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Thoughts About athenahealth
By Deborah Peel, MD
Another misguided, uninformed EHR vendor will discount the price of EHR software for doctors willing to sell their patients’ data!
How is it possible to be so unaware of what the public wants? The public doesn’t want anything new or earth-shattering, just the restoration of the right to control who can see and use their medical records in electronic systems.
Not only is the practice of selling your patient’s data illegal and unethical, but the new protections in the stimulus bill require that patients give informed consent before their protected health information can be sold. So selling patient data without consent is now a federal crime.
Quotes from the story:
- athena’s EHR customers who opt to share their patients’ data with other providers would pay a discounted rate to use athena’s health record software.
- athena would be able to make money with the patient data by charging, say, a hospital a small fee to access a patient’s insurance and medical information from athena’s network.
- Caritas Christi [Health Care] initially launched athena’s billing software and service in October and then revealed in January that it decided to offer the company’s EHR to physicians.
- How many patients would agree to sell their health records to help their doctor’s bottom line AND at the same time put their jobs, credit, and insurability at risk?
Health information is an extremely valuable commodity, so people are always thinking of new ways to use it.
What will athena’s informed consent for the sale of health patients health data looks like? Will athena lay out all the risks of harm? Will athena lay out the fact that once the personal health data is sold, the buyer can resell it endless to even more users? Will athena caution patients that once privacy is lost or SOLD, it can never be restored?
I guess some people are so out of it they do not realize what a barrier the lack of privacy and lack of trust is to healthcare. HHS reports 600,000 people a year refuse to get early diagnosis and treatment for cancer because they know the information won’t stay private. Another 2,000,000 refuse early diagnosis and treatment for mental illness for the same reasons.
Check out slides from a recent conference at the UT McCombs Business School on the subject of patient expectations, privacy and consent.
Deborah C. Peel, MD is a practicing physician and the founder of Patient Privacy Rights.
Thoughts About athenahealth
By Truth Seeker
Um, I think we need to settle down here, folks. I may be wrong, but I believe when athena refers to athenaCommunity and the exchange of information, they are referring to the following hypothetical scenario:
A patient whose primary physician is an athena customer needs to be admitted to the hospital. athena delivers to that hospital a clean, clinically accurate, and up-to-date record of that patient’s medical history and charges the hospital a few bucks. athena is able to charge the primary care physician a lower fee for their EMR service because they are shifting some of the financial burden to the hospital. And intuitively, this make sense for a couple reasons:
The push towards electronic medical records is to enable greater exchange of information and better coordination of care, etc So when athena talks about athenaCommunity, I’m fairly certain that they’re not talking about a sinister plot to share info with hospitals so they can refuse to admit high-risk or expensive patients. (Seriously, the conclusions people draw from articles like this without doing their homework can be completely ridiculous, but I suppose that casting baseless aspersions is just the nature of informed discussion in the Internet era.)
They’re just talking about handing the patient over to another provider and making sure that the new provider has a completely accurate and up-to-date record of that patient’s medical history, and of shifting the financial burden from the handover away from the primary care physician. What a "privacy disaster" … a sheer outrage!
And second, I’m no healthcare economist, but I’m pretty sure that a) the hospital really wants and needs that patient’s medical history and that athena is probably better positioned to deliver it in a more useful format than a lot of their competitors; and b) it’s probably worth a lot more to the hospital than a few bucks.
I’m not an athena employee or other stakeholder, but I do think that they continue to think of innovative new solutions to problems, bottlenecks, and inefficiencies in the healthcare system. Unfortunately, they seem to have a bulls eye on their backs right now. I for one am happy that we have smart people like Jonathan Bush out there coming up with creative new solutions.
Why Emergency Physicians Prefer Best-of-Breed IT Systems
By John Fontanetta, MD, FACEP
According to a recent report from KLAS, some hospitals are replacing standalone, best-of-breed (BoB) emergency department information systems (EDIS) with enterprise solutions that are leaving ED clinicians — and often their patients — unsatisfied. Why unsatisfied? Because the clinical functionality in enterprise solutions is both less comprehensive and less efficient for the ED environment and they are just so hard to use.
This report has re-energized the debate over the benefits of the two kinds of systems. IT professionals prefer the seamless interoperability supposedly offered by single systems, but the fact is that many large vendors have simply bought and shoehorned in a separate ED system. The resulting systems have their own interface issues.
Like many of my fellow ED physicians, I have found that a first-class BoB system tailored specifically to the needs of the ED, in our case EDIMS, offers a number of advantages. For example:
- Workflow in the ED is measured in seconds and minutes rather than hours or days. The fewer clicks required, the faster the care. At Clara Maass Medical Center, we can issue complete sets of orders in as few as three clicks, enabling our physicians to be more productive.
- Trying to retrofit an inpatient IT system to the ED is difficult because the ED is just so different from the floors. Customized ED order sets with a linked charge capture system means less delay between treatment and billing, not to mention a more accurate capture of charges, which has dramatically increased our per-patient revenue.
- In the same way, customized alerts that tell the ED staff what they’re forgetting to document cuts back on the number of claims denied due to missing or inaccurate information. At Clara Maass, we have slashed such denials by 75%.
One of the most important things about a good ED system vendor is responsiveness. The vendor should be able to quickly accommodate the ongoing changes in standards and regulations. For example, at Clara Maass, when the H1N1 virus first appeared in 2009, we had templates for recommended care and discharge instructions built into our system by our BoB vendor within 24 hours. And when we decided to create an observation area, they promptly responded with observation-specific templates and order sets and created a secondary note option for the observation physicians.
The EMR system has enabled us to make a number of other improvements in our ED. For example, we have reduced the average patient turnaround time by over 30%. We have boosted the number of EKGs we perform within five minutes of a patient coming through the door from 46% to more than 90%.
Overall, my specialty has been slow to adopt EHRs, not because we don’t see their importance, but because they have a reputation for being unwieldy and unresponsive to the requirements of the ED. With more and more EDs adopting BoB systems that are designed to support ED clinicians’ intricate and demanding workflows, physicians are starting to realize that an EHR can actually be an advantage in our fast-paced environment, rather than a burden.
CIOs are finding that these BoB systems can offer the same, if not better, integration capabilities than a single, enterprise solution. While many of the HIS vendors are inflexible when it comes to working with other systems, BoB systems have always had to offer integration solutions and many pride themselves on their ability to integrate with almost any system.
Digging for Gold in your HIT Applications
By Ron Olsen
Over the past few years, hospitals have focused IT budgets and resources on purchasing applications to enhance their HIS. Many facilities have spent tens or hundreds of thousands — millions for the larger hospitals — on licensing, maintenance, and ongoing professional services.
In the feeding frenzy to continually acquire and implement the latest healthcare information technology, most IT/IS teams are neglecting to ask basic but important questions about their existing applications, such as:
- Are we using the software to its fullest extent?
- Have we turned on every feature we’re currently licensed for?
- Are HIT products meeting the needs we identified when planning the deployment?
- Have we asked users what they’d like to see added to the product, and if so, has that been communicated to the vendor so they can include it in a future version?
Asking questions does not cost anything and end users are usually very vocal about what they’d really like to see software do for them. Their invaluable real-world input is useless if there’s no feedback mechanism, or if your team refuses to incorporate it into product roadmap discussions with vendors.
In a time in which hospitals’ funds are tighter and IT budgets frozen or cut, it’s time to double back and review what products you have purchased and their capabilities. Maybe re-present the product to different areas of the facility explaining existing functionality again, and introducing new features that have been added since the initial implementation. Now that the users have gotten a refresher, they may identify functionality that was not implemented initially and would now prove useful.
Healthcare technology vendors are always eager to showcase new features and theoretical uses for these at sales presentations, but IT/IS admins often overlook “hidden gems” in the software that other hospitals are actually using. If the vendor has a user group, listservs, or an online forum, these are great places to start, not to mention that they cost nothing and consume very little time.
These collaborative tools may enable your team to discover other use cases that even your vendors have not thought of. There are a lot of people in the healthcare IT trenches creating workarounds every day. There may be capabilities within current products to join with other systems within your tool bag to create a new or improved process that is, again, a freebie.
One of the most over-used buzz words in healthcare IT is “interoperability,” a is really a big word that self-important people use to describe data transfer. When thinking about data transfer at a basic level, almost every HIT product can output to a printer. A printer can be easily set up to print to a file. So now you have data in a file format.
Scripting tools can manipulate those files, turning them into almost any format imaginable. With the correct format, data can be transferred to disparate systems, individually or concurrently, via a data stream. This could be a raw text file, compressed zip file, encrypted e-mail file, FTP, or an HL7 file.
This method is easily applied to an enterprise forms management system. If it has a decision engine, you could print a form set from it and then have the engine input the data to a database for audit trails (you should be able to choose the data points). Next, the engine sends the data to a file and launches an application to text the ordering physician that the patient just presented, based on the data in the text file.
If you’re a budget-conscious healthcare IT professional who wants to better meet the needs of your user community, I implore you to take another look at the systems you’re already working with. In my many years as a system admin at a community hospital, getting more out of the tools available to me (instead of just relying on new purchases) helped me deliver more effective tech solutions to my users, positively impact patient service, and keep decision makers happy by saving money.
You, too, have gold nuggets hidden in your existing software. It’s up to you to find and use them.
Ron Olsen is a product specialist with Access.