ONC’s Federal Health IT Strategic Plan: Comments Filed on Behalf of the Society for Participatory Medicine

David Harlow

First published 5/31/11 on HealthBlawg

Society for Participatory MedicineWe e-patients are an impatient lot, and therefore we may not be big fans of the Five-Year Plan approach to creating change.  The Office of the National Coordinator for Health IT released a draft federal health IT strategic plan in late March, via blog post (the plan itself is linked to from the post; a copy is posted here).

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Accountable Care Organization (ACO) Regulations: First Look

David Harlow

First published on 4/3/11 and 4/5/11 on Health Blawg

ACO regulations and related federal issuances hit the street last Thursday, after several months of waiting — from CMS, OIG, FTC, DOJ and IRS.  They cover the waterfront, ranging from the central regulation defining the structure and workings of the ACO, to  limited Stark self-referral ban and anti-kickback statute waivers in the fraud and abuse arena, to new frameworks for antitrust analysis, to rules governing joint ventures involving taxable and tax-exempt organizations.

I had the opportunity to discuss the regs the day after they were issued on a special edition of the Blog Talk Radio show, ACO Watch, hosted by Gregg Masters(@2healthguru).  Gregg’s guests included Mark Browne (@consultdoc), Vince Kuraitis(@VinceKuraitis), Jaan Sidorov (@DisMgtCareBlog) and yours truly (@healthblawg).  We are geographically diverse, and bring a variety of perspectives to the table.  I invite you have a listen — we enjoyed the opportunity to discuss the rules, we all learned from each other, and we hope you enjoy the conversation as well.  (It runs about 90 minutes.)

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Who Owns Patient Data? (The Walgreens Edition)

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant.  To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal regulations.  However, the relevant regulation (45 CFR 164.514(b)(2)(ii)) also provides that this only works if “the covered entity does not have actual knowledge that the information could be used alone or in combination with other information to identify an individual who is a subject of the information.” Thus, the problem with this approach is that, these days, nobody can disclaim knowledge of the fact that information de-identified by removing this cookbook list of 18 identifiers may be re-identified by cross-matching data with other publicly-available data sources. There are a number of reported instances of this sort of thing happening. The bottom line is that our collective technical prowess has outstripped the regulatory safe harbor.

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HealthNet and HIPAA Again…So, Does HIPAA Work?

David Harlow

First published 3/15/11 on HealthBlawg

HealthNet either lost, or had stolen from it, computer hard drives with PHI of 1.9 million subscribers that had been in a California facility.  This latest HealthNet data security breach, which may have included names, Social Security numbers, addresses, health information and financial information comes a little over a year after a widely-reported data security breach by HealthNet in Connecticut which resulted in the first state Attorney General action under the HIPAA amendments contained in the HITECH Act.  HealthNet is notifying affected individuals and is offering two years of no-cost credit monitoring and fraud resolution services, and credit restoration and identify theft insurance as needed.

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Medicaid: Busting the Budget Buster with Real Innovation or Re-Arranging the Deck Chairs on the Titanic?

David Harlow

First published 3/3/11 on HealthBlawg

Medicaid has been front and center this week as President Obama addressed the National Governors Association, and several governors testified before the House Energy and Commerce Committee.  Obama told the governors that he supports the Wyden-Brown bill, which would accelerate the availability of waivers under the Affordable Care Act (from 2017 to 2014), so that states would not have to first create health insurance exchanges under the law, and then only later have the right to dismantle them and replace them with other mechanisms to achieve coverage goals of the law without additional cost to the federales.  (See Wyden-Brown fact sheet)  The law as it stands hurts the early adopters.  Without the change, the sponsors’ home states, Oregon and Massachusetts would have to dismantle parts of their own health reform efforts in order to align with the federal mandates, only to potentially change things up agian three years down the road.  (Wyden has been a longer-term proponent of experimentation and innovation in health reform than Brown, and the opportunity to innovate three years down the road is in the ACA because of him.)

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Putting Patients Into Meaningful Use: Regulators and Providers are Catching Up with e-Patients

David Harlow

First published 3/1/11 on HealthBlawg

The Health Research Institute at PricewaterhouseCoopers released a report last week entitled Putting patients into “meaningful use.” It begins with the anecdote I’ve blogged about previously regarding a diagnosis by Facebook in lieu of a PHR, which some have highlighted as a great success for social media in health care. I am much less sanguine on that front. The PwC report, of course, has much more than that story in it; here are the key takeaways, backed up with some survey data and interviews:

  1. Engaging external constituents may postpone achievement of “meaningful use.”
  2. Patient awareness of and access to available health IT tools is low; social, expectation, and education hurdles also exist.
  3. Patient engagement in “meaningful use” is still low, despite consumer interest.
  4. “Meaningful use” has yet to explicitly call for measuring the level of patient engagement.
  5. Health systems will need to compete for consumers in the PHR market.

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Measuring Patients’ Experience of Care

DAVID HARLOW

First published 2/9/11 on Health Blawg,

There is a growing recognition within the medical-industrial complex that the patient is a key element of the enterprise, and that patient satisfaction, patient experience, patient engagement, patient activation, patient-centeredness are very important.  Some research shows that patient activation yields better patient outcomes, and that patient activation can be measured.

Patient-centeredness and patient engagement are two of the key metrics to be used by the feds in describing Accountable Care Organizations (ACOs), if the internecine battles within government are resolved soon enough to actually release draft ACO regulations in time to allow for sufficient advance planning for the January 2012 go-live date.  (Wearing one of my many hats, I’ve had the opportunity to submit a response to CMS regarding the RFI on these metrics on behalf of the Society for Participatory Medicine.)  These measures go into the Meaningful Use hopper as well, as Meaningful Use Stage 2 metrics are being reviewed.

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Accountable Care Organizations: The Emperor Has No Clothes, Or, Jeff Goldsmith’s Plan B

DAVID HARLOW

Originally published 1/06/11 on HealthBlawg

The current all-ACO issue of Health Affairs includes a piece by Jeff Goldsmith entitled: Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers.  It is a proposal for how private sector health plans ought to pay for services, in order to save us all from what Goldsmith sees happening in the near future thanks to the Gold Rush mentality among health care provider organizations working to become ACOs before they’ve been defined in regulation.

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