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FCC highlights ONC Office for Consumer e-Health plans for 2014

One of the things I would like to get back in the habit of in the new year is to contribute more again to this blog, which I started in 2009 with help from John Lynn at Healthcarescene.com.  Part of the challenge of keeping an ongoing stream of thoughts here has been both my busy life as an active provider of subspecialty healthcare, the growth of my practice as a business, and most importantly the emergence of new ideas for consideration and writing.

Luckily, I have been able to find some novel sources recently, and so I am going to try to reach out to these resources more often to gain insight and ideas for new and interesting topics on which to blog.

One of these sources recently highlighted an interview with Lygeia Ricciardi, the ONC Director of Consumer eHealth.  The ONC is under the purview of the Department of Health and Human Services.  Ms. Ricciardi recently attended the FCC’s mHealth Innovation Expo in Washington, DC, on 12/6/13.  She highlighted work on policies for mobile health apps and cited a goal of helping to reach everyday people and empower them to improve their ability to participate in their own healthcare.

M-health apps are currently under voluntary control in whether or not their developers follow ONC guideines for design. Such apps may help patients, who are now often referred to as “consumers”, in such tasks as shopping for good-quality healthy food and reading nutrition labels.  In 2014, the ONC Office of Consumer e-Health plans to launch a website for helping patients find where to gain access to their own health data online.  Such information can include medication lists, laboratory reports, and other records.  Ms. Ricciardi likens this initiative to the “Blue Button” project that targets making medical data available to veterans at VA hospitals.

Access remains a key concern since once patient data is downloaded through a third-party app, such data will then by definition not be protected under HIPAA.  A third-party app developer will automatically gain access to this data during the process.

Ms. Ricciardi also cited possible other uses for mHealth apps, including helping people make participating in the healthcare both fun and interactive.  Examples were provided of apps that can help patients play games to compete against each other to see who can follow healthy habits better, e.g. who can exercise more, check blood pressure more, lose more weight, and check their blood sugars more often (for diabetic patients).  She further stated that consumers are being brought into the ONC process for m-health app policy development on a regular basis to ensure that there is some public guidance for what is and is not desired.  She cited the new paradigm, often quoted by now, that a cultural shift is changing towards more shared decision making in healthcare and giving more power to patients to participate actively in their healthcare rather than being passive bodies directed by healthcare professionals.

She encouraged individual patients/consumers to get more actively involved in their own healthcare.  According to Ms. Ricciardi, although the current medical environment is still mostly of two separate worlds, with little sharing of medical information between medical practitioners and patients, the coming world of m-health apps promises much potential for changing this.

December 29, 2013 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

EMRs’ big gaping hole of secure messaging

Today’s post begins a series inspired by my recent participation in a breakfast panel in Washington, DC, Doctors and Patients Bridging the Digital Divide. There were a lot of useful ideas discussed during this panel, and so I decided to capture and share some with you.

One of the biggest holes in electronic medical records currently seems to be a lack of secure messaging systems built into the software.  Although maybe not universally true, this still represents a huge problem that also represents a great opportunity for gains in technology that will enhance the doctor-patient relationship and move digital healthcare forward into the future.

Currently, my electronic medical record vendor does not supply this feature as part of its software package.  However, as part of the Meaningful Use Stage 2 requirements by the federal government, the use of a certified EMR system that supports this function will be required.  A HIPAA-compliant secure messaging system will be needed as a part of every electronic medical record going forward.

Currently, if I wanted to use secure messaging to communicate with my patients, I would have to purchase a separate third-party vendor’s online software to communicate in a HIPAA-compliant fashion.  This involves an additional service agreement between the third-party and me, as well as monthly fees they can be expensive.  This would grant me the right to not only communicate with patients but also to bill third-party insurance companies for providing such electronic health services.  However, what may people do not appreciate is the small reimbursement allowance for such services, which is quite minimal.  Thus, regardless of the demand by patients, it’s currently more financially lucrative simply to see another patient in the office for a follow-up visit rather than answer a message electronically.  If an electronic medical record vendor builds secure patient messaging into their platform, when there is already a contractual arrangement between the doctor and EMR vendor, then a third-party cost would potentially become unnecessary.  The prospect of using a built-in, HIPAA-compliant, secure messaging system suddenly becomes much more attractive and potentially fiscally responsible.

Unfortunately, many EMR systems are in still developing stages at which they do not yet have built-in secure messaging features in their PHR or personal health record modules.

But what a wonderful and potentially powerful area for future development in order to further promote patients to become more engaged in playing a more active role in their own health care.  The ability of a patient to reach their doctor through the Internet is certainly an attractive feature if done right and seems potentially better than a patient spending five minutes on hold listening to elevator music only to finally speak to a front desk staff member who will only be able to forward a message, which may or may not be forwarded accurately.

September 12, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

Data breaches and EMRs: bad guys or just dumb mistakes?

I love this post by George V. Hulme at CSO Online because it really highlights my high level of skepticism regarding all the need for worry about encrypting everything to death where electronic medical records are concerned.  Yeah, yeah, yeah.  I’ve heard it over and over, ad nauseam.  I don’t necessarily disagree that data security is important, but just please someone name me some examples of where a nefarious miscreant was purposely trying to steal protected health information (PHI) electronically with hacking.  I’m sure such documented incidents must be out there somewhere, but they don’t seem common since I’ve never heard of any actual cases.  Even the strange one reported (but not really well referenced) in the above post was, okay technically crime, but not electronic at all.  The criminal cited in the story was apparently trying to manually steal what sounds like a hardcopy paper file from the doctor’s home.  I’ve always told my colleagues and friends, “What the bleep would anyone want with some average patient’s health information?  And who’s gonna go to the level of sophisticated, tech-savvy theft to get it?”

It really seems like crazy paranoia to me to think that anyone cares about Mrs. Smith’s medication doses, whether she smokes or has a beer every now and then, or when she was last seen in the office.  Come on, people, that’s not going to make anyone rich — pretty much has no street value at all on the surface.  So I ask again for your assistance in throwing me a bone.  Help me understand where the rubber meets the road and we really need to go crazy with overly expensive and extreme technology to avoid electronic data theft.  Someone think up the next blockbuster summer movie script.  “The Net III”?  I’ll take crazy Sandra Bullock movies for $100, Alex.

Dr. West is an endocrinologist in private practice in Washington, DC.  He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

August 3, 2011 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.