The Politics of Health Care : EHR/EMR/PHR

Achieving Meaningful Use

Frank Irving — Tue, 17 Nov 2009 16:33:00 GMT

Guest commentary from Celwyn C. Evans, a senior partner at Greencastle Associates Consulting in Malvern, Pa. With the passage of the American Recovery and Reinvestment Act (ARRA) and the Health Information Technology for Economic and Clinical Health (HITECH)...(read more)

Flexible Accreditation: The Politically Acceptable Key to Accountability — and Interoperability

Frank Irving — Mon, 04 May 2009 15:09:00 GMT

Guest commentary from Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC), a non-profit standards-development and accreditation organization. Information technology has been mature enough to transform...(read more)

Will the Weight of EMRs Break IT?

Frank Irving — Thu, 09 Apr 2009 20:53:00 GMT

Guest commentary from Alex Adamopoulos, executive vice president and COO of Exigen Services Pulling together as a nation to overhaul an aging, often paper-based medical records system is long overdue. We can all agree it will create jobs, pump money into...(read more)

For EHR Implementation, the Time to Act is Now

Frank Irving — Thu, 26 Mar 2009 18:37:00 GMT

Guest commentary from Thomas L. Pettibone, founder and managing partner of Transition Partners. President Obama's economic recovery package allows for billions of dollars for health care IT investment. As the recovery package begins to be distributed,...(read more)

EHR Rework Ahead

Frank Irving — Wed, 25 Mar 2009 15:27:00 GMT

A large majority of readers -- 65 percent -- who answered ADVANCE 's online opinion poll during the past month said they need to rework their existing EHR plans in light of the HIT provisions of the recently enacted American Recovery and Reinvestment...(read more)

Change Can’t Happen with Technology Alone

Frank Irving — Tue, 03 Mar 2009 16:39:00 GMT

Guest commentary by Michael L. Cowan, MD, chief medical officer at BearingPoint and former surgeon general of the U.S. Navy

It's official. The economic recovery package has been signed and $19 billion is marked for health information technology. But, before we can fix anything or facilitate technology adoption, we need to understand the major shifts and changes that are occurring in health care today.

Since President Bush's call to action in 2004, the government has made some progress with electronic health records and regional health information exchanges. These are good first steps, but advances in technology and changing values in our society mean our industry must become more agile to accomplish the radical transformation the industry needs to undergo. The rapid increase in consumer uses of Web 2.0 for health care information and community-building has changed the nature of the doctor-patient relationship and the way health care is consumed today. At the same time, the increasing amounts, depths and accessibility of medical knowledge have necessitated a change in thinking about the way medicine is taught and will be delivered in the future.

From a consumer perspective, the Internet has democratized health care. Access to vast quantities of vetted, actionable and reliable health care information has shifted the "power of knowledge" from the doctor to the patient. In earlier generations, only doctors had the latest medical information or experience managing disease. Now, people are constantly "plugged-in" and can easily search online for health care information. They also can access social networks of people with similar ailments with whom they can share their collective wisdom. This has irrevocably changed the nature of a doctor's relationship with patients. As part of health care reform, the new Secretary of Health and Human Services will need to think about how we can change the structure and policies of health care to acknowledge this and monetize the automated, online or virtual service models that consumers are demanding.

Furthermore, unlike past generations, today's patients have become more empowered and active in managing their own wellness. Web-focused, techno-savvy health care consumers are more willing to store personal or private information online in the hope of speeding progress for cures. Many now create and manage their own personal health records online. Hopefully, the new Secretary will work with President Obama to help cultivate this consumer grassroots movement to personal health records with the right incentives, standards and economic policies.

From a medical perspective, the recent completion of the Human Genome project will enable a new frontier in personalized medicine. The study of genomics has progressed to the point where experts can not only identify more than 20,000 individual genes in a human's DNA, but also how they relate to drug treatment. This advanced medical knowledge, combined with improved information access, will enable preventative and diagnostic care to match unique personal genetic characteristics. The impact of this is that future drugs will be tailored to an individual's genetic composition and history, making them more effective in treating diseases in each individual. However, before we achieve this goal, personalized health care will require many factors -- both diagnostically and therapeutically -- to be managed in a completely different way from the past.

With these trends in mind, I hope the new administration understands people are increasingly thinking of health care as a consumer service. Today's patients comparison shop and have become "prosumers." They not only choose their own care, but also produce vital information in the process. As a result of this health care consumerism and the rise of the Web, doctors will act more and more like consultants as the main mode of doctor/patient communication transitions to the Internet instead of a visit to the doctor's office. Thus, virtual management of patient conditions will become increasingly common. I hope the administration keeps these trends in mind and works toward enabling a future in which personalized healthcare and mass customization of treatments becomes a reality.

I am hopeful the administration will approach health care reform with an open mind, listening to alternative views, embracing current realities and facilitating positive change. If so, we will all benefit from a new frontier in health care in 2009 and beyond.

Consumers Need All of the Facts in the Privacy Debate

Frank Irving — Thu, 26 Feb 2009 18:06:00 GMT

Guest commentary by David St. Clair, founder and CEO, MEDecision

The economic stimulus package that President Obama has signed contains upwards of $20 billion to create electronic health records for most Americans within five years. The president has been very outspoken in his belief that EHRs are essential to health care reform and that the subsequent savings they'll generate will help to strengthen the larger overall economy.

Whenever the subject of proliferating EHRs catches the national spotlight, you can bet that debates about privacy aren't far behind. Indeed the privacy issue has already started to gain some traction in the media. In this video clip, CNN's Campbell Brown and Elizabeth Cohen examine how easy it is for someone to obtain private medical information online by simply using someone's Social Security number and date of birth.

While this assessment may be accurate, it's a bit light on the fairness scale. Brown and Cohen only make brief mention of facts like President Obama's plan to appoint a chief privacy officer and to implement unprecedented privacy controls to safeguard the EHR transformation. Instead they emphasize the more sensational angle implying that electronic health information just isn't safe. They also seem to downplay the fact that a simple thing like creating a password can protect one's private information.

I suspect the privacy issue is going to reach a crescendo in the coming months, and it's very important that Americans have all of the facts. There are unfortunately people in the world who are going to try to illegally obtain and misuse private health information. But that doesn't mean we should just write off EHRs as a bad idea. We simply need to be vigilant and proactive in incorporating the highest security measures into the planning process -- which the president has done. To borrow an analogy from a close colleague: We don't stop building roads because some people drive drunk. We punish the drunk drivers and continue building roads because of the tremendous benefits they bring to the rest of our law-abiding society. There is too much at stake for the health care system and the nation's economy to allow over-dramatized and misperceived weaknesses in EHR security to thwart progress.

Additionally, to make the privacy debate a fair one, we must ask what's more dangerous: the potential misuse of information or simply not using information at all? Should we put the privacy of an overwhelming minority of people ahead of safer, more efficient, more affordable and potentially life-saving health care for the overwhelming majority? In reality, the only people who stand to be harmed by an unlikely EHR privacy breach are celebrities and other high-profile individuals. Even if someone were to gain access to the average person's health information, there isn't much they could do with it, other than cause that person some personal embarrassment. In a very real sense, the question then becomes whether we value the privacy of information more than its potential to help us lead healthier lives.

Without question we must make ensuring privacy a top priority in any plans to implement EHRs. I'm confident that the Obama plan does so and, in fact, I think we'll see even stronger controls than we may have previously imagined. No EHR is going to come with guaranteed safety, but I would argue that the risk level is the same or less than that associated with online retail and banking transactions. The public needs to understand this. It is up to those of us in the industry to ensure that the facts are clear and readily available. Hopefully the media will choose to report all of them so that Americans can form opinions based on complete information.

Thinking Beyond EHRs

Frank Irving — Mon, 09 Feb 2009 17:22:00 GMT

Guest commentary from Ned Moore, CEO and co-founder, Portico Systems, Inc.

With the passage of the Obama economic stimulus package by the House of Representatives, now in Senate review, there has been a lot of discussion about what the $20 billion slated for health care IT will mean for the industry. The plan places heavy emphasis on electronic health records (EHRs) as a way to lower costs and improve care. While this is an important first step, the administration needs to be thinking about what comes after EHRs and include payers in the provider-patient equation.

The stimulus plan proposes the creation of a nationwide health information network built on an interoperable technology architecture that supports electronic exchange and use of health information. It promises that every person in the United States will have an electronic health record by 2014. There is a tremendous opportunity to extend these efforts to enable transparency of cost and quality information.

American consumers have come to expect the availability of vast amounts of Web-based information thanks to the technology investment made by dozens of other industries. Only in health care do consumers consent to pay for services without access to cost and quality information. Numerous studies have shown that the fees for medical procedures and services can vary greatly even in the same geographic region. Controlling the cost of health care requires that consumers have access to the same level of information that they get from other industries.

The health information network should be built with a framework that supports extending transparency beyond health records to enable providers, patients and payers to exchange cost and quality information and facilitate collaboration between these stakeholders. Consideration needs to be given now to the technology tools needed to make cost and quality information available to consumers. Waiting until later will increase the cost and burden of implementation and negatively impact consumer adoption. We've seen historically low EMR and Health Information Exchange adoption rates. It makes sense to leverage the efforts of the government to make health information available and extend that push to cost and quality transparency.

Driving down the cost of health care and improving care has to include accessibility to what providers charge and how well they deliver care as a critical component to decision-making. Without access to this information, we run the risk of having suboptimal cost savings after a large investment in technology platforms that do not support informed decision-making on the part of those consuming health care services.

Whose Position is it?

Frank Irving — Wed, 28 Nov 2007 00:15:00 GMT

A Democratic presidential candidate proposes the following three measures to improve adoption of electronic medical record systems, according to his/her official Web site:

1) Invest at least $1 billion per year in moving to electronic health record systems.

2) Provide grants to states to develop EMRs and other health IT systems.

3) Assist hospitals, medical facilities and doctors in upgrading to electronic record systems and implementing them.

Whose position is it?

Joe Biden's.

A Case of Murder and EHRs -- Final Chapter

Frank Irving — Tue, 06 Nov 2007 12:40:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

Editor's note: This is the final chapter in this series of blog posts, completing the co-authors' short story. If you don't want to spoil the ending, please be sure to scroll back and read the progression of chapters from the beginning. We'd love to hear your reaction to this series.

CHAPTER ELEVEN

"Welcome back to this special coverage of the presidential election results. If you have not heard, Democratic Congressman Stan Martin has beaten his opponent in a landslide victory."

"Some might say Congressman Martin, or I should say President-elect Martin, was helped by the recent harrowing events that took place at the Martinsburg VA Medical Center. An attempted assassination plot was foiled by the computer security measures embedded in the VA's electronic health record system, designed to both protect patients and their confidential medical information. Even as the hospital computer system was used to foil the murder attempt, President-elect Martin's doctor used the same system to discover a life-threatening brain tumor. Physicians successfully removed it within days after the assassination attempt."

"When questioned about his experience at the VA Medical Center, President-elect Martin had this to say":

"I have always stood behind the VA and its use of an electronic medical record. Ever since the tragedy of my wife's death, I have seen the need for a better health care system within our country. My opponents used patient privacy and computer security concerns as a way to discredit my call for a national health care solution and the use of electronic medical records systems similar to that used by the VA. I have seen not only the workings of the electronic medical record, but also the extensive security measures put in place to protect that record. I have also learned first-hand how such a system could actually save my life, and the lives of my fellow Americans."

*** This story and all characters are purely fictional. ***

About the authors

Peter J. Groen is on the faculty of the Computer & Information Science Department at Shepherd University in West Virginia. He is one of the founders of the Shepherd University Research Corporation.

Jaime Nasuti is a graduate of Shepherd University, a former English teacher and an aspiring author. She currently works for a national health care provider organization on the development of training programs and materials for EHR and other health IT systems.

A Case of Murder and EHRs -- Chapter Ten

Frank Irving — Mon, 05 Nov 2007 14:59:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER TEN

As Dr. Douglas was recovering from the unbelievable events that had unfolded just days before, he made a final detailed pass through Congressman Martin's electronic medical record as he prepared to discharge him. He wanted to make sure only his orders had been entered in the electronic chart, that everything was clearly documented, and that no mistakes had been made.

He carefully looked through the clinical images from the CT scan and other radiology tests he had ordered. The radiologist had read this scan in record time, he remembered. Apparently having a high-priority presidential candidate makes everyone move a bit faster. Congressman Martin had presented with basic symptoms of a heart attack, but that was ruled out due to his normal EKG. An anxiety attack was the final diagnosis, which was no wonder considering the pressures of running for office. But the slightly slurred speech and extreme headache had forced Dr. Douglas to order the CT scan of Martin's head. Was it possible something was missed?

As he double-checked the images, Dr. Douglas noticed a slight irregularity in the scan that caused him to jump up from his chair and run down the hall.

They had missed something!

A Case of Murder and EHRs -- Chapter Nine

Frank Irving — Fri, 02 Nov 2007 13:56:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER NINE

The Secret Service agents suddenly had their hands full. Dr. Rose immediately denied any wrongdoing and went on the offensive when confronted about his unauthorized access to a patient’s medical record.

However, Dr. Rose had no idea there was enough security in place within the VA’s hospital computer systems to pinpoint the exact time and place of a login, whose record was accessed, by whom, and what actions had been taken -- keystroke by keystroke. He knew nothing of the ISO capability to monitor suspicious activity within the system, or of the automatic flags that went up when access was made without authorization.

The evidence collected by the system’s security software module was damning. The Secret Service arrested Dr. Rose and took him away.

A Case of Murder and EHRs -- Chapter Eight

Frank Irving — Thu, 01 Nov 2007 16:34:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER EIGHT

Dr. Douglas, the cardiologist taking care of Congressman Martin, sat in a stupor in the chief of staff's office. What was going on? Dr. Rose was not his favorite colleague...but to be tampering with his patient's medical record, ordering unauthorized meds, potentially deadly ones...

The chief of staff's phone rang loudly in the deadly silenced room. The chief of staff raised his eyebrows as he listened. The director, who was also in the office, watched him closely. Dr. Douglas noticed the perspiration beginning to bead on the chief of staff's face.

"I think we better call the head of the congressman's Secret Service detail and have them meet with me and the director here in two minutes! You better come too, Dirk, so you can brief them in detail and show them what you found in the computer system."

A Case of Murder and EHRs -- Chapter Seven

Frank Irving — Wed, 31 Oct 2007 14:37:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER SEVEN

The warning message began flashing on Dirk's computer screen, a somewhat rare occurrence. Not too many high-profile public officials tend to be admitted to the VA Medical Center in Martinsburg, West Virginia, for treatment. Especially not a presidential candidate.

"I better check this out right now," he thought.

As the VA's information security officer (ISO) for the Martinsburg VA Medical Center, it was one of Dirk's jobs to keep an eye on suspicious activity within the VA health IT systems. Dirk opened up the warning message from the computer and quickly scanned and evaluated the information the computer had automatically gathered and forwarded to him. He saw that Dr. Douglas had ordered a series of tests for Congressman Martin. He called the chief of staff to confirm that Dr. Douglas was the physician officially assigned to care for the congressman. This was confirmed and Dirk hung up the phone relieved.

Politicians never sat well with Dirk. With the upcoming election looming, Dirk made it a point to watch the numerous debates just so he could speak intelligently about why he hated all the candidates. However, a recent interview had caught his attention when a candidate began talking about the VA's electronic medical record. No one ever seemed to give the VA any recognition for its technological advances in the field of medicine or the high quality of care it provided, as confirmed by the Joint Commission on Hospital Accreditation. But it still didn't matter to Dirk. He still wasn't going to take the time to go down to his local precinct to cast a vote on Election Day.

Just as he hung up, another security alert appeared on his computer screen. Dirk opened the computer-generated warning and noted that another physician, Dr. Rose, had apparently logged on to the hospital's computer system, accessed Congressman Martin's chart, and had placed an inpatient pharmacy order. This was odd, especially since the chief of staff had just told him Dr. Douglas had been assigned as the Congressman's primary treating physician. It was not an unusual occurrence for doctors to open the chart of a patient being treated by someone else, since they often worked in teams or were asked to consult on a case.

However, it was unusual for a doctor to order a prescription for another doctor's patient. The computer was also indicating that the prescription could result in a deadly drug-to-drug interaction. Something definitely seemed out of place.

Dirk immediately called the chief of staff's office again. He gave the secretary a rather curt response as to why he was calling to speak to the chief of staff. She could tell this was an urgent matter and quickly connected him. Once the chief of staff got on the phone Dirk quickly explained what he had discovered. The chief of staff was silent for a moment and then said he needed to get the hospital director involved.

He then said, "Make sure! Double-check the computer's audit trail and let me know everyone who accessed the congressman's record and what they did. I will personally put a hold on anything in Martin's record and verify nothing adverse has been given to him. I hope this turns out to be a non-issue, but you never know."

After he hung up, the chief of staff called his secretary into his office. "Get the director on the phone," he said. "Also, find Dr. Douglas now! Get him in here and be quiet about it."

A Case of Murder and EHRs -- Chapter Six

Frank Irving — Tue, 30 Oct 2007 14:00:00 GMT

A Case of Murder and EHRs

Published with permission of the co-authors.

CHAPTER SIX

Dr. Rose was a relatively new physician on the medical staff of the hospital. Upon hearing of the presidential hopeful's admittance to the hospital, Dr. Rose decided to take a quick look at the medical record of Congressman Martin. It was not that he had any need to look at the record, but he was disturbed by this upstart politician's liberal position on health care and just wanted to know more about this man with whom he strongly disagreed on so many levels.

If he could be the one to keep Stan Martin from continuing on his quest for the presidency, he would be held up as a hero by some of his peers. He might also just get that position he had been dreaming about at the highly prestigious Johns Hopkins medical center. He decided to use the VA's EHR system to learn more about the patient. How ironic, he thought, to use the very type of system Congressman Martin was promoting to bring about his downfall. If the system could be used to harm the congressman, that would prove his plan for a national health care system and the use of EHR systems was wrong and just might just cause him to lose the election.

Dr. Rose reasoned with himself that he was doing this for the betterment of the citizens of this country.

Logging in at a nearby computer console, Dr. Rose pulled up Stan Martin's electronic chart. With adrenaline pumping, he felt a deep urge to do something to keep this candidate off his feet. The longer he was not on the campaign trail, the better it would be for his opponents. Dr. Rose knew that this candidate for president was bad news for health care and private industry.

Seeing no one around, Dr. Rose quickly placed a pharmacy order, logged off the computer, and walked away.