Archive for the ‘Electronic Health Records (EHR)’ Category

Health Information Bill of Rights

December 2, 2009

Consumers are familiar with HIPAA and aware that it protects access to personal health information at a national level.  Consumers may be surprised to discover that only “covered entities” (healthcare providers, health plans and health clearinghouses) are required to comply with these regulations.  Many entities that access and use the same information are not bound by the same regulations.  Each state has its own regulations regarding health information.  These regulations vary and there is no uniform national standard.

As the country moves closer and closer to full digitalization of all health information, security becomes a greater concern and patients deserve to know who has access to their information and how their information is protected.

In light of this, the American Health Information Management Association (AHIMA) designed a Health Information (HI) Bill of Rights as a model for protecting personal health information.  The Bill contains seven rights “for the sole purpose of protecting healthcare consumers”:

  1. The right to access your health information free of charge
  2. The right to access your health information during the course of treatment
  3. The right to expect that your health information is accurate and as complete as possible
  4. The right for you or your personal representative(s) to know who provides, accesses, and updates your health information, except as precluded by law or regulation
  5. The right to expect health care professionals and others with lawful access to your health information to be held accountable for violations of all privacy and security laws, policies, and procedures, including the sharing of user IDs and passwords
  6. The right to expect equivalent health information privacy and security protections to be available to all healthcare consumers regardless of state or geographic boundaries or the location (jurisdiction) of where the treatment occurs
  7. The right to the opportunity for private legal recourse in the event of a breach of one’s health information that causes harm

Vera Rulon, AHIMA president, said the bill was made necessary by “Repeated abuses of access, accuracy, privacy and security of the most basic rights of individuals whose trust has been betrayed and dignity compromised.”  The seven point bill eases patient’s fears about security by increasing transparency and encouraging providers to give the strictest protections to personal health information.

Posters featuring the HI Bill are already making their way into health facilities and physicians offices.  Wallet sized cards with the Health Information Bill of Rights Preamble on one side and the seven rights on the other are being developed.  The card will give consumers easy access to their HI rights whenever or wherever they are.

Unfortunately at this time the HI Bill of Rights is only a model.  It has not been signed into law and until it is or something comparable is, there will continue to be fears and concerns about the safety of personal health information.  However, the HI Bill of Rights is a step toward making consumers more informed about their health information and confident in how that information is managed; it is a step in the right direction.

Questions: What do you think about the HIM Bill of Rights?  Do you think there are any key points missing?  

About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the blog.

AHIMA Health Information Bill of Rights

AHIMA Rights Bill Sets Ideal Standard for Protecting Consumer Health Information


Health Information Technology and the Stimulus Package: Information and Changes for the Public and Employment Opportunities

November 16, 2009

Health information technology (HIT) is a broad term used to describe the digital storage, management, and secure exchange of health information between patients, providers, government, and insurers.  The information being exchange primarily refers to but is not limited to Electronic Health Records (EHRs are sometimes called electronic medical records (EMRs)).

Earlier this year, Obama’s American Recovery and Reinvestment Act of 2009 (the Stimulus Bill) was signed into law.  One part of the Stimulus Bill; the Health Information Technology for Economic and Clinical Health (HITECH) Act, aims to increase the use of an EHR by doctors and hospitals by:

  • “Requiring the government to take a leadership role to develop standards by 2010 that allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care.”
  • “Investing $20 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors and hospitals to use HIT to electronically exchange patients’ health information.”
  • “Saving the government $10 billion, and generating additional savings throughout the health sector, through improvements in the quality of care and care coordination, and reductions in medical errors and duplicative care.”
  • “Strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of Health IT.”

Information and Changes for the Public:
Health information technology and electronic health records will not only improve patient care but also change the way we experience health care.   Even the best doctors can make mistakes or unintentionally overlook important details; an EHR will reduce the risk of these errors.   EHRs negate mistakes made due to sloppy handwritten notes.  They have automatic drug-drug/ drug-food interaction and allergy checks, and since they are online, standard drug dosage information and educational patient information can also be accessed.  Built- in alerts remind doctors of preventive care timelines, and can track referrals and test results.

Another major advantage of EHRs is they are maintained digitally and once they progress to their full potential, they can be accessed from anywhere.  Because it is simple to back-up this data to another location, EHRs also guarantee information will never be lost or damaged as a result of a natural disaster.  In the event of an emergency hospital visit or sickness while away from home, a doctor will immediately be able to pull up a patient’s chart and access information potentially crucial in diagnosing and treatment.  Referral doctors will be able to see any treatment a patient is undergoing by other doctors and make decisions that will not interfere with that treatment.

Though there are many benefits, HIT is not without its drawbacks.  Advocacy groups like the ACLU are wary of HIT and question how secure confidential medical records will really be if they are kept digitally online.  The potential for online medical records to be hacked is real and very serious; electronic databases and servers regularly experience hack attempts and an EHR would be no different. 

It is easy to placate the fear of EHRs being hacked and find comfort in the idea that “if someone really wanted my medical file they could just as easily break into my doctor’s office.”  This leads to the conclusion that “nobody would break into my doctor’s office to steal my records, because I am simply not that important.”  However, hacking into an EHR system is not the same as breaking into your doctors.  The threat of your EHR being attacked is not only about your personal health information; hacking into an EHR means gaining access to everyone’s valuable health information.  Hackers could sell the information found in the nation’s family histories, mental health history, test results, current medication, etc… or use it to bribe and blackmail people in countless ways for countless amounts of money.  Even worse, they could change the EHR causing unimaginable damage.

However, the benefits of an EHR far surpass the risks.  The government is working hard to minimize the threat of hacking.  Part of the HITECH is to strengthen “Federal privacy and security law to protect identifiable health information for misuse as the health care sector increases use of Health IT.”

Information and Changes for Employment:
Employment for medical records and health information technicians is very good and is expected to grow faster than the average professional field.  The projected employment for 2016 is 200,000.  That is 30,000 more than 2006 or an 18% increase.  Physicians’ offices, home health care services, outpatient care centers, and nursing and residential care facilities will have the most job growth and creation of new jobs.  Job growth in hospitals will not be as great but new jobs will still be created.

The growth of HIT and increased use of EHR will benefit everyone and is not something to be scared of.

Questions: Does anyone work in a facility that has already implemented an EHR?  Have you experienced or do you foresee any other problems or risks with an EHR other than hacking?

About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the blog. 

Bureau of Labor Statistics.  Occupational Outlook Handbook, 2008-2009 Edition.  Medical Records and Health Information Technicians.

Title IV- Health Information Technology for Economic and Clinical Health Act.  January 16, 2009.

The Fate of Medical Transcriptionists and the Advancements of Voice Recognition Technology

September 29, 2009

GetAttachmentMedical transcription is a lesser-known profession to the general public in spite of the fact that medical transcriptionists (MTs) are a part of everyone’s health care.  Medical transcriptionists transcribe the dictated recordings made by doctors or health care professionals into reports, correspondence, and other administrative documents.  An example, familiar to anyone who has watched one of the highly popular crime dramas on television is when a medical examiner is seen saying the findings of an autopsy out loud; it is a MT who turns that recording into a written report.  In addition to autopsy reports, MTs are also responsible for referral letters, discharge summaries, diagnostic imaging studies, medical histories, physical examination reports, operative reports, and consultation reports.  The completed transcript is returned to the professional who dictated it for review, signature, and movement into the patients file.

The future and security of MT’s jobs has begun to be questioned as voice recognition (VR) technology becomes increasingly refined.  VR converts spoken words into text, potentially eliminating the need for MTs.  Proponents for VR advertise how VR will save medical professionals thousands of dollars over employing MTs.  However, the reality is VR is nowhere near refined enough to replace MTs. 

VR technology would need to be able to “understand” different accents, separate background noise from what is being dictated, and convert any abbreviations used into their full form.  In addition, context plays a large role in understanding spoken language.  VR needs to “understand” context to differentiate between: urine vs. you’re in, cauterize vs. caught her eyes, align vs. a line, dilate vs. die late, and so on before it can replace MTs.

Currently, VR for the purpose of medical transcription is being used in two ways, front-end VR and back-end or deferred VR.  Front-end VR creates a report that rarely goes through an MT but is more time consuming for the medical professional.  Medical professionals using front-end VR dictate into a recognition system and the words are displayed on a monitor as they are spoken; the dictator is responsible for catching mistakes, editing, and completing the document for sign off.  The question for professionals using front-end VR is; is editing reports a better use of their time than seeing additional patients?

Back-end VR is when a recording of what is being dictated is played and a draft document is created.  Both the draft document and voice recording are sent to an MT who listens to the recording, edits the draft, and finalizes the report for sign off.  Back-end VR is the most common form of VR being used in medical transcription.  Back-end VR has made medical transcription more efficient and helps MTs generate more reports in less time.

VR will not make MTs obsolete. The duties and responsibilities of MTs may change due to advancements in VR technology but the day when VR completely eliminates the need for MTs is not in the foreseeable future.  According to the Bureau of Labor Statistics, the outlook for job opportunities for MTs is good. The aging baby boomer population will increase the demand for MTs.  Employment opportunities for MTs are projected to grow faster than the average.  A 14 percent growth is expected between 2006- 2016; in 2006 98,000 MTs were employed, by 2016 112,000 MTs are expected to be employed.  MTs jobs are secure and they should view VR as a tool to aid them in their job, not as threat.

About the Author: Erika Christenson is a Staff Writer with the Clear Medical Solutions Communication Team.  Her work is regularly shared on the Clear Medical Agency newsletter and the blog. 


Bureau of Labor Statistics “Occupational Outlook Handbook, 2008-09 Edition.”

 MedGenMed “Voice Recognition and Medical Transcription” August 27, 2004.

Regional Health Information Organizations have a Long Ways to Go

September 1, 2009

In reading about Regional Health Information Organizations (RHIO), it is interesting to note how colossal and incredibly complex some possible solutions seem.  Health information exchange (HIE) is the goal of these organizations along with facilitating improvements in healthcare.  Unfortunately, many of the proposals being ping-ponged about today lose track of this goal due to financing, collaboration, and planning issues.  Currently, this movement and the technology are still largely in the visualization and troubleshooting phase.  There never has been a one-size fits all solution that could cure the health care system, and yet that is how many innovations including Electronic Medical Records, Computerized Physician Order Entry (CPOE), and RHIOs are presented.  It is important that development and application do not interfere with the health care process.  As a distant goal, HIE is an excellent idea that has the potential to facilitate a lot of positive developments, but perhaps on a smaller scale.  As a more immediate endeavor, it is presenting with mixed results and stumbling on issues like implementation, usability, and lack of collaboration.   pnetwork1m2

While each individual HIE endeavor and its successes and failures are unique, collaboration is an element that should be included in business plans more and more.  Many health care professionals continue to maintain that patients, consumers, physicians, IT professionals, and accountants should all be a part of discussion, development, and usage of RHIO and HIE.  In his article, “Health Improvement Technology,” Dennis Schmuland, M.D., writes, “The fixation of the industry and health information technology community on digitizing and exchanging health data and information has caused the industry to undervalue the breakthrough possibilities of collaboration technologies.”  Technology provides a means to achieve, but health information exchange cannot occur without participation from all parties involved.  Here in Milwaukee County, a major part of the Emergency Department Linking Project was an agreement and collaboration between the “CEOs of all the major health systems in the Milwaukee metropolitan area to commit to the project” (Hagland 1). 

Per the ED Linking Project Information Paper, “The primary goal of the ED Linking project is to provide patient health information where currently there often is none or very little available to help ED and Community Health Center clinicians in Milwaukee County provide patients quality, safe, and cost-effective health care” (Webb 1).  Initially, the project focused on sharing information on patients and visits to the emergency department.  Laboratory results, medication data, and insurance information will eventually be exchanged as well, if they are not already a part of this project.  Perhaps what hurts health information development most is extremely aggressive deadlines which make agreeable growth and collaboration between vendors, IT professionals, doctors, health care providers, and patients.  The incremental approach Milwaukee’s ED Linking project has taken allows for adjustment, adaptation, and room for growth.  According to Dr. Mark Friesse, Professor of Biomedical Informatics at Vanderbilt, “Every state is doing great things.  Everyone is teaching us a different part of the answer” (Blair 6).  In some ways, this may broaden perspectives and help piece together a model RHIO or HIE to build off.  Undoubtedly, some will chalk this up to progress being made, but real progress might more clearly be made via collaboration and real health information exchange. 

Unfortunately, there is no shortage of obstacles to tackle and issues to understand surrounding RHIO and HIE foundation.  If everyone was equally motivated, eager to learn, and up to date with the state of health care, modernization might be much to easier achieve.  Kind of like a science fair, this phase will undoubtedly have more successes and flops.  Establishing more meetings to initiate these exchanges is a good way to enable health information exchanges.  There are groups that focus solely on idea sharing, learning experiences, and problem solving dialogue for these reasons.  Listed below are some examples:

  1. North Carolina Healthcare Information and Communications Alliance Inc.
  2. HIE Seamless Exchange Solutions

What do you think about the progress of RHIO’s so far?  Is it beneficial for all to collaborate and work together? Please, don’t hesitate to chime in and share your thoughts. 

About The Author:

Mario Raspanti is a Staff Writer with the Clear Medical Solutions Communication Team.  His work is regularly shared on the Clear Medical Agency newsletter and the blog.  

Blair, Robin.  “RHIO Nation.”  Health Management Technology:  The Source for Information Systems Solutions.  February 2006.

 Hagland, Mark.  “From Struggles to Success:  Part technology, part cooperation and part good old fashioned trial and error are what it takes to build or break a RHIO.”  Healthcare Informatics.

 Schmuland, Dennis.  “Health Improvement Technology.”  Health Management Technology:  The Source for Information Systems Solutions.  May 2009.

Webb, Denise.  “Emergency Department Linking Project Information Paper.”    <;

Hospital Gambling on EHR

August 4, 2009

I caught this story on the news and was surprised at first, but then on second thought I realized it’s not that surprising given the state of our rural hospitals in many areas.  I’m sure many hospitals might have to make tough decisions just like Sac-Osage Hospital in Missouri. 

A few details about Sac-Osage Hospital:

  • 47 bed hospital
  • Spending $1 million to move to an Electronic Health Record (EHR)
  • Operating on a $370,000 deficit
  • Hoping the Obama Stimulus Package will help make this change profitable in 2011
  • E.R. and ambulance services facing closure of services depending on whether or not local voters approve property tax

Sac-Osage has an average census of 5 inpatients per day, so obviously they will have difficulty raising revenuSac-Osage Hospitale to cover this large of an expense.  However, they are looking into the future, hoping that they will meet the criteria of “meaningful use” of the EHR as stated in the Obama stimulus package, and then receive some unknown amount of the stimulus money that will help offset the costs.

Some might say it is risky, but if they don’t do it now, they will not have enough time to prepare for the stimulus package and starting 2015, healthcare providers who haven’t made the switch may face financial penalties.  Whether Sac-Osage Hospital decided to take action or continue as is, the future of their facility is unforeseeable at this time.    

If you are interested in the full story, click here:;jsessionid=93CF354D45905A0D57914503C657E091?full=true&contentguid=LUV8siO4&detailindex=#display

What do you think about this?

If you were a small rural hospital in the same situation, would you bite the bullet and take the chance on an EHR in hopes it will be worth it in the end, or would you continue operating the same way and plan to make the change to an EHR later on down the road when/if you can afford it?

Please, feel free to share your thoughts!

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