HIE and privacy
Rather than having to comply specifically and uniformly with federal guidelines in this area, there should be a intent test. This test would allow states to continue to utilize the laws, guidelines and practices that they have worked hard to gain broad stakeholder agreement to implement their RHIOs, HIE exchanges and technology exchanges that require data exchange.
On personal health Information policy, patients would be 'astounded'
The reported recommendations by the Tiger Team do not deal with the requirements in HIPAA that privacy notices tell patients how to exercise their rights to control their [personal health information] under state laws and medical ethics. [Government Health IT, Oct. 18, 2010, "HHS: Patients should receive easily understood HIE privacy notices" ].
This is not a new requirement, but it is one that is vitally important to put into place now, because patients do not want unfettered use of or access to their PHI via data exchanges or NHIN models.
The Tiger Team again totally misunderstands what the public expects if it is guided by the "principle that patients should not be surprised by what happens to their information." Patients will be very surprised, astounded, and repelled to learn that their data will be exchanged and disclosed without their consent.
The Tiger Team should be guided by the fact that Americans have longstanding strong rights to control the use of their health information. HIPAA is not a ceiling, its a floor.
HHS stated in issuing the amended rule: "The Privacy Rule provides a floor of privacy protection. State laws that are more stringent remain in force. In order to not interfere with such laws [affording a right of consent] and ethical standards, this Rule permits covered entities to obtain consent. Nor is the Privacy Rule intended to serve as a 'best practices' standard. Thus, professional standards that are more protective of privacy retain their vitality." 67 Fed. Reg. at 53,212 (August 14, 2002).
The planned use of patient health data without consent for HIEs and the NHIN, without the ability to decide who sees which parts of their health records, and without any way to refuse data sharing violates our strong existing health privacy rights.
In addition, the Tiger Team is still ignoring the new federal privacy policy. Secretary Sebelius announced a new "administration-wide commitment to make sure no one has access to your personal information unless you want them to" on July 8th. How is that principle reflected in their recommendations?
Dr. Blumenthal stated in support at the same press conference that "we want to make sure it is possible for patients to have maximal control over PHI."
It makes no sense to build systems that violate the new federal privacy policy and Americans' rights to control access to and use of their health information. The public won't trust these systems and the stimulus billions will be wasted.
Viva the digital divide?
This administration boggles my mind. Dictating to private companies that they serve specific markets! Where does it end? Why is there a complete unwillingness of anyone to recognize the core problem? [Government Health IT, Oct. 19, 2010, "Blumenthal warns of risk of EHR 'digital divide'" ].
Government disruption of natural market laws has completely skewed the supply side of the equation. Government regulations need to be squelched. Why does a company have to spend $10 million developing a pricing software for Medicare renal dialysis reimbursements? Quite ridiculous in my opinion!
Feeling chipper
All people should be implanted with an identification chip, similar to what is used for canine identification. Only the chip would allow access to medical records. No one would need to be governed, and a huge amount of medical testing would be eliminated, greatly reducing costs. Medical care would be far faster and more accurate. [Government Health IT, Oct. 26, 2010, "Health IT panel wants feedback on NHIN governance" ].
-- Name withheld by request.
Health USB
Another alternative (or supplement) to incorporating mobile health onto a patient's cell phone is to use a personal, portable health record USB storage device that can be carried in the patient's wallet like a credit card or worn around the neck like a dog tag. [Government Health IT, Oct. 13, 2010, "VA expands program to bring EHRs to the home" ].
Our company is the maker of the 911 Medical ID card and medallion. It allows those with chronic health conditions to enter their health histories, current medications (including dosages and frequencies), and known allergies to prevent treatment delays and medical errors in the event of a medical emergency. 911 Medical ID also allows patients to upload their important medical documents, including lab results, Living Will, X-rays, Treatment Consent Forms, and more to help reduce costs associated with unnecessary or redundant medical testing and to expedite treatment.
Personal, Portable Health Records (PPHRs) are the wave of the future in health care because they allow patients to assume personal responsibility for, and take charge of, their own healthcare. It would be a smart addition to the VA's goal of bringing EHRs into our veterans' homes. One low fee, no recurring costs, with free, automatic software upgrades for a lifetime.
NHIN governance
Security should have a more significant role [Government Health IT, Oct. 26, 2010, "Health IT panel wants feedback on NHIN governance" ].
Data base input needs to be standardized across the various EHR data bases, so that all EHR systems collect needed data.
There needs to be a priority and metrics in accountability that demonstrates the importance of the various functions, programs, projects.
Organizational responsibilities need to be detailed to insure the right stakeholder input and that all important stakeholders are part of the process - and that necessary information is not overlooked or ignored.
Also one needs to have high level support.
-- Allan Shapiro, Providence, R.I.
