Tuesday, May 26, 2009

EMRs & PHRs Discussed

Leading experts came to the May 21st Steering Committee on Telehealth and Healthcare Informatics lunch briefing held on Capitol Hill to discuss how EMRs, PHRs, and hybrid systems are going to operate and change in the coming years.

Congressman Patrick Kennedy (D-RI) lending his support to the Steering Committee’s work, was introduced by Neal Neuberger, Executive Director of the Institute for e-Health Policy. Congressman Kennedy told the attendees that we are so fortunate that $19 billion is out there to support health IT, but he emphasized that legislation needs to be crafted to fit and work with those dollars so that the money will be spent wisely.

Jeff Margolis Chairman and CEO, TriZetto, defined Integrated Healthcare Management as the system application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The reality is that our healthcare system is in crisis which is going to require that any technology used in healthcare will need to be integrated. Every time that you combine good information with technology, the healthcare system can only win.

He explained that the core elements for an integrated healthcare management system depend on value-based benefits, value-based reimbursement designs, systematic health management, and the active engagement of all constituents in a culture of health. All of these elements need to be based upon a growing body of evidence-based medicine.

Additionally, breaking down information silos by taking the best of benefits information and adding this information to the best of care information helps the consumer at the right time and provides effective information management.

Alfred Spector, PhD., Vice President, Research and Special Initiatives, Google Health, stressed that it is important for PHRs to put order to disorganized information so that the information can be shared. Google’s PHR system is able to store large amounts of data, manage the data, and then make the information accessible.

Google’s vision is to provide a non-tethered PHR where the user controls and owns the data, and where Google is able to add on services and tools personalized to suit the users’ needs. The business model enables the product to be offered free, no advertising is permitted on the site, and the data is not sold. The only time the data is shared is if the user gives permission.

As Dr. Spector told the group, there are still challenges to using the technology since there are still interoperability issues, problems at times getting accurate and complete data, incorporating the PHR data into the physicians’ electronic medical record, and finding ways to increase the consumer’s use of the site.

Deven McGraw, Esq., Director of the Health Privacy Project, Center for Democracy and Technology, pointed out that it is not yet clear how regulators and courts will interpret ARRA’s health privacy provisions. ARRA charges the FTC to work with HHS to report to Congress on privacy and security recommendation for PHR vendors. PHRs are covered by HIPAA if offered by a covered entity or business associates but is not covered by HIPAA if offered by an independent vendor.

McGraw explained that HIPAA permits broad information sharing for treatment payment and healthcare operations. This is the right approach for the health system but the wrong approach for a tool intended to be used by consumers. Today and in the future, health privacy needs to build on HIPAA, establish new protections to address concerns, and develop specific rules to make electronic medical records and PHRs sustainable over the long term.

John Hummel, CTO, Perot Healthcare Services, said the company provides innovative technology to improve the safety and quality of care. Services are provided to over 1000 hospitals, to over 65 million health plan members, and to more than 70 health insurers.

In his own experience he has seen his wife receive duplicate tests and duplicate drugs simply because the hospital couldn’t communicate the information to the right place at the right time. Obviously, our healthcare system has to be able to provide data that is accurate, timely, secure and private.

Hummel joined Perot Systems coming from the California Prison Healthcare Receivership. The receivership was a federal court takeover of California’s failing prison healthcare system which was declared unconstitutional due to the deaths of inmates. In California, there is a death every five days since prisoners receive below third-world country care levels of medical quality and safety. Hummel worked to ensure that the most clinically, technically, and cost-effective tools were designed and deployed to help repair the problem.

HIMSS launched the Washington-based Institute for e-Health Policy last year and manages the Capitol Hill HIT briefing series. For more information, go to www.e-healthpolicy.org.