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Health Data HIT Patients

All Over the Map: Patient Access to Clinical Lab Information

Last September, the Department of Health and Human Services introduced an amendment to the CLIA Program and HIPAA Privacy Rule: Patients’ Access to Test Reports. The rule proposes that patients have unfettered access to clinical lab test reports upon request. While hospitals, clinical labs, and clinicians say they support the proposal, implementation may have its share of problems. Added costs, new processes, privacy protections, and training of lab personnel would be required to comply with the rule.

If the federal rule is adopted, it would override the current model which provides authority to the state health information exchanges who determine accessibility rules. Today, patients’ access to clinical lab information is determined by the states. The rules are, literally, all over the map. I spent the afternoon building a US map in Powerpoint of patient lab data accessibility rules thinking that I would be able to find a rational pattern across the country.

I made a few presumptions.

  • Do states with strong medical lobbies only allow reports to go the the medical provider?
  • There are a cluster of states in the Mid-Atlantic (DC, DE, MD, NJ, WV) that already allow patients access to lab data. Has the “open health” movement in DC had any influence on policies in neighboring or nearby states?
  • Do states that have large health systems (like Kaiser Permanente in CA, OR, WA, DC, MD, and VA ) with patient portals that share data with patients already have a consistency in policies across states?
  • Is there an alignment of data accessibility policies between “blue” states and “red” states?
  • Is limited accessibility by patients aligned with strong statewide tort reform and medical malpractice caps?

The answers, for the most part are, “not necessarily.” In politics, it is a mistake to look for rational patterns. Politics aside, looks like the same goes for health care.

This post originally appeared on DrChrono’s Blog. 

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HIT

Coal Miner’s Doctor

Occupational and Environmental Medicine is a specialty where physicians are responsible for the health of workers. While your average office cubicle dweller doesn’t usually think twice about workplace health hazards, those in mining, manufacturing, and the military have good reason to be concerned.

Typically an occupational health record and a medical record take two completely separate paths, and rarely does a practitioner get the benefit of being able to see both in the same system. As a patient’s work affects their health and vice-versa, this report proposes that an EMR also capture occupational health information. The Institute of Medicine, the Government’s most august body of academic physicians and policymakers just issued a report that examined the rationale and feasibility of incorporating occupational information in patients’ EHRs. Patient records and occupational health records typically exist in separate systems – probably because reimbursement systems differ. To unify these records would give a physician a full picture of the patients’ health, potentially making care more effective and lowering costs.

Though the most obvious place for an occupational health department is a health care setting, occupational health physicians can practice just about anywhere. Judging from a few recent listings on the American College of Occupational Medicine’s website, in addition to the usual suspects like large health systems, occupational health physicians are currently needed at the Harley Davidson Plant in Tomahawk WI, the Social Security Administration in Baltimore, MD, and SeaWorld. It seems that a physician who works at any of these atypical settings would benefit from an EMR that speaks specifically to the needs of these particular sets of patients. A diver at SeaWorld and a line worker at the Harley plant would benefit from a customized OnPatient experience when seeing an occupational health physician. Physicians who work in these environments also need to have their own set of efficiencies built into their workflow given the variety of environments they work in.

Occupational and Environmental Medicine is a specialty where physicians are responsible for the health of workers. While your average office cubicle dweller doesn’t usually think twice about workplace health hazards, those in mining, manufacturing, and the military have good reason to be concerned. Typically an occupational health record and a medical record take two completely separate paths, and rarely does a practitioner get the benefit of being able to see both in the same system. As a patient’s work affects their health and vice-versa, this report proposes that an EMR also capture occupational health information. The Institute of Medicine, the Government’s most august body of academic physicians and policymakers just issued a report that examined the rationale and feasibility of incorporating occupational information in patients’ EHRs. Patient records and occupational health records typically exist in separate systems – probably because reimbursement systems differ. To unify these records would give a physician a full picture of the patients’ health, potentially making care more effective and lowering costs. Though the most obvious place for an occupational health department is a health care setting, occupational health physicians can practice just about anywhere. Judging from a few recent listings on the American College of Occupational Medicine’s website, in addition to the usual suspects like large health systems, occupational health physicians are currently needed at the Harley Davidson Plant in Tomahawk WI, the Social Security Administration in Baltimore, MD, and SeaWorld. It seems that a physician who works at any of these atypical settings would benefit from an EMR that speaks specifically to the needs of these particular sets of patients. A diver at SeaWorld and a line worker at the Harley plant would benefit from a customized OnPatient experience when seeing an occupational health physician. Physicians who work in these environments also need to have their own set of efficiencies built into their workflow given the variety of environments they work in.

This post originally appeared on the Dr. Chrono Blog

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HIT

Hot Dogs and Health Records

The next time you’re at Costco ogling flat screens and buying a pallet of paper towels, you may also be surprised to learn that Costco members are now eligible to receive incentive pricing on a Costco-branded cloud-based electronic medical record. During my maiden voyage to Costco after arriving in the Bay Area,  I saw a promotion for a Costco-branded EMR, billed as a “Service of the Month.” I was so baffled that I almost crashed into the guy with the cart brimming with hot dog buns. Fortunately, he was more amused than annoyed with me. (When I asked him to pose for this photo, he thought I was crazy.)

I’m not sure if posting marketing materials in Costco’s exit lane is an effective way to target a potential audience of EMR purchasers. However, it demonstrates that EMR marketers will take just about any approach to find a customer.

I picked up the promotional materials on the way out of the store and conducted some research after getting home. I was also surprised to learn that the Costco/EMR partnership was not a first for big-box retailers. Sam’s Club and Dell had a brief affair with another EMR company, eClinicalWorks in 2009, but soon dissolved its partnership due to lack of interest among members.

Given the failed relationship between Dell, Walmart and eClinicalWorks, why is Costco now selling a cloud-based EMR? I asked myself this question. Then I asked this question on Quora and am beginning to collect responses. What’s yours?

(This post originally appeared on Dr. Chrono’s Blog)