Archive for the ‘Government’ Category

Feds propose stronger patient privacy rights

July 11, 2010

We just saw this on the HIM Circle facebook page (


The U.S. Department of Health and Human Services (HHS) proposed a new federal healthcare information privacy rule yesterday that would expand patients’ rights to access their information and restrict certain types of disclosures of protected health information to health plans, according to InformationWeek.

The proposed rule is part of the Obama administration’s plan for every citizen to have an electronic medical record by 2014.

The changes are also a response to the Health Information Technology for Economic and Clinical Health (HITECH) Act, which requires HHS to change the Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules by strengthening the privacy and security protections for health information.

The proposed rule would strengthen and expand HIPAA privacy, security and enforcement rules by:

• Expanding individuals’ rights to access their information and to restrict certain kinds of disclosures of protected health information to health plans;
• Requiring business associates of HIPAA-covered entities to follow most of the same rules as the covered entities;
• Setting new limitations on the use and disclosure of protected health information for marketing and fund raising; and
• Prohibiting the sale of protected health information without patient authorization.

For more information check out the new HHS Website:


January CMS Updates

December 19, 2009

Below are January CMS updates compiled by Sheila at the RWHC:

Here is a link to the January Integrated OCE

Here is the link to the January PPS updates – for both the Medicare Benefit Policy Manual and Claims Processing Manual

Here is a link to the Consult EM changes information

Why Consumers Need to Demand More From Drug Companies

November 9, 2009

A recent article in the New England Journal of Medicine, Lost in Transmission- FDA Drug Information That Never Reaches Clinicians reported that key information is missing from prescription drug labels.  Authors Dr. Lisa M. Schwartz and Dr. Steven Woloshin wrote, “Much critical information that the Food and Drug Administration (FDA) has at the time of approval may fail to make its way into the drug label and relevant journal articles.”  They go on to explain, “FDA approval does not mean that a drug works well; it means only that the agency deemed its benefits to outweigh its harms” and “drug labels are written by drug companies, then negotiated and approved by the FDA.” GetAttachment2

Schwartz and Woloshin profile three drugs, Zometa, Lunesta, and Rozerem as examples of how drug labels are missing information.  All three drug labels were indeed missing information.  In their review of Lunesta and Rozerem however something stands out, both Lunesta and Rozerem had intense direct- to- consumer advertising campaigns.  Lunesta is reported have spent more than $750,000 a day in its 2007 advertising campaign and to have sales reaching almost $800 million last year.  Rozerem is described as being “aggressively promoted to consumers.”  This information could easily be omitted from the article without detracting from the issue of drug information not reaching clinicians; the inclusion of this information is interesting.

In 1997 the FDA issued new regulations governing television advertising of prescription drugs; following this change direct- to- consumer drug advertising soared.  Prescription drugs became commercialized; direct- to- consumer advertising repackaged drugs into a shiny product to be sold to the public.  In this light, is it surprising that drug companies would over exaggerate the benefits of their drug and down play the risks?   The purpose of advertising is to make consumers think they need a product and make them want to buy it; drug companies are no different.  Consumers have learned to be skeptical of the dubious claims made by advertisements but direct- to- consumer drug advertising is new.  Consumers have more faith in the claims made by drug companies because the idea that drug companies might manipulate information at the risk of the consumer is so unsettling.

By including information on the direct- to- consumer advertising campaigns of Lunesta and Rozerem, Schwartz and Woloshim provide further insight into the motivations (money) behind excluding certain information from drug labels.  It also highlights how for years the public has accepted and believed the claims of drug companies without question despite numerous incidents of drug companies being exposed as less than forthright.  You can be angry with the drug companies for omitting information or mad at the FDA for not making it easier to access the information.  But isn’t it time we as consumers start to demand more from drug companies?

Questions: Do you agree with the above statement that as consumers, it is time to start demanding more from drug companies?  Have you experienced any type of negative side effects to your medication that was not listed on the label?

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. 


Lost in Transmission- FDA Drug Information That Never Reaches Clinicians

HIPAA and Its Implications

November 2, 2009

From its birth in the U.S. Congress in 1996, HIPAA has played both normative and authoritative roles with respect to patient privacy as well as health insurance security.  The Health Insurance Portability and Accountability Act (HIPAA) is composed of two separate Titles, each pertaining to issues of health insurance proteHIPAAction for employees and their families during a change or loss of occupation, and medical record privacy.  This article will consider Title II of the Act and some of the ways in which it affects both health care workers and patients.

Title II, Administrative Simplification (AS) provisions, calls for and prescribes the establishment of nationally cohesive standards for all health care transactions, or rather, the use and dissemination of health care information.  Its primary intention is to help protect and retain the privacy of such health care information.  (I.e.: medical records, payment history, etc.)  The AS is comprised of five sets of rules, two of which are relevant to our purposes.  The Privacy Rule pertains to both paper and electronic health care files, and prescribes regulatory measures for both the use and disclosure of protected health information (PHI), being “any information held be a covered entity which concerns health status, providers of health care, or payment for health care that can be linked to an individual”.  This particular rule also requires the training of all individuals working within a medical establishment with regard to the proper procedures concerning both PHI and HIPAA.

Another relevant aspect of HIPAA, with respect to privacy, is a subsection of the Security Rule, a rule that is concerned only with electronic data, known as the Physical Safeguards. This facet of the Act itself attends to the control of physical access in order to protect against any inappropriate entrance into classified data.

HIPAA violations are far from uncommon.  Many are reported, but few are actually prosecuted.  This was not the case, however, in a recent incident involving a nurse in a midsize regional medical establishment.  This individual, Ms. A (whose actual name shall not be disclosed), had been employed by her respective clinic for 5 years and, as of late, was married to a man who had been involved in a car accident for which he was being sued.  She came upon the file of her husband’s plaintiff at her office during the course of the lawsuit, took some notes that had been kept in the plaintiff’s medical file, and brought them home to her husband.  In turn, Mr. A contacted the plaintiff urging him to drop the lawsuit given certain facts regarding what had surfaced in his medical record.  The plaintiff immediately contacted the clinic as well as his attorney.  Ms. A was subsequently and instantaneously fired from her job.  The couple were indicted a month later and charged with violating HIPAA, with “conspiracy to wrongfully disclose individual health information for personal gain with maliciously harmful intent in a personal dispute”, and with witness tampering (which was charged to her husband exclusively).  The charge against Mr. A was dropped after negotiations.  However, Ms. A still faces up to 10 years in prison and up to $250,000 in fines.  Not only this, but the nursing board in her respective state is attempting to have her nursing license revoked.  For the full story, visit

This case is a blatant and highly perceptible situation in which a health care employee violated the boundaries of normative ethical privacy practices in the pursuit of personal gain.  However, no malicious intent need be present in order to carry out such violations.

Though HIPAA has undoubtedly protected innumerable individuals’ health care privacy, it has also raised certain complications as well as costs.  Training with respect to HIPAA has proved to be insufficient and toilsome as a staggering majority of health care workers report being uncertain of its scope and needless to say, its more specific mandates.  Not only this, but costs for medical institutions have significantly increased in tandem with the increase in paperwork required by the Act.  Due to the deducible detriments that have, and may very well continue to occur as a result of such confusion and costs, it is imperative that these matters are resolved by both legislators and by those who manage health care institutions.  

Questions: Do you think Mrs. A and Mr. A faced a fair punishment?  Should Ms. A be subject to high fines and 10 years in prison for her actions?

About the Author: Patricia Heise 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. 


“Staff Nurse Faces Jail Time for HIPAA Violations.” Ann W. Latner, JD. October 1, 2008.

“Health Insurance Portability and Accountability Act of 1996.” 104th Congress. August 21, 1996.

“Health Insurance Portability and Accountability Act.”

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.”    <;

Healthcare Cost Reduction Initiative

May 23, 2009

This past week healthcare executives have vowed to take a semi-united front to align with President Obama’s goals to lower the cost of healthcare. Armed with the goal of saving $2 trillion over the next 10 years, industry leaders have volunteered to reduce the growth rate of national health care spending care costs by 1.5moneytab% every year.  

Fox News reported that six leaders of the health care industry penned a letter to Obama stating that: “We will do our part to achieve your administration’s goal of decreasing by 1.5 percentage points the annual health care spending growth rate, saving $2 trillion or more. This represents more than a 20 percent reduction in the projected rate of growth.”

Though this declaration is advantageous to Americans, it is not without its benefits to health care leaders.  Namely, “they hope to stave off new government price constraints that might be imposed by Congress or a National Health Board of the kind favored by many Democrats” (


One reason that healthcare costs are so out of control is due to the lack of productivity.  In a report being sent to Congress on Monday, two research and advocacy groups, the Center for American Progress and the Democratic Leadership Council, say that productivity growth in health care has lagged behind that of other industries.  The government could save nearly $600 billion over the next decade if the health care industry increased its productivity growth by 1.5 to 2 percentage points a year, said the report, by David M. Cutler, a Harvard economist.

Taking a cue from industry leaders, members of the medical and insurance sector are also eagerly waving their hands to join the Lower Health Care Cost Team.  But before they receive the MVP award it is important to notice their timing.  Some Washington officials claim that the plan is for them to give in to some cost control concessions presented by the Obama Administration in an effort to thwart the implementation of a public heath care plan and to have at least some say over the direction of the overhaul.  But history might repeat itself: “the health care industry’s offer to slow the rise in health care costs mirrors a trend that goes back to 1993, when President Clinton launched his reform effort. The rate of health care inflation had been in the double digits before that and it begun rising after the Clinton administration’s effort failed, reaching its most recent peak of 9 percent in 2002.  In 2006, healthcare consumed 15% of gross domestic product” (

Some leaders believe that improving the use of EHR technology will result in increase productivity and decreased costs.

What do you think?


About The Author:

Kristen Mirsky 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.  

Privacy wins in Obama’s $19 Bil EMR Plan

February 13, 2009

Bloomberg News  reports that patients’ rights proponents won in obama-stock-phototheir victory to defeat the Senate version of the stimulus package which allowed for looser privacy standards. 

The report also provided the following details:

  • $2 Billion in grants to creat a national system of computerized health records
  • $17 Billion in higher CMS payments for doctors and hospitals to adapt the technology.
  • Doctors would be eligible for $40,000 to $65,000 in grants if they began using EMR technology.
  • Penalties for those who fail to adapt the systems would begin in 2014.
  • The bill also tightens restrictions on the sale of medical data.

To read the entire report, click here:

The plan includes both incentives and penalties.  Do you think government intervention will help or hurt HIM departments or hospitals in the long run?

How will this affect you?

Feel free to comment below:

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