Death by a Thousand Clicks: Where Electronic Health Records Went Wrong

Erika Fry and Fred Schulte
Fortune.com
Originally posted on March 18, 2019

Here is an excerpt:

Damning evidence came from a whistleblower claim filed in 2011 against the company. Brendan Delaney, a British cop turned EHR expert, was hired in 2010 by New York City to work on the eCW implementation at Rikers Island, a jail complex that then had more than 100,000 inmates. But soon after he was hired, Delaney noticed scores of troubling problems with the system, which became the basis for his lawsuit. The patient medication lists weren’t reliable; prescribed drugs would not show up, while discontinued drugs would appear as current, according to the complaint. The EHR would sometimes display one patient’s medication profile accompanied by the physician’s note for a different patient, making it easy to misdiagnose or prescribe a drug to the wrong individual. Prescriptions, some 30,000 of them in 2010, lacked proper start and stop dates, introducing the opportunity for under- or overmedication. The eCW system did not reliably track lab results, concluded Delaney, who tallied 1,884 tests for which they had never gotten outcomes.

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Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country—essential when life-and-death decisions are being made in the ER.

But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records—with the federal government, so far, sinking $36 billion into the effort—America has little to show for its investment.

The info is here.

Healthcare Data Breaches Up 40% Since 2015

Alexandria Wilson Pecci
MedPage Today
Originally posted February 26, 2017

Here is an excerpt:

Broken down by industry, hacking was the most common data breach source for the healthcare sector, according to data provided to HealthLeaders Media by the Identity Theft Resource Center. Physical theft was the biggest breach category for healthcare in 2015 and 2014.

Insider theft and employee error/negligence tied for the second most common data breach sources in 2016 in the health industry. In addition, insider theft was a bigger problem in the healthcare sector than in other industries, and has been for the past five years.

Insider theft is alleged to have been at play in the Jackson Health System incident. Former employee Evelina Sophia Reid was charged in a fourteen-count indictment with conspiracy to commit access device fraud, possessing fifteen or more unauthorized access devices, aggravated identity theft, and computer fraud, the Department of Justice said. Prosecutors say that her co-conspirators used the stolen information to file fraudulent tax returns in the patients' names.

The article is here.

US Health Information Breaches Up 137%

By Roger Collier
CMAJ News
Originally posted March 5, 2014

More than seven million health records in the United States were affected by data breaches in 2013, an increase of 137% over the previous year, according to the annual breach report by Redspin, an information security company based in Carpinteria, California.

Since 2009, there has been a rapid rise in the adoption of electronic health records in the US. There have also been 804 breaches of health information affecting nearly 30 million patient health records reported to the Secretary of Health and Human Services, as required by law.

The entire article is here.

Are Forensic Evaluations “Health Care” and Are They Regulated by HIPAA?

By Bruce Borkosky,  Jon M. Pellett, and Mark S. Thomas
Psychological Injury and Law
June 2013

Abstract

Forensic mental health providers (FMHPs) typically do not release records to the examinee. The Health Insurance Portability and Accountability Act (HIPAA) federal regulations might change this position, given that they have created a basic right of access to health care records. This legislation has led to a disagreement regarding whether HIPAA regulates forensic evaluations. The primary argument (and the majority of scholarly citations) has been that such evaluations do not constitute “health care.” Specifically, in this position, the nature and purpose of forensic evaluations are not considered related to treatment (amelioration of psychopathology) of the patient. In addition, it asserts that HIPAA applies solely to treatment services; thus, forensic evaluations are inapplicable to HIPAA. We describe the evidence for and against this argument, the strengths and limitations of the evidence, and recent court decisions related to it. The weakest part of the “HIPAA does not regulate forensics” argument is that HIPAA has no exclusion criteria based on type of services. It only creates an inclusion criteria for providers; once “covered,” all services provided by that provider are thence forward “covered.” Authoritative evidence for patient access can be found in the HIPAA regulations themselves, the US Department of Health and Human Services’ commentaries, additional statements and disciplinary cases, the research literature, other agency opinion, and legal opinion. It appears that the evidence strongly suggests that, for those forensic mental health practitioners who are covered entities, HIPAA does apply to forensic evaluations. The implication is that FMHPs potentially face various federal, state, and civil sanctions for refusing to permit patient access to records.

The article is here.

In Second Look, Few Savings From Digital Health Records

By REED ABELSON and JULIE CRESWELL
The New York Times
Published: January 10, 2013

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The entire story is here.

New designs to make health records easier for patients to use

HHS.gov
U.S. Department of Health & Human Services
NEWS RELEASE
FOR IMMEDIATE RELEASE
January 15, 2013

Winning designs of printed health records to help patients better understand and use their electronic health records (EHRs) were announced today by Farzad Mostashari, M.D., the national coordinator for health information technology. The designs, created through a HHS Office of the National Coordinator for Health Information Technology (ONC) challenge contest, all met the goal of making EHRs valuable to patients and their family members.

“Patients that are engaged in their health care treatments have better outcomes in their health,” said Farzad Mostashari, M.D., national coordinator for Health Information Technology.  “The design challenge winners all proposed patient-friendly designs that will help to translate technical health information into easy-to-understand information that will help patients work closely with their doctors to manage their care.”
More than 230 submissions to the design challenge were submitted. Winners of the Health Design Challenge include:

• Best Overall Design – “Nightingale” - Amy Guterman, Stephen Menton, Defne Civelekoglu, Kunal Bhat, Amy Seng, and Justin Rheinfrank from gravitytank in Chicago, Ill.
• Best Medication Section – “M.ed” - Josh Hemsley from Orange County, Calif., presented a modern and intuitive design to help patients better understand how to properly adhere to their medication
• Best Medical/Problem History – “Grouping by Time” – Mathew Sanders from Brooklyn, N.Y., aimed to provide more context by listing items in chronological order instead of grouping by functional type so cause and effect can be seen
• Best Lab Summaries – “Health Summary” – Mike Parker, Dan McGorry, and Kel Smith from HealthEd in Clark, N.J., brought life to lab summaries through an aggregate health score and rich graphs of lab values
• The Best Overall Design winner will receive $16,000, while the winners in the remaining categories will each receive $5,000.

The Health Design Challenge supports ONC’s efforts to engage consumers in their health through the use of technology, including the Blue Button, and is part of ONC’s Investing in Innovation (i2) Initiative. The i2 Initiative holds competitions to accelerate development and adoption of technology solutions that enhance quality and outcomes.

"This challenge was unique because it engaged professionals and students inside and outside of the health care industry to participate and propose real solutions," said Ryan Panchadsaram, presidential innovation fellow for ONC." We’ve assembled a showcase of top entries that challenged the status quo and inspired the health community."

More information about the winning submissions and other top entries can be viewed in the online gallery at http://healthdesignchallenge.com . For more information about health information technology, visit:  www.healthit.gov.

The release was posted here.

Medicare Is Faulted on Shift to Electronic Records

By REED ABELSON
The New York Times
Originally Published: November 29, 2012

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

The entire article is here.

The Ups and Downs of Electronic Medical Records

By MILT FREUDENHEIM
The New York Times
Originally published October 8, 2012

The case for electronic medical records is compelling: They can make health care more efficient and less expensive, and improve the quality of care by making patients’ medical history easily accessible to all who treat them.

Small wonder that the idea has been promoted by the Obama administration, with strong bipartisan and industry support. The government has given $6.5 billion in incentives, and hospitals and doctors have spent billions more.

But as health care providers adopt electronic records, the challenges have proved daunting, with a potential for mix-ups and confusion that can be frustrating, costly and even dangerous.

Some doctors complain that the electronic systems are clunky and time-consuming, designed more for bureaucrats than physicians. Last month, for example, the public health system in Contra Costa County in California slowed to a crawl under a new information-technology system.

The entire story is here.

Secrets And Electronic Health Records: A Privacy Concern

By David Schultz
The KNH Blog
Originally published on June 11, 2012

Does your orthodontist or opthamologist need to know what you tell your psychotherapist in order to provide you with quality care? In the age of electronic medical records, a whole range of health care providers may have access to this information whether you want them to or not.

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Here’s what many say is the problem: If a mental health specialist types up his or her notes from a therapy session and puts them into a patient’s electronic medical record, that file can be shared with any doctor the patient sees within their health system. And, because of a loophole in the Health Insurance Portability and Accountability Act, or HIPAA, there’s nothing a patient can do to stop this from happening.

Many mental health professionals, who consider their patients’ privacy and confidentiality to be sacrosanct, find this appalling. But often times, the decision of how they file their patients’ records is not up to them.

The entire blog post is here.

mHealth: Remote Patient Monitoring Is On The Rise, With Smartphones Leading The Way

By Rip Empson

Tech Crunch

Originally published February 8, 2012

Last month, we took a look at someof the ways mobile technology is transforming the health industry. While there are many factors affecting this transformation, like artificial intelligence, big data, 3-D printing, social health networks, and remote communications, to name a few (check out Josh’s post on this here), unsurprisingly, change is coming at the hands of the growing ubiquity of cell phones, smartphones, and mobile devices.

Early last year, PEW Researchwas already reporting that 17 percent of mobile phone users were using their devices to look up health and medical information, and Juniperrecently estimated that 44 million health apps were downloaded in 2011.

In turn, the amount and availability of health data is exploding in tandem with the growing adoption of health and medical apps and devices, thanks to the increasingly wearable and user-friendly devices that use smart sensors to capture and transmit a variety biometric data. Electronic medical records (EMRs) are being made available on mobile devices — even KaiserPermanente is getting in on the digital revolution.

The mHealth industry is growing fast. According to Research2guidance‘s calculations, the size of the mHealth app market will nearly double in 2012 to $1.3 billion, up from $718 million in 2011. (I discussed the volatility of these statistics, the still-changing definitions of mHealth and mHealth technology, and conflictingreporting on these numbers here.)

While these numbers can sometimes be misleading, the mHealth sector is not only going to continue to expand, its profitability is going to skyrocket. This is because, in juxtaposition with the $7 trillion global healthcare market, the mHealth market remains incipient. Healthcare companies, startups, and beyond are just beginning to tap into the potential of mobile technology, both in terms of quantified self devices, which bring healthcare in the clinic home, the mobility of data and communication channels. Companies are beginning to spend more and more on research and development, the big kahunas of the medical world are starting to release real, functional mobile apps, and consumer-facing medical devices are just starting to see real market penetration.

The entire information is here.