Jun. 2006
Is Clinical HIPAA on the Way?
All signs are pointing toward the government getting serious about electronic health records. But what will it take to make it happen? Contributor Bill Bysinger says many of the issues are the same as those faced by the Health Insurance Portability and Accountability Act of 1996.
All signs are pointing to the government getting serious about electronic health records. The president, members of Congress, Medicare, state Medicaid, and state governors are all addressing electronic health records; in addition, many healthcare consumer groups are touting the merits of such records. Many medical societies have published studies supporting electronic medical records and digitized clinical data.
These positive indicators seem to imply that the industry is enthusiastically embracing electronic medical records. But in fact, the penetration of electronic medical records in medical practices is below 20 percent, recent studies suggest.
If it electronic records are so important, why aren't they more prevalent? The key question is: What will it take to make it happen?
The issues that could impact the answer to this question are the same issues that the Health Insurance Portability and Accountability Act encountered when it became law in 1996. To make electronic records work, the industry, the government and the consumers of healthcare must exhibit serious efforts and focused diligence. The key is unrelenting industry/government collaboration and highly visible consumer demand for digitized clinical data to create a better U.S. healthcare infrastructure.
Stars are aligning
With the rapid movement of the Certification Commission on Health Information Technology, which is chartered to certify health information technology and, specifically, electronic medical records, along with the design of standards for clinical content, vocabulary and clinical transmission standards, the pieces are falling in place for an industrywide clinical data architecture. This very much resembles what happened from 1996 to 2000 with HIPAA.
The difference is that the industry is heavily driving the adoption of electronic medical records with the support of the federal government. The industry is demanding a way to make clinical content accessible, and healthcare consumers are agreeing that electronic records will be good for patient care and healthcare in general.
Lessons learned
The difference between this clinical data revolution and HIPAA, the insurance/billing data revolution, is that the legislation is not leading the charge to make it happen. Between the electronic medical records certification movement and Regional Health Information Organizations--the state health information exchanges being established for the secure and accurate movement of health information--the infrastructure is being created first. The prototyping for these RHIOs and their interaction with electronic patient data are in development and are funded by the Department of Health and Human Services. Healthcare technologists are engaged in this process with the support of federal and state governments. So why are many providers not engaged and ready for rapid adoption?
During HIPAA's development, the implementation models and the rules took too long and caused many to believe that HIPAA wouldn't fulfill its promise. It also created considerable debate and confusion, as well as considerable complexity for an initially simple process.
In the clinical data area, the process has been more organized. With the advent of the Office of the Coordinator for Health Information Technology, there is now a singular focus point in the government to support the health information technology. David Brailer, M.D., Ph.D., has made great strides in communicating to Congress and the industry the need for health information technology in all medical practices--specifically, the advantages and efficiencies electronic medical records can bring to the industry. Brailer’s departure should not impact the momentum he brought to the industry and the commitment he fostered in Congress to move this digital healthcare world forward.
Will a clinical mandate happen?
The only way to create cost savings, quality improvement, improvement in patient safety and enhancement of the provider/patient relationship is through digitized clinical content securely available over networks as evangelized by Brailer. These will only take place if all physicians, clinics, hospitals and healthcare facilities utilize electronic medical records and patients are connected using electronic health records.
Given the reluctance of the healthcare industry to embrace technology over the years, a mandate is required to make this transformation happen. As with HIPAA, electronic transactions would never happen without a federal requirement. The same holds true for clinical content.
Catch up with the world
If we cannot digitize clinical data, we cannot move ahead. The healthcare payback from digitized medical records is substantially greater than digitizing billing records and billing transactions. The future of healthcare depends on digitizing records in the U.S. healthcare system. Most of the developed countries in the world are already on electronic medical records standardized within those countries' boundaries. In this respect, the U.S. is years behind the rest of the world. The U.S. is the most technologically savvy society in the world, yet the majority of our medical records live on paper in manila folders.
Electronic medical records, Regional Health Information Organizations, and clinical standards create the highway we need for creating accessible quality healthcare information. There is no doubt we need clinical HIPAA.
The question is: Who has the guts to promote it, and how do you make the industry comply? I propose five simple goals:
Without clear objectives, we will be debating this issue longer than the 10 years it took HIPAA to see the light of day. But this line in the sand costs money, and someone must help pay the bill. The money has to come from state and local governmental bodies in the form of tax credits, grants, low interest loan guarantees and other creative ways to fund these efforts.
If the U.S. healthcare system is to cost less, deliver higher quality and be more patient-focused, this digitizing of healthcare information must be well-funded. There are no other choices, and it may be that only a federal mandate can drive EMRs into practices, resulting in clinical process success.
The industry must commit to a digital healthcare infrastructure and press Congress and the states to allocate the funding for success. Healthcare is a high priority, and it is time to make it well.
Bill Bysinger is executive director and CEO of eMRnet, a provider of electronic medical records over secure Internet. He was heavily involved in the development of the HIPAA rules and the implementation of HIPAA transactions, privacy and security. Bill can be contacted at bbysinger@emrnet.com .
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