In the 21st century, successfully storing, and electronically communicating data will only be possible if that data is trustworthy, accurate, complete, and secure. The “Capitol Hill Steering Committee on Telehealth and Healthcare Informatics” session held March 27th discussed all of the vital issues related to achieving data integrity. The event was arranged and presented by the Institute for e-Health Policy.
Focusing on the mechanics of providing data is necessary but to do this, we need adequate policies and procedures in place, according to Neal Neuberger, Executive Director for the Institute for e-Health Policy and moderator for the event.
Farzad Mostashari, MD ScM HHS National Coordinator for Health Information Technology said, “This is a remarkable period in healthcare in terms of the number of doctors and hospitals that have already adopted EHRs. Adoption has even dramatically spread to small medical offices.”
Dr. Mostashari reports that nearly 2,000 hospitals have received incentive payments and hospitals have doubled their use of EHRs in the last two years. Also, more than 60,000 doctors have received incentive payments for ensuring meaningful use of health IT. The goal for CMS and ONC is to help over 100,000 healthcare providers qualify for incentive payments while over 85 percent of hospitals report that by 2015, they fully intend to take advantage of incentive payments.
As reported, HHS released a Notice of Proposed Rule-Making (NPRM) for Stage 2 of “Meaningful Use” with CMS and ONC to govern incentive payments. It is expected that Stage 2 will be implemented in 2014 under the proposed rule with Stage 3 to be implemented in 2016.
According to Dr. Mostashari, HHS has acted to enable the exchange of information in a standardized secure format. The first step was to put out a call to industry stakeholders, academia, and to the public to work on the process for developing standards and to reach consensus within 90 days. Eighty organizations came to work on the project which with over 1,000 volunteers signing up to work.
In addressing data essentials, Dan Rode, Vice President Advocacy and Policy, American Health Informatics Management Association (AHIMA), said, “The need for information and data is a means to help diagnose health and medical complaints, record information, collect and store information, provide data for outside care, and to send and receive laboratory and radiology results.
In addition, information needs to be made available for secondary uses that may include making claims, referrals, for public health purposes, understanding population health needs, to measure quality, analytics, to help make decisions, help researchers, produce registries to help the public, and very importantly, provide information for the patient and the consumer.
As Rode explained, “It is very important to have not only have transaction standards but also to establish vocabulary standards so that a common language is available across sites of services and geography.”
Both transaction standards and vocabulary standards are needed to provide for patient safety, deal with any record legalities, provide for accurate public health reporting, enable larger research analysis, provide for better application of uniform privacy rules and security applications, and also to transfer data to other systems.
There is still room for errors made when dealing with vast amounts of data even if standards are in place. To achieve data integrity, systems software still needs to be tested and audited, vocabularies need to expand and be uniformly modified, vocabularies need governance and acceptance, and the move to global classifications is needed to help all nations.
Rode discussed data integrity in terms of privacy. Without trust, the health record will never be complete and the integrity of the data can always be questioned. Trust will not be given if individuals feel that the data can be used against them. He feels that we must address any inappropriate discrimination through the access to medical information no matter where the information or data exists.
Neal Ganguly, Vice President/CIO CentraState Healthcare System Freehold New Jersey, reports that CentraState a 282 bed acute care medical center, has 2,400 employees, 500 plus board certified physicians, and serves a population of 360,000 in four counties in central New Jersey.
However, he pointed out that hospitals can make numerous and serious mistakes in producing and updating Master Patient Indexes when patients come into the system to be initially registered. As he explained, it can be very difficult to keep track when employees are very busy and overworked.
He cited an example of how difficult it is for a system in Harris County in Texas with 12 years of data on 3.4 million patients in a hospital database to keep up the Master Patient Index. The system shows 249,213 patients listed having the same first and last name, shows 69,807 pairs sharing both names and birth dates, 2,488 patients are named Maria Garcia, and 231people with the name of Maria Garcia were listed with the same birth date. Evidently, there is a problem coping with the massive amount of the data in their system.
To address some of the issues involved in dealing with the enormous amounts of data available and being used. CHIME and HIMSS formed a Coalition of Stakeholders last year with the intent of raising Congressional awareness. An important first step was to request that a study be done by the Government Accountability Office (GAO). The objective would be to examine the costs, benefits, and how to implement a consistent approach when trying to match patients with their data.
The objective for the project would be to study mismatches nation-wide including the costs for correcting these errors, patient safety risks of not utilizing a national patient identity solution, availability of current and near term technologies, and how to develop best practices for assuring patient-data matching while at the same time, enhancing patient information privacy and security. Efforts are underway to secure Congressional signatures on a bipartisan letter to GAO to officially launch this study.
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