Thursday, February 23, 2012
Now Here Is An Approach That Might Actually Make A Difference! Fascinating Stuff.
The following appeared a few days ago.
9 February 2012 Rebecca Todd
Emergency physicians at Scarborough Hospital say introducing a GP clinical record viewer has been like “turning on a light."
Lead A&E consultant Dr Andy Volans says staff can barely remember how they coped before TPP’s new CRV went live on 25 January.
The viewer allows hospital clinicians to access a read-only view of the patient’s full electronic record held by a TPP practice. It is currently being used in A&E but will be rolled out to other departments.
Dr Volans said the viewer was especially useful when dealing with the area’s large nursing home population.
In the past, elderly patients would often arrive in A&E with no GP letter, nobody from the nursing home to explain why they were there, and unable to communicate their own medical conditions and medications.
“Consequently you’re working a bit blind, so we’re particularly targeting those patients so we know what the GP knows about them,” he explained.
Staff must use their role-based smartcards to access the viewer.
Admission, Discharge and Transfer (ADT) messaging is used to communicate between the CRV and the hospital's patient administration system, which, at Scarborough, is iSoft's iPM.
When a patient is registered on the PAS, a message is sent to the CRV, so the hospital can retrieve the patient's SystmOne record, subject on their giving consent.
A template pulls down relevant information, including most recent acute illnesses, any chronic illnesses, acute drugs, blood pressure readings, and the last three attendances or clinical interactions with a GP.
This is an astonishingly good story and makes a it makes great deal of intuitive sense that such a system could really make a difference in a local area. The concept of an access only view makes a great deal of sense as does the smartcard access control.
Of course there are always caveats - and here they come from across the Atlantic from the example above.
February 13, 2012
In September the Office of the National Coordinator for Health Information Technology launched the Consumer e-Health Program to encourage individuals' engagement in their healthcare. One of the major goals of the program is to provide patients with easy access to their medical records. To accomplish this goal and others, ONC created the Healthy New Year Video Challenge and is developing an animated video to explain the value of health IT to consumers, among other initiatives.
Hospitals are also encouraging patients to take a more active role in their care by providing easy access to patients' lab reports and other medical information. Jan McDavid, general counsel and compliance officer, and Steve Emery, director of product management, at HealthPort share five considerations for hospitals when providing patients with electronic access to their medical records.
1. Compliance. Whenever dealing with patients' protected health information, hospitals need to ensure compliance with HIPAA and other applicable federal laws. HIPAA requires patients' records to be provided within 30 days of their request, barring certain exceptions. For instance, if a physician decides providing the full record is not in the best interest of the patient, the physician may withhold certain parts of the record.
Hospitals also need to be aware of laws of the state in which patients' medical records are located. Ms. McDavid says in general, that when federal and state laws differ, hospitals should follow whichever set of laws is stricter. She suggests hospitals' privacy and security officers constantly educate themselves on updates to the law and the specific facility's policies regarding patients' medical records. Policies may include requiring documents with confidential information to be shredded, prohibiting the sharing of passwords, and mandating training on HIPAA.
2. Security. Hospitals releasing medical records to patients need to consider both the physical and electronic security of the records. For example, Ms. McDavid says hospital officials should ensure restricted areas are enforced if a computer containing patient records is located there. In addition, computers with screens that can be seen by patients may need privacy screens. Hospitals may also need to develop policies on where to store patients' charts, which are typically placed outside the patients' doors and are easily accessible to unauthorized individuals.
Furthermore, computers and the hospital network need to be electronically secure to prevent viruses and people from accessing information. A best practice for securing medical records is encryption. While encryption is not required by law, it lessens the reporting requirements if breaches occur, Mr. Emery says. Another best practice for securely releasing medical records to patients is two-factor identification. For example, the hospital would send the patient an email with a link to a website that hosts medical records. The patient would then have to authenticate his or her identity with personal information and a password to access the records.
Learn more about HealthPort.
Again this is a fascinating discussion of the issues you face when opening access up to the EMR for the patient. In the UK you are at least giving access to another clinician who will typically ‘get’ what is said! It might be just that much harder with patient access!
As I have said before we really do live in some exciting and interesting times and I have to point out that this sort of innovation rather makes the PCEHR so 1990’s!
Posted by Dr David More MB PhD FACHI at Thursday, February 23, 2012