Wednesday, June 17, 2009

Electronic Health Records (EHR) – Interoperability of Disparate Systems – Political

The top box in the figure below (adapted from the first figure in my June 16 post) contains the label "Political," and the video in my May 13th post (repeated below) shows excerpts from a recently held hearing in the United States Senate Committee On Finance, chaired by Senator Max Baucus. The latter motivated the former. But, I've had additional reasons to think about the influence of national politics upon the architecture of the upcoming IT-based EHR system.

Montana Senator Baucus is the Senate’s point man on healthcare reform. A new article in the Montana Standard finds that Senator Baucus has received more campaign money from health and insurance industry interests than any other member of Congress. The article says, “In the past six years, nearly one-fourth of every dime raised by Baucus and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.”

Moreover, it’s hard for even the most casual follower of the daily news to avoid finding his or her own reason to believe that national politics will play a major role in the rollout of our EHR system.

The vast majority of the funds within the HITECH Act (the health IT component of the American Recovery & Reinvestment Act) are assigned to payments that will reward physicians and hospitals for effectively using a robust, connected EHR system. Few should doubt that how these billions of dollars are distributed will have a profound impact on the shaping of our national EHR system.

In addition to funding EHRs (also called electronic medical records, or EMRs), HITECH adds some privacy-enforcement teeth to HIPAA, which has long been criticized for loopholes’ allowing the release of medical record information to health care vendors for marketing purposes. Pharmaceutical companies, for instance, have frequently used prescription information from these records to target their mailings for new or alternative drugs and treatments. HITECH now mandates that individual patients’ consent be obtained before releasing any information to vendors -- or to anyone not in the immediate health care loop that includes physicians and hospitals as well as insuring and billing entities (for a scary look at how easily this loop can expand, read “Health Privacy—The Way We Live Now”). The new provisions also require voluntary and affirmative disclosure of any breaches or violations of private records. However, as the final stimulus package wended its way through Congress, so many loopholes (five pages’ worth) were added that just about any group with political connections, or with loose medical affiliations, could gain access to everyone’s personal EHR just by asking for it or by paying for it.

While there are workgroups and committees of experts working diligently to shape an EHR that helps bring about a better healthcare system for the nation, the members of these groups don’t control the purse strings. Politicians do. Stay tuned.