HIPAA remains the EMR deterrent

HIPAA remains the EMR deterrent

Summary: Either eliminate the market incentive to peek, which insurers are offering to do (so long as a "public option" doesn't exist) or give them the data they need to do business.


Ina Fried has a great two-page piece up on EMRs over at News.Com.

I recommend it.

But I especially recommend the second part, where she has a pullquote from John Halamka (author of the blog Geekdoctor) answering the key question of why we don't already have this stuff:

The challenges are more on the policy side than the technology side...It's who gets to see what? When do you get to see it? What is the patient consent?

Most of these problems come out of the HIPAA law, but more of them come out of the need for that law. The law is necessary because insurers routinely use health records to raise prices or deny coverage altogether. Employers seeking to limit their own costs share this incentive to pry.

HIPAA was a band-aid around this gaping wound. Almost as soon as the law was passed an arms race began, fueled by lawyers and lobbyists, aimed at getting around the law. Many doctors opted-out of the war, taking advantage of a provision that allowed small practices to stick with paper.

Without HIPAA, and the need for HIPAA, there is no doubt more doctors would be paperless. We might have already gone through several generations of electronic systems, and ironed out many bugs that still exist.

Automation saves money and saves lives, in every industry where it is deployed. There is no reason for medicine to be 20 years behind the times, other than the political battle between privacy and market incentives.

There are two ways this can end. Either eliminate the market incentive to peek, which insurers are offering to do (so long as a "public option" doesn't exist) or give them the data they need to do business.

We have seent the third option and it doesn't work.

Topics: Government US, CXO, Government, Health, IT Employment

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  • First off.. its no longer called EMR.. its called EHR.. and oh the holes

    HIPAA is not the reason EHR is not being adopted quicker. Its money. Many of the software EHRs already have built in encryption for communication(no external devices needed!) and secondly HIPAA, if you have even read the law doesnt even state what type of security you need. Yes this does cause some confusion in the adoption process, but anyone actually looking into an EHR system will find out quickly that the majority of the EHR ( and all of the major ones ) have built in protection.

    Adoption right now comes down to two things:

    -Providers not wanting to or unable to learn new technology.

    -Providers and provider based organizations not wanting to put out the funds to enable an EHR system in their organization.

    The first reason will be an issue, the second is being handled though. Some EHR systems are offering hosted services with full support for less cost than hosting it internally. The goverment is offering grants to help subsidize cost

    Finally, organizations like JACHO and some goverment entities are forcing requirements that basically require an EHR to meet.

    Yet again.. facts need to be straightened out before reporting on them.
    • EMR vs EHR

      An EHR contains all your interactions with all
      your medical professionals. An EMR is what your
      doctor has.

      EMR, singular. EHR, plural.

      That's why I chose the term EMR here. We're
      talking about the individual choices of doctors
      and hospitals for EMR software.

      Thanks for all your good points, though. I do
      appreciate them. You have a lot of
      understanding, and I hope others read what you
      have to say.
      • As a doctor currently implementing EMR...

        ...I say everyone has made some valid points.

        And yes, we like to call it EMR SYSTEM (as opposed to an electronic medical RECORD, which can just be paper notes scanned into a computer, or EHR, which is the newer term coined by the 'industry' pundits to denote the cyber-cloud of our most intimate personal health information soon to be copyrighted by Microsoft or Google).

        But, I digress. We are currently 6 months into our phased EMR rollout in a practice with 11 physicians and 5 locations. We are fortunate enough to have three full-time IT employees. Because we opted to have a more robust platform that is customizable to fit the way our workflow processes, it does indeed require more tweaking, but it has allowed us to practice without any significant decrease in productivity.

        It is possible for physicians, particularly solo or small groups, to spend quite a bit less for an 'out-of-the-box' EMR solution but they will need to adapt to it instead of vice versa.

        Physicians are complaining because we have to foot the bill, and insurance companies and other middlemen will probably make out like banshees when money starts to flow from Uncle Sam. The government is offering little carrots to those who get on the bandwagon and threatening big sticks for those who don't.

        Bottom line: physicians are spending a princely sum on technology which will give government and insurance companies a more efficient way to audit and control them.
    • Both points well taken (except the EHR part)

      You're right! It's money and fear of technology. But I would add a third factor--a lack of competent IT professionals for the medical industry. EMR software usually needs a considerable amount of customization. The going rate for freelance template editors is $125-225.00 an hour and you can hardly find anyone who can do the work. The very best EMR software available is far from perfect. And it can be *very* expensive. Premium EMR software can cost $250,000.00 for, say, 5 doctors with 70 users, and up to $80,000 more for premium clustered servers to ensure reliability. That's a lot of money in these times, but these servers must be much more reliable than regular small-business servers. For an oncologist who can't get access to patient information because of a server failure it might become a life or death situation for their patients. Medicine is a serious business, and requires a special dedication from its IT professionals. Many doctors will soon require at least one highly competent IT professional on staff. Many medical groups will need an IT department staffed by two or more people. This is a major new opportunity for seasoned IT professionals to find work.
      • Ka-<b>CHING!</b>

        [i]his is a major new opportunity for seasoned IT professionals to find work. [/i]

        Gravy train departing station 5!

        That's the great thing about this country -- there are so many ways to get a piece of the action.
        Yagotta B. Kidding
  • Reign in health insurance companies

    Personally I don't see why we should be
    concerned about health insurance
    companies when looking at EMR/EHR.

    It's about time we TELL the companies
    how they will operate at a national level,
    or they will loose their right to do
    business in this country.

    The other important factor would, of
    course, be a windfall profits tax for those
    that do not cover all people at the same

    Considering that the industry CEOs had
    the highest median compensation of all
    sectors there is no need to cry for these

    I believe that we need to move forward
    with a "public" option and let the private
    sector compete for our business. With the
    long term belief that government workers
    are far too inefficient there should be no
    problem with them competing.

    I also believe that there needs to be an
    assigned risk pool, run by the
    government, that people can join if they
    have had problems with existing
    conditions. The insurance companies can
    finance these if they don't want to work
    with these patients.
    • competing with a public plan

      [i]"With the long term belief that government workers are far too inefficient there should be no problem with them competing."[/i]

      The problem isn't competing with government workers. The problem is the private sector can't print dollars to subsidize their losses.