Patient's Rights and the Required Standardization (Health Insurance and Portability and Accountability Act (HIPAA) of all Medical Forms- Part II of a II Part Series
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Standardization (Health Insurance and Portability and Accountability Act
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((3/11/20)- The Department of Health and Human Services (HHS) announced new rules that will allow the consumers to use apps of their choice to retrieve their health records from their providers.
HHS officials said the new system was intended to make it easier for people to manage their healthcare on their smartphones.
Americans have had the right to obtain a copy of their personal health records for over 20 years, but they often face obstacles in getting the data from their health provider.
The new rules will require doctors and medical center to send a core set of medical data directly to third party apps, such as Apple Health Records, after the patient authorizes the transmission of the information. The data will contain clinical notes about a patient’s surgery, hospital stays, imaging tests and pathological results.
Health providers and health record vendors will have two years to comply with the A. P.I (application programming interface) requirements or face up to a $1 million fine for each violation. Doctors accused of blocking could be subject to federal investigation.
(4/26/18)-Seema Verma, the head of the Centers for Medicare and Medicaid Services (CMS), which is part of the U. S. Department of Health and Human Services (HHS) announced that all hospitals that the agency makes payments to will be required to post their prices online.
Hospitals are required to disclose their prices publically, but this latest pronouncement requires them to put the prices online in machine-readable form, that can be easily processed by computers. Starting in 2021, Medicare will base part of a hospitals payments on how well it performs.
(3/19/16)- New York State has a mandatory requirement for all prescriptions to be sent to pharmacies electronically by March 27. It is the first state to so do, but its hospitals and doctors are having a hard time in complying with the law, so several are asking for waivers. There are penalties that are tied into the deadline.
Montefiore Health System, Northwell Health System, NYU Langone Medical Center and Mount Sinai Health System are among the institutions requesting waivers and extensions of time.
The law, known as the 1 STOP Act or Internet System for Tracking Over Prescribing requires that doctors electronically send prescriptions to the pharmacy as requested by the patient. Assemblyman Michael Cusick, (Dem.-S.I.) sponsored the legislation because of what he said was the “opioid epidemic” inflicting Staten Island.
A spokesman for the Northwell Health System stated that the 21-hospital group, formerly known as the North Shore-LIJ Health System would have initial capital costs of $9 million to install the system, including $900,000 for technical support.
Among those that will be ready for the March 27 deadline are New York-Presbyterian, Memorial Sloan Kettering Cancer Center and NYC Health and Hospitals Corp.
(5/30/15)- Dr. Karen B. DeSalvo, the national coordinator for health information technology asserted that tech companies, hospitals and laboratories are intentionally blocking the electronic exchange of health-information because they fear that the sharing of the information will be detrimental to their own businesses.
The federal government has poured more than $29 billion in an attempt to computerize the health-care system and its record keeping, but many of the systems in operation can’t operate on another company’s system.
Many doctors and hospitals have begun using electronic medical record keeping, but providers with different systems oftentimes are unable to share data in electronic form. Providers are also charging high fees to be able to tap into other different operating systems.
Congress recently enacted a law that requires doctors and hospitals to share information if they receive federal bonus payments for using electronic health information. A House committee approved a bill that defines “information blocking” as a federal offense.
(4/13/15)- A report from the Office of the National Coordinator for Health Information Technology slammed the vendors of electronic health records for overcharging for its fees to set up connections and share patient information; requiring customers to use proprietary platforms; and making it extremely expensive to switch systems.
The report also blasted some hospitals whose system made it difficult to transfer patient records to rival systems, labs or physicians.
Congress requested the report last December as a result of the numerous complaints that some technology companies were overcharging for their products, and of the inability of different systems to communicate the needed information about patient’s health records to one another.
President Obama has called for $28 billion in incentives to date to modernize the electronic health-record (EHR) system, with almost 80^ of doctors and 60% of the hospitals having converted to electronic systems for health record information.
It is estimated that only 20% to 30% of providers are able to share records with outside providers, according to the latest government surveys.
(12/20/14)- There will be more than 257,000 U.S. doctors who will see their Medicare payments cut by 1% next year for failing to meet the federal goals set for using electronic medical records (EMR0, said the Centers for Medicare and Medicaid Services.
The requirements were part of the 2009 stimulus package aimed at getting the medical profession and hospitals to emphasize computerized records instead of paper ones. The law offered incentive payments if providers could show “meaningful use of EMRs. About 400,000medical professionals have received bonuses since 2011 for meeting their goals.
Under the law, those incentives are gradually being replaced by penalties for physicians who are not participating. Those facing fines in 2015 missed a key deadline in 2013.
The cuts will be assessed on every Medicare bill during the year, even if the doctor and hospital have since complied.
Medicare payments to physicians also are set to decline by 2% across the board every year under the deficit-reduction rules. Combined cuts and fines could cost doctors a total of 11% of their Medicare billings by 2017, according to the American Medical Association.
(11/7/14)- Electronic medical records (EMR) are now being used to help flag travelers from West Africa who may be potential Ebola victims. Up until recently there were no applications that included the travel itinerary of patients showing Ebola symptoms in the electronic medical records of a patient.
EMR vendors now include screening questions and alerts to their systems so that the mistakes that were made at Texas Health Presbyterian Dallas Hospital in connection with its treatment of Thomas Eric Duncan do not occur again. Mr. Duncan died at the hospital on October 8. Once the system detects the possibility of the patient’s having Ebola symptoms, an alert pop-up appears that instructs the user how to proceed with the isolation and treatment of the patient.
(4/4/14)- A spokesman for the Centers for Medicare and Medicaid Services (CMS) said they would release Medicare and Medicaid reimbursement information made to medical professionals on April 9, or shortly thereafter showing billing data for the almost 800,000 health-care providers in the programs.
The data will include how many times the providers carried out a particular service, whether it was done in a medical facility or in an office setting, the average amount charged for the service, the average amount they were actually paid for the service, and the total number of people they treated.
The data would show the names and addresses of the providers, but would not include data on each particular claim submitted. As noted in our item dated 12/10/11 below, Dow Jones & Co., the parent of the Wall Street Journal, brought suit in Florida to require federal officials to release this information. A federal judge in Florida lifted the ban on the publication of this material under a 1979 federal law forbidding its release to the media.
Jonathon Blum, principal deputy administrator at CMS stated; “The Department concluded that the data to be released would assist the public’s understanding of Medicare fraud, waste, and abuse, as well as shed light on payments to physicians for services furnished to Medicare beneficiaries,”.
(2/11/14)- A federal rule that was first proposed in 2011 by the Department of Health and Human Services has now been put into effect, according to an announcement from HHS Secretary Kathleen Sebelius.
Under the terms of the rule, clinical labs must give patients access to their own lab test results upon request, without going through the physician who ordered the test. “Information like lab results can empower patients to track their health progress, make decisions with their health-care professionals and adhere to important treatment plans,” according to a statement from Ms. Sebelius.
The final rule amends two existing federal laws, the Health Insurance Portability and Accounting Act (HIPAA), and the Clinical Laboratory Improvement Amendments, or CLIA, which regulates most of the clinical testing labs in the U.S.
The new rule gives the labs 30 days to report the results to the patient who requests it. The requesting physician for the test would get the results, as soon as the lab has it available. Seven states and the District of Columbia already require labs to give patients the results directly. Thirteen states expressly prohibit it; seven allow it only with the health-care provider’s permission; and 23 states have no policy on it, according to the HHS.
The new rule supersedes all state laws, although this may be tested by a lawsuit. HHS estimates that affected labs will receive between 175,646 and 3.5 million patient requests a year.
(1/9/14)- In a report issued from the Office of the Inspector General for the Health and Human Services Department, data showed that there were not enough safeguards put in place to prevent electronic health records (E.H.R.) from being used to inflate costs and overbilling by doctors and medical facilities.
This was the second report in 2 months that warned about flaws in the oversight management of medical records. In spite of spending “considerable resources to promote widespread adoption of E.H.R’s”, the government has failed to modernize the way it looks for and finds fraud and abuse of the system.
The report was especially critical of the technique of “cut-and-paste”, which allows information to be copied from one document to another to claim more expensive treatment procedures. The report faulted Medicare for failing to provide guidance to its contractors who handle the payments for medical claims. The office plans to closely scrutinize this cut-and-paste procedure.
The percentage of hospitals that have adopted a basic electronic system has almost tripled since 2009 to 44% of all institutions.
(5/27/13)- Starting in 2015 the federal government will penalize health providers who have not begun using electronic health records through lower reimbursements for treating patients. According to the latest figures from the Department of Health and Human Services, more than 55% of the office-based providers eligible for federal incentives for using electronic record keeping received bonus payments.
These same figures indicate that 3,880 hospitals have also made the change and are receiving bonus payments.
Doctors have been paid about $5.9 billion to date for participating in the incentive program that was established in 2009 under the economic-stimulus law. About $8.7 billion has gone to hospitals that are participating in the program. Under the law, about $18 billion was set aside for the bonus inducement program.
In order to be eligible to receive the bonus, providers must have set up electronic systems that contain patient records, with details such as blood pressure, weight and height and medications prescribed for the patient. They must also write prescriptions electronically.
(5/3/13)- New rules that went into effect in March, revised some of the provisions of the Health Insurance and Portability and Accountability Act (HIPAA) of 1996, but gives providers until September 23rd to comply with or face penalties for failing to do so.
One of the key new provisions is especially causing consternation and confusion. It requires doctors and hospitals not to disclose medical information if the patient requests it, and pays for the services out-of-pocket.
The information can be noted in the patient's medical file, but that data can not be revealed if the patient paid for the treatment or test.
(1/15/13)- In a reassessment study of the expected savings from digital care record keeping, the influential think tank RAND Corporation rejected the expected savings from its earlier report in 2005, because the savings just have not occurred.
In addition, electronic record keeping has not improved efficiency nor patient care. "We've not achieved the productivity and quality benefits that are unquestionably there for the taking", said Doctor Arthur L. Kellerman,one of the authors of the reassessment by RAND, that was published in this month's edition of Health Affairs.
President Obama had allocated $18 billion towards the goal of electronization of health records. Health care spending has risen by $800 billion since that original report in 2005.
(1/8/13)- According to NCHS Data Brief No. 111, Dec. 2012, "In 2012,
72% of the office-based physicians used electronic medical record or electronic
health record (EMR/EHR)systems, up from 48% in 2009.
EMR/EHR use ranged from 54% in New Jersey to 89% in Massachusetts."
(12/4/12)-Medicare has paid doctors and hospitals billions of dollars to switch from paper to electronic health records without verifying that the new systems meets required quality standards, according to a federal audit released Thursday, November 29th, 2012.
(5/15/12)- Fifty-eight percent of office-based health care providers prescribed drugs electronically last year, up from three years ago when 10% did so, and more than a third of all prescriptions in 2011 were written electronically, according to a Surescripts study.
(12/28/11)- Along with the astronomical rise in the digitization of medical records, the risk of breaching the privacy of those records is rising rapidly also. According to the latest data from the Centers for Disease Control and Prevention about 57% of office-based physicians now use electronic health records. This represents a 12% increase from last year.
Under the budget stimulus law, about $18 billion was to be used to increase the usage of digitized records by medical professionals and their facilities.
The number of reported breaches is up 32% this year from last year, according to the Ponemon Institute, a security research group. Health organizations are required by federal law to report data breaches that affect more than 500 people to the Department of Health and Human Services. The breaches are reported on the department's Office of Civil Rights site, which presently has listed 380 breaches affecting more than 18 million people
(12/10/11)- Dow Jones & Co., had filed a lawsuit earlier this year that sought to overturn a 1979 federal court injunction barring the release of Medicare physician information. In a surprising development, the Department of Health and Human Services announced a policy change that would make the Medicare database available to about 25 nationwide organizations so that they can issue and publish report cards on certain procedures, hospitals or doctors.
The subjects of these report cards will have to be notified 60 days in advance of publication of the data. Patient information will remain confidential. The organizations that will be allowed to view the database will be community groups comprising doctors, health insurers, and businesses, consumers and governmental agencies that work to improve health care at the local level.
Marilyn Tavenner, the acting administrator of Medicare stated: it will "ensure consumers have the access they deserve to information that will help them receive the highest quality care at the best value for their dollar."
(5/31/11)- The Government Accountability Office (GAO)issued a report in February of this year in which it stated that despite spending billions of dollars on upgrading their data systems, the Defense Department and the Department of Veterans Affairs, the systems did not coordinate with each other.
After a meeting held between Robert M. Gates, the defense secretary, and Eric K. Shinseki, the secretary of veterans affairs it was announced that a compatible system would be developed between the two departments, so that the health record of all veterans would be available from the time of their enlistment through death.
There are presently 15 million active-duty troops, retirees, veterans and their families. The undertaking will take several years to complete, but a joint system is already under development in Chicago, where the Department of Defense and Veterans Affairs share a medical center, the Capt. James. A. Lovell Federal Health Care Center.
(5/5/11)- Does it violate the First Amendment if a state passes a law that restricts drug data mining companies from evaluating prescription drug records in order to be better able to market drug information to doctors? Vermont passed such a law, and the legality of the act is being decided by the U.S. Supreme Court in the case of Sorrell v. IMS Health, No.10-779.
Vermont's attorney general William H. Sorrell, petitioned the court to review the case afteran appeals court ruled in favor of three leading data collection companies including IMS Health, a health information company, and the Pharmaceutical Research and Manufacturers of America (PhRMA), the drug industry's leading trade group, and against the legality of the Vermont law.
The law was upheld at the trial level but was struck down by a divided panel of the federal appeals court in New York. New Hampshire and Maine have similar laws to the one in Vermont, and the federal appeals court in Boston has upheld those laws.
The data has become available because pharmacies are required by law to collect and maintain detailed data about each prescription filed. The pharmacy can sell the records containing the doctor's name and address, along with the amount of the drug prescribed, to data brokers. Patients names have to be deleted along with certain other personal details covered by Health Insurance Portability and Accountability Act (HIPAA).
The state law gives the doctors the right to consent before their prescribing information may be sold and used for marketing, in which case his name must be deleted from the information.
The Vermont law allows the information to be used in research and by law enforcement agencies. Drug makers can buy these records also so that they can identify doctors whose patients might be good candidates for clinical trials or to communicate drug safety updates.
The state law forbids the sale of prescription drug data to market drugs and bars drug companies form using the data to market drugs, unless the prescribing doctor consents.
Drug marketers spent about $6.3 billion on marketing visits to doctors in 2009, the last year that such figures were available, according to IMS Health.
(12/19/10)- The Institute of Medicine has created the Committee on Patient Safety and Health Information Technology to run a yearlong study and issue recommendations in evaluating how well the health information technology system is working..
The FDA reported back in February that it had received 260 reports of malfunctions related to health information technology "with the potential for patient harm", including 44 reported injuries and 6 reported deaths in 2008 and 2009. These malfunctions were reported voluntarily to the FDA, mainly by hospitals.
Dr. Jeffrey Shuren, a senior FDA policy and enforcement official noted that these reported malfunctions were done on a voluntary basis, so that it may only be the tip of the iceberg that we are seeing in this area.
In the 2 years that have followed since almost $19 billion was included in the stimulus package to promote electronic health record keeping, less than one fourth of the nation's doctors have converted to an electronic record system. On the other hand, hospitals, aided by the subsidies they have received to change their medical record keeping over to the electronic system have had a much higher conversion record than have the individual doctors, who are also being subsidized to modernize their record keeping systems.
"All options for assuring safety are on the table" according to Dr. David Blumenthal, the Obama administration's national coordinator for health information technology. His office granted the Institute of Medicine $989,000 for the patient safety panel, which is being led by Gail L. Warden, the former president and chief executive of the Henry Ford Health System in Detroit.
The 16-member panel held its first meeting in Washington last week.
(7/19/10)- "Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records, " said Kathleen Sebelius, secretary of health and human services.
Under the program we refer to in our item dated 6/17/10 below, health-care providers can receive up to $44,000j through Medicare and $63,750 through Medicaid to cover the cost of converting their records to electronic files for their patients. Starting in 2015 medical providers who do not convert to electronic files face penalties for non-compliance, in the form of lower payments.
Because of the large outcry from the medical profession as to how difficult it was for doctors to meet the 25 criteria, or objectives, and for hospitals to meet the 23 standards, the Obama administration recently announced an easing of the "meaningful use" requirements.
The new standards are less demanding and more flexible. Doctors will have to meet 15 specific requirements, plus 5 chosen from a list of 10 objecitves. Hospitals will have to meet 14 requirements, plus 5 chosen from a menu of 10 goals.
The rules do not guarantee that doctors and hospitals can electronically exchange clinical information on patients.
(6/17/10)- The $787 billion federal stimulus package that was passed in 2008 called for the spending of $19 billion for the electronification of medical records over the next 10 years. Under the Obama administration's computerization of record keeping plan, doctors and hospitals will receive incentive payments for "meaningful use" of "certified" records.
Medical and health officials are now reporting that the eligibility criteria proposed by the administration is so strict and ambitious, that hardly any doctors or hospitals can meet them.
Kaiser Internmountaink the Mayo Clinic and Partners HelathCare System in Boston, which includes Brigham and Women's Hopital and Massachusetts General Hospital are all reporting that the criteria set up by the government to receive the payments are too difficult to meet.
At least 27 senators and 245 House members have sent letters to administration officials expressing their frustration with the system.
There are 48 requirements that have been established. To qualify for a payment at least 23 of the criteria have to be met before an incentive payment can be made to hospitals starting in October, and to 25 of the criteria have to be met by doctors who would begin to get payments in January.
In general, a doctor can receive up to $18,000 starting next year and $44,000 over five years.
Hospitals and doctors will be fined if they are not using electronic health records by 2015
(4/29/10)- Data from Surescripts LLC, the electronic network communications company shows that the number of original e-prescriptions transmitted nearly tripled last year to 191 million from the 68 million in 2008. There were about 1.63 billion original prescriptions issued last year. This data excluded prescriptions for refills.
For the first three months of this year, nearly one in five prescriptions was filed electronically. The company estimates that about one in four doctor's offices have the technology to e-prescribe, more than twice as many as at the end of 2008.
Doctors will be allowed to e-prescribe controlled medications such as narcotics and anti-depressants electronically shortly because of a recent change in the regulations in this matter. Under Drug Enforcement Administration rules, doctors previously had to hand write prescriptions for these types of medications.
Nearly all chain drug stores and 62% of the independent pharmacies now accept e-prescriptions that are uploaded directly to their computers.
The Centers for Medicare and Medicaid Services (CMS) will begin paying doctors a bonus for e-prescribing, and starting in 2012 doctors will be penalized if they don't do their prescribing by the electronic system.
Preliminary 2009 estimates by the CDC show that about 44% of office-based physicians use full or partial electronic health record systems (EHR). Researchers said that EHR use didn't change significantly from 2008 to 2009, based on the preliminary estimates.
(3/4/10)- The director of the Office of Device Evaluation at the Food and Drug Administration announced that she would be leaving the organization this month to join the Washington office of Microsoft Corp.
Dr. Donna-Bea Tillman said in an interview that she would be part of the company's plan to increase its efforts to develop medical information technology systems. Dr. Tillman had been with the agency since 1994, and she said in an email that she will become part of the company's health-solutions group as director of regulations and policy.
Electronic health record systemization is in the forefront of the $18 billion in federal stimulus money to be spent under the Obama program.
(2/19/10)- Under a pilot program that has been initiated by 5 of the largest private health insurance companies in New Jersey, doctors and hospitals will be able to go into a single site to see which insurance covers a patient and to track the progress of their claim.
The site is the one that NaviNet already offers for individual health plans. Insurers started a similar pilot program in Ohio, and Florida and California are also discussing such a system.
Aetna, AmeriHealth New Jersey, Cigna, Horizon Blue Cross and Shield of New Jersey and United Healthcare, which represent about 95% of the people covered by private insurers in the state are participating
The number of physicians and other prescribers using e-prescription increased from 74,000 in 2008 to 143,000 now. By the end of August, 110 million of more than 3.7 billion prescriptions filled yearly among retail pharmacies in the country were filed electronically, a report from Surescripts said. The figures indicate that "federal incentives are working," a Surescripts official said.
(11/28/09)- According to the results of a new study that was financed by the federal government and the Robert Wood Johnson Foundation that compared 3,000 hospitals at various stages in the adoption of computerized health records, there has been very little shown in the way of improved quality of care.
The researchers in the study were led by Dr. Ashish K. Ja, an assistant professor at the Harvard School of Public Health and Catherine M.DesRoches of Massachusetts General Hospital.
It is estimated that about 20% of physicians currently use electronic record keeping technology.
Under the Obama administration's computerization of record keeping plan, doctors and hospitals will receive incentive payments for "meaningful use" of "certified" records. The government expects to spend about $19 billion of federal money on this program.
The study placed hospitals into three groups: those with full featured electronic health records, those with only basic ones, and those without computerized records. It then looked at their performance on federally approved quality measures in caring for patients.
For hospitals with fullo-featured digital records, the average length of stay was 5.5 days; for those with only basic computer records, 5.7 days; and those without, 5.7 days
(10/5/09)- North Shore-Long Island Jewish Health System plans to offer its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to be used to adopt a digital patient record keeping system. This subsidy would be in addition to the federal support for computerizing patient records, which can total $44,000 per doctor over five years.
The federal program is part of the large stimulus package passed that include about $19 billion in incentive payments to computerize patient records, as a way to improve care and lower medical costs in the long run.
Memorial Hermann Healthcare System in Houston, Texas and Tufts Medical Center in Boston, Mass., have undertaken a similar program, but the North Shore-LIJ program is the largest one undertaken so far in this country.
The subsidy will be 50% of the total cost for physicians who simply install electronic health records that can communicate between the doctor's office, labs and hospitals.
The subsidy will rise to 85% of the total costs of digital records for physicians who agree to share data on patient measures. Personal identifiers of the patients will be stripped from the data.
The program will begin with about 100 physicians and then roll out more broadly.
(4/22/09)- President Barack Obama and his administration continues to lead the medical community towards greater adoption of a nation-wide electronic e-health record system. In furtherance of that objective, he announced that the Defense Department and the Department of Veterans Affairs would collaborate on building an electronic database of all administrative and medical information for all U.S. servicemen and women.
The new Joint Virtual Life Record (JVLR) is expected to track individuals once they enlist, through their military service and beyond. The JVLR system will help deliver health-care benefits to veterans and active duty military members.
The president made the announcement of the new system before an audience of veterans, including patients at the Walter Reed Army Medical Center, the National Navy Medical Center and the D.C. Veterans Medical Center.
The president's fiscal 2010 budget calls for the largest ever one-year increase for the Veterans Affairs Department, and a $25 billion increase over the next five years for the department..
The stimulus package that was passed by Congress allocates over $19 billion to be used to expand the electronic medical records keeping system in this country.
The following is an email that we received from the Department of Health and Human Services concerning obtaining continuing information about HIPAA:
Dear HIPAA-Regs listserv subscriber:
We want to make you aware the HHS Office for Civil Rights (OCR), which is responsible for implementation of the HIPAA Privacy Rule, has announced the creation of a listserv to distribute announcements, notices of available resources, and other educational information about the HIPAA Privacy Rule.
You are receiving this initial mailing because of your interest as a subscriber to other HHS lists relating to similar topics. We encourage you to take advantage of this new opportunity and register for this tool to receive up-to-date information from OCR.
OCR also invites you to visit its website, www.hhs.gov/ocr/hipaa/, where a wide range of helpful guidance and technical assistance materials about the Privacy Rule as well as civil rights are available. OCR continues to add materials to this site, such as a recent letter to healthcare providers highlighting how educational materials and technical assistance information available at the website respond to myths about the Privacy Rule.
We trust this information will be helpful to you.
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FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin
updated March 11, 2020