to Google and you'll be met with a plethora of misinformation (and some helpful articles that clear up the misunderstanding). I really enjoy the articles that even make up their own date for the "mandate," say, 2010, maybe 2012. So no, the world will not come crashing down if, and when, the majority of Americans don't have an EHR by 2014. That "when" is further reinforced by the study released today, and you can check out its full text here.

Are You Changing Careers?

2008-06-18T20:30:00Z

I'm working on a story that deals with making a transition but staying within HIM. I'm seeking out people who've made the switch from MT to coder, from coder to cancer registrar, from coder to MT-along those lines.

Out at conferences, and even sometimes on phone interviews, I often have people ask me about "the other side." MTs question me about coders, what they do and what training is needed. Coders ask similar questions about MTs. Plus, two of our bloggers, Jeanne and Carol, are currently going through transitions of their own right now, so we figured these transitions that are occurring within HIM warranted an article in our print edition.

If you are currently going through a transition, or have already made the switch, from one field of HIM to another, contact me and we can set up a time to talk. You'll get a chance to see the article before it goes to print to make sure everything's accurate. I look forward to hearing from all of you adventurous types out there!

What the Internet Says

2008-06-17T13:24:00Z

I've had so many things that I've wanted to post about lately. Unfortunately, time has been a bit crunched. I'm working on a few articles that I'm excited about, and I'm also trying to get a brand new Salary Survey up and running so we can bring you the most accurate and relevant results. Also, here at ADVANCE, we're entering the wide world of Web 2.0. We're working on getting a Facebook page for the magazine, which is both slightly scary (hello, old boyfriends!) and really something to look forward to as I'm finding out how cool the Internet is (on Facebook, it generates a list that says here are people you might know--and it was right! I did know the people it chose! Let's see mIRC do that!).

Anyway, I'll just summarize some of the more interesting things I've stumbled across lately on the World Wide Web. Here goes:

I interviewed Amy Lynch for my Generation Y story about a year ago, and she sends me updates from her company, Bottom Line Conversations. She recently penned an article that caught my eye. I'm a Gen Y girl (actually, I'm on the cusp of Gen X and Gen Y, so I suppose I have traits of both). The article deals with Generation Y's lack of decision making, and she refers back to a blog I like by Fortune's Nadira Hira (you might recognize her from those "Lifestyles of the Rich and Famous" style shows on various cable networks). If you deal with Generation Y workers daily, Amy's article is definitely a worthwhile read, and from the Gen Y perspective, I found it to be accurate.

Next up, there's great news on the medical identity theft front. At the American Health Information Management Association's (AHIMA) conference last year, I learned a ton about medical identity theft, and honestly, it terrifies me. Our assistant editor Ainsley did a story on it for the Web site, and our "Hands-on Help" column also featured medical identity theft. For even more information, you can visit the World Privacy Forum (WPF), run by Pam Dixon, who spoke at AHIMA and made a stunning case about medical identity theft. The WPF site is really a must-see for any HIM professional. Now onto that news I promised--the Office of the National Coordinator for Health Information Technology (ONCHIT) is paying attention to the threat of medical identity theft. In fact, they awarded a $450,000 contract to Booz Allen Hamilton to take a look at the threat of medical identity theft in the U.S. There is, however, still a lot of work to be done.

I liked this story about a doctor who, frustrated with the Cerner system his medical center was using, went off and created his own EMR. This isn't a rare occurrence; the article explains that hundreds of doctors have done the same. But I'm pretty sure none of them expressed their befuddlement with their center's EHR in these words: "It's about as popular as malaria."

Finally, if you can slog through the many ads on this site, this post is a decent one. It deals with HIPAA and the Family Educational Rights and Privacy Act (FERPA), and offers a pretty thorough overview of what college and university student health center HIM departments have to deal with. I did an article on student health center HIM departments some time ago, and the ones I spoke to had some great technology, were amazing to work with and one even let us drop by for a photo shoot. They definitely have a lot to deal with when it comes to privacy.

AHIOS Comments on Pending Louisiana Acts

2008-06-11T17:49:00Z

We received this statement from the Association of Health Information Outsourcing Services (AHIOS) in our inboxes this morning here at ADVANCE. I've covered AHIOS before, for an article on a different release of information (ROI) law. I've linked to the bills below, and I'd like to hear what you have to say about them from an HIM professional's viewpoint. And, as promised, here's the statement:

There are currently several Louisiana bills that aim to prevent health care providers from charging a fee for copies of billing records, prevent any fee for additional requested services--such as for certification of records to be presented as evidence in litigation--and to lower the rates received today for the release of medical information. AHIOS, an organization committed to promoting excellence in the handling and dissemination of confidential patient-identifiable information, has serious concerns about the Act's potential impact on health care providers in Louisiana, as well as the precedent it sets for other states.

The Louisiana laws (HB 217, HB 1073) attempt to minimize or eliminate fees associated with the complex, labor-intensive ROI process, thereby placing the burden of these costs on hospitals and other health organizations.

"Laws governing the release of confidential patient health information must establish fees that appropriately reimburse providers for the costs they incur in providing the information to requestors to avoid creating an unnecessary cost burden for hospitals," said Jan McDavid, general counsel and compliance officer at HealthPort Technologies. "Certification of records is a necessary step in the release of information process, ensuring that all released information is both valid and authorized."

One of the major issues with HB 217 in particular is that often billing records are not stored in the HIM department, but rather at a completely different building on campus, or at a different location entirely. Therefore, when a request is made for all records (both medical and billing records of a particular patient) it is no simple task.

"AHIOS works to educate the industry about the complexity and risk involved in the ROI process and help requestors understand that it is an entirely different process than simple copying of paper," said Joe Fournier, vice president for legal affairs and administration at ChartOne, Inc. "Electronic formats have created the perception that all a facility needs to do is click a button to send someone information, but there are several steps involved in the process and none can be neglected."

AHIOS will continue to support any legislation that makes it easier for health care organizations to produce information efficiently and cost-effectively. It also encourages state legislators who are considering similar legislation to become fully educated about the ROI process before passing new laws and offers its support in this endeavor. Interested parties are encouraged to contact Bonnie Coffey at 800-688-9644 or bonnie@cminfospec.com.

Pondering PHRs

2008-06-06T16:33:00Z

After reading this article on CNN.com, I became curious about my own health information. I visited my health insurer's portal, and after struggling for quite some time to remember the password and user name I used way back when, I got a peek at what health information is available on me online.

It isn't very much. I visited a doctor last July. That's pretty much all that's listed, and since I'm now telling you, Internet, about that, it's obviously not very secret information. It doesn't say that I visited the doctor for shoulder strain (a moving-related injury, and I still can't look at the bulky TV in my bedroom without recalling the ouch that it caused), and it doesn't say what prescriptions I received (large blue and yellow pills that comically reminded me of the ones from the "Dr. Mario" video game. Anyone remember that? And more importantly, does anyone have it and a classic Nintendo I can borrow?).

The CNN article basically tells readers that their health information might be online somewhere, most likely on the Web sites of insurance companies. Like the author of the article, I'm not really sure that I enjoy having the information there, especially since I didn't put it there. But then, I'm not entirely against it either. The insurance company's posting it, and they obviously have my information anyway. They're just sharing it with me now.

The writer also brings up personal health records (PHRs), although she doesn't refer to them as such. I just finished up an article on health record banking for an upcoming print issue. Health record banking is a concept that treats medical record information like financial information, and aims to have a network of banks that compile information that's either entered by the patient or compiled by the bank itself. Google Health and Microsoft's HealthVault loosely fall into the categories of health record banks.

In my interviews for the article, several sources brought up the fact that insurance companies have PHRs that their customers can use. The companies have spent, in some cases, massive amounts of money developing the PHRs, and according to my sources, they're not seeing the best results because people just aren't using them, and users may view the PHRs offered by insurance companies somewhat as the fox guarding the henhouse, so to speak.

That's why people may turn to the PHR offerings of Google and Microsoft, instead, rather than those of the insurance companies, if they are going to use any PHR at all. As mentioned in the CNN article, the PHRs of Google and Microsoft aren't covered by HIPAA. Likewise, other health record banks aren't covered by HIPAA either-they're not covered entities.

William Yasnoff, MD, PhD, FACMI, managing partner of NHII Associates and founder of the Health Record Banking Alliance, noted that the banks, are, however, covered by something stricter than HIPAA, under the Stored Communications Act. Dr. Yasnoff and the others I talked to for the article are all against an expansion of HIPAA to include health record banks, as the expansion would, in their opinions, just complicate things and would actually allow health record banks to be more lax about disclosures.

As HIM professionals, would you be hesitant about putting your information online, as it is not covered by HIPAA? Also, do you maintain a PHR, and if not, why?

I'm not an HIM professional, just a writer who writes about the industry (much like the "I'm not a doctor, I just play one on TV" line). And no, I don't have a PHR. When I think of going back to get my past medical records, I get overwhelmed. I'd have to travel back home, 2 hours away, and try to track down my eye doctors, my numerous primary care providers (I had a lot of different insurance companies when I was younger, which meant a lot of different physicians), my hospital records (a horrible stomach virus and an allergic reaction to a gnat bite, if you were curious) and, if I feel like really keeping the records straight, even records from my pediatricians (two of them). Then there are all of my records from the ‘burbs where I currently live, both hospital, physician and specialist records. Also, I lived in New Jersey for a summer, so I had a physician there. And I'm only 25.

I think for me, a going-forward type of PHR would be best, where I just compile the medical information from here on out, rather than getting all comprehensive. Somehow I don't think the stomach virus I had when I was 8 will have much bearing on my future health, anyway, although the allergic reaction to the gnat might.

And thus, I come back to the beginning of this blog post (see how that worked out?)--keeping health information online. I am willing to do this, but I probably wouldn't choose my insurer's PHR option. I also don't know about storing information with the "big guys," Microsoft or Google. I do hopefully have some time to debate my options. I don't have any medical appointments scheduled anytime soon. However, I am moving this month ... I'll try to steer clear of lifting the TV.

What are your thoughts on PHRs and storing medical information online?

What Are You Hearing?

2008-05-08T13:56:00Z

I've heard and read the horror stories: the physician who dictates from her child's swim practice, the doc who treats MTs to his hacking cough, the PA who insists on scarfing a Big Mac while telling MTs about a patient.

I recently finished an article on dictation practices for our May 19 issue, and let me tell you--it's certainly an issue MTs are passionate about. The article focused more on the ways that MTs, MTSOs and HIM managers can quell bad dictation practices, so I didn't get to really go into all of the nasty things that MTs are privy to when they sit down to listen to dictations. I know there are some awful stories out there, so what's yours?

All the sources I spoke to had a particularly nasty story about dictation. One recalled physician who dictated from the bath. She also related a story about a report with 25 blanks. After the MT got two more people involved with the difficult report, they finally got it down to eight blanks--but it took 2 hours to finish--and the report was only 110 lines total. Another source talked about reports where the MT had to listen to 20 minutes of dead air for reports that ended up being less than a page long--where the MT must be a captive audience to the silence because they can't hang up, and they have to listen because the dictator may start speaking again.

All the sources concluded one thing--better dictation practices will mean better reports and better patient care. Gone are the days of the private dictation booths in hospitals. Dictators now find themselves crowded into the nurses' station, huddled and interrupted in a busy environment, at best. Hence, the horror stories.

Can you top the stories above? Not only will venting your dictation horror stories possibly prove to be a bit cathartic, it might also open up some eyes to what MTs really hear when they listen to a patient's story--from chewing to splashes to who knows what else.

USA Today Features Article on Patient Records

2008-04-29T14:54:00Z

The headline screams, "Across USA, Anxiety Over Access to Patient Records." It grabbed my attention, and I found it to be an interesting read. It seems that back in 2006, USA Today set up a patient safety Web site to give readers a venue to express concerns about inadequate medical care. Readers can send in their own stories, including anything they feel compromised the quality of health care.

Turns out, missing or disputed medical records are the most common source of complaints on their Web site, so they've done an expose on two situations in California where patients didn't get the medical records they requested. Be sure to check it out, and the interesting comments too. Then come back here and tell us what you think. It's always interesting to get the HIM professionals' perspective on things like this.

In the Privacy Hot Seat

2008-04-09T16:59:00Z

I'm sure most of you have heard about the privacy breaches at UCLA Medical Center by now. You can't turn on an entertainment show or open a newspaper without being barraged by "Celebrity Patients Need Privacy Too" or "More UCLA Record Abuses Found."

The saga actually began last spring, when a tabloid ran an exclusive story about Farrah Fawcett's cancer returning. Shortly after UCLA doctors told Fawcett that her cancer had returned-and before she could even tell her son and closest friends-the National Enquirer posted the news on its Web site. Lawyers for the star claim that the information was leaked or sold to tabloids. After UCLA launched a thorough investigation, the medical center discovered "multiple reviews" of Fawcett's records by a worker who was not involved in her treatment.

Flash forward a few months and UCLA is back in the news as it takes steps to fire at least 13 employees and suspend at least six others for snooping in the confidential medical records of pop star Britney Spears during her hospitalization in its psychiatric unit.

State regulators entered the picture, and the California Department of Public Health reported that several investigations were under way.

Flash forward again about 3 weeks and UCLA is front and center in the headlines. On April 6, hospital officials reported that an employee improperly viewed the EHRs of 33 celebrities, politicians and other high-profile patients, including California first lady Maria Shriver. Overall, the medical records of 61 patients were accessed improperly.

OK, so that's the basic gist of the story. You can find all the sordid details by doing a Google search. Hundreds of headlines will no doubt pop up.

For its side of the story, UCLA Health System issued a statement on its Web site:

"...After news stories first appeared in May 2007 about an unauthorized release of patient information, we conducted a full investigation and determined that a single worker, who is no longer employed, was responsible for that incident, as well as the unauthorized viewings of multiple patient records. Consistent with state law and based on the findings of our investigation, we did not notify the Department of Public Health or the affected patients at that time.

"Like other medical institutions in California and across the country, UCLA Health System is engaged in a continuing effort to strengthen its information technology infrastructure to protect against the potential of patient information breaches. We continue to take steps to improve security systems designed to preclude access by unauthorized individuals, while also ensuring that properly assigned medical personnel can quickly retrieve the information required for emergency or other treatment decisions to best meet the needs of its patients.

"Importantly, UCLA Health System has stringent policies familiar to all employees to protect patient confidentiality. All staff and faculty members, contractors, volunteers and other workers are required to sign confidentiality agreements as a condition of their employment and they complete extensive training on federal HIPAA-related privacy and security issues. ..."

So, what do you think? As HIM professionals, the stewards of patient privacy, is this just unfathomable to you? Is UCLA Medical Center under added pressures because they treat more celebrity patients than the average hospital? Is HIPAA training and signed confidentiality agreements enough to guarantee a patient's right to privacy? Is HIPAA even working?

I'd love to hear your thoughts on this topic.

Patient Information Dumped

2008-03-20T17:00:00Z

Last night, I watched "Trauma: Life in the ER" on Discovery Health. Doctors worked to help a patient who needed an arm amputation, was full of second degree burns and also suffered a ruptured spleen, which the docs described as "hamburger meat," after a drunk driver hit the patient's pickup truck head-on. I also saw--up close and personal, thanks to a lingering camera shot--a woman's blown apart hand, which she accidentally shot herself.

I took all this in while munching on a baked potato and chicken strips. I suppose you could say I have a strong stomach.

This story today somewhat turned that strong stomach. The tummy churning really has little to do with the fact that it's an abortion clinic, in all honesty. Any medical waste just laying out (investigators apparently found it "on the pavement across a five-lane street," as well as in Dumpsters) grosses me out, not to mention the fact that one woman actually picked the waste up and carted it back to her home. I was also shocked by the clinic operator's initial explanation of "They had a new employee on Saturday," which is in this article here, and serves as his explanation as to why medical waste and patient information was tossed in a Dumpster at one of the clinics.

But getting beyond all of the delicate topics involved and the queasiness factor, an important HIM-related issue also exists in this situation. While the pro-life activist that found the patient information turned what she found over to police, she "made copies of ‘representative samples of what was found in the trash,'" and according to the FOX article, she said she found 200-300 patient records. Dr. Abraham Alberto Hodari, who operates the WomanCare chain of clinics, said in the Detroit Free Press, however, that the protestors found patient sign-in sheets, rather than actual full medical records. The Detroit News article says that the patient information found was in "300 medical documents that included insurance, pathology and abortion schedules. Most were dated in 2008 and some included patients' names, phone numbers, pregnancy stage and abortion date." A police officer involved in the preliminary investigation said last week "that up to 50 patients could be identified in medical records, which were mostly created in February and included personal information and the types of procedures performed."

Scary stuff, no matter what exactly was found in the way of patient information. Already, according to FOX News, "at least one document has been posted on the Web site of an anti-abortion activist." Also, on a bit of a lighter note (and this story is just begging for a lighter note, is it not?) for you HIM professionals, the FOX article also gently informs readers that "throwing unshredded medical documents into a Dumpster is not considered a reasonable safeguard" to ensure that protected health information is not misused or wrongfully disclosed under federal patient privacy rules. Just so you know. The article also offered another caution to readers: "Officials advised against individuals digging through medical waste." Again, thanks.

Dr. Hodari invited a reporter from the Free Press in to see his spanking new biomedical waste bags, trash cans and paper shredders. He may face a misdemeanor charge for improper disposal of patient records and also may face sanctions for improperly disposing medical waste, a charge that would include a fine of up to $2,500 per violation and an additional $1,000 for each day the violation continues.

Looking at it only from an HIM standpoint and not at the medical waste/abortion rights aspect, how does something like this happen in the age of HIPAA and state laws? If I knew my medical record was one of the ones that might've ended up in the Dumpster, and then landed in the hands of protestors angry about what was in that record, I'd be terrified. In my opinion, cases like this are the reasons that privacy laws exist: information could end up in the wrong hands.