Posted in February 2012

Privacy and Meaningful Use Stage Two Proposed Rule

Meaningful Use Stage Two

As you might know, this week the Center for Medicare and Medicaid released its proposed rule for Meaningful Use Stage II.

You will note that the proposed rule emphasizes direct contact with patients, patient safety (especially in medication administration to those hospitalized) and a modicum of flexibility in order to reduce burdens upon providers and vendors.  There didn’t appear to be much discussion of HIPAA/privacy.

I spend a great deal of time in my practice thinking about issues of privacy and security and HIPAA compliance and was therefore interested in seeing how the draft rules dealt with these.

Where is Privacy Considered Within Meaningful Use?

A rudimentary word search revealed that the first reference to privacy was found on page 77 of a 445 page document.  That particular reference basically exorts eligible providerss”Oh, and hey, by the way, remember that thing called HIPAA!”  Actually, the reference goes on to redeem itself a bit, because it then explicitly tells provider that HIPAA does not restrict a provider from giving the patient access to his/her clinical summaries.  Indeed, the rule requires the patients be provided with their clinical summaries within 24 hours 50 percent of the time.

The next two references were music to this breach avoidance evangalist’s ears!  The draft points out the vital nature of encryption and states that almost 40 percent of large breaches rep0orted to HHS involve lost or stolen devices.  If these devices are properly encrypted, covered entities basically “get out of jail free.”  Thorough risk analysis and security updates are  also highlighted.

The rule drafters take pains to highlight that discussion of certain  HIPAA requirements within the context of defining Stage Two Meaningful Use does not in any way diminish the requirement that eligible providers adhere to all requirements of the HIPAA Privacy and Security Rules as well as state confidentiality rules.  Additionally, those providing substance abuse and mental health services are reminded to review SAMHSA regulations.

Stage Two also includes a requirement that Eligible Providers give patients the ability to access view, download and transmit their own health information within 4 business days of the information being available to the Eligible Provider.  This is less a nod to HIPAA than it is to Fair Information Practice Principles, implemented in the 1970’s, which set forth minimum standards for allowing citizens access to information collected about them.  These principles were instrumental in HIPAA’s development.

Meaningful Use Presupposes Some meaningful protection of PHI.

In sum, the Proposed Rule defining Stage Two of Meaningful Use highlight the need to ensure adequate protection for protected health information.

The #: meaningfuluseprivacy

The 140:  Meaningful Use Stage 2 mentions HIPAA compliance & incorporates by reference more than emphasizing it.










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The Waiting Game

The 140: I’ve been waiting too long @ the Sprint Store

The hash#:  Startac=d no waiting

Many of us depend to an almost unhealthy level on our smartphones and other mobile connective devices.  I sometimes wish for my old Star-Tac Motorola phone with the gray and orange display screen.  It was solid, yet small and it always worked for making and receiving calls.  I don’t think I ever waited to have it repaired.  It was hard as a rock.  It also had a cool feature wherein you could flip the phone closed when you concluded and unpleasant conversation.  Not quite as satisfying as flipping them off in real life, but gratifying nonethless.  None of that with these smart and delicate phones,  They don’t like being yelled at.

 The More the Phone Does, the less it does better and the more you wait.

What I have noticed is that as the mobile phone has evolved to include more functionality, it has become something that often fails to simply be a phone. That has brought me this afternoon to my local Sprint Store.  While I could tweet, blog, facebook, linkedin, gmail from the phone, when a call comes in the system “fails” and I cannot even identify the phone number of the caller.  The phone calls out just fine,  but just not so hot on the receiving end.  On somewhat of a lark, I dropped into the store to see if I could get the system remedied quickly and easy.

 Wait…where are you taking my phone?

Hmm.  My phone has disappeared into the bowels of the building and I sit in this purgatory-like waiting room waiting for my phone to emerge from surgery.  I have somewhere to be at 2:30.  I have been here over an hour.  I should have known I was in for a wait when they insisted on “checking” me “in” like I was going to be staying in a Holiday Inn Express, but with less comfort. Of note, the Sprint store does not have a restroom and waiting patrons are told to go next door to “Bed Bath and Beyond” if they need that particular functionality.


In the meantime, I have seen people drift in and out in various stages of disorientation.  I see a display here in the showroom of phones that are “talk and text” only.  I’m tempted to get one just so I can make and receive mobile calls reliably.


We love our technology and get testy when it breaks.  Today,I am yearning for my 1990’s phone and blogging about it on my mobile laptop powered by my Verizon air card.  Sprint does not have free wi-fi for its waiting customers.

How do you feel about what you have read?  Leave a comment below and enjoy your day!

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Health Information Exchange Developments in Florida

The 140: Health Information Exchange continues to evolve in Florida

The hash#: #stakeholderinterests

The Central/North Florida Chapter of the Health Information Management Systems Society met today in Tallahassee.  In case you missed my live tweets, here are a few highlights:

The Florida Department of Health has a robust comprehensive disease reporting system that is a model for the nation.

State Representative Gayle Harrell is a statewide and national leader on health information exchange. She took comments and concerns from the stakeholders about health information exchange and electronic health record adoption.  As someone with a compliance orientation, I appreciate her understanding of the need to emphasize privacy and security in these systems to enhance patient trust.

Dr. Kenyatta Lee, M.D. Assistant Professor of Community and Family Medicine Department at University of Florida College of Medicine spoke about how electronic health record adoption fosters the patient-centered-medical home model of health care delivery.

Harris Corporation presented an update on the progress of Health Information Exchange in Florida.

Finally, professors from Florida International University presented on their ongoing evaluation of Harris Corporation’s performance in building the statewide HIE infrastructure.  FIU has diligently and continually soliciting and accepting input from stakeholders.  I participated in the interview process as a member of the Health Information Exchange Coordinating Committee. FIU emphasized that they are acting as independent evaluators, however they are being paid by AHCA.  It will be interesting to see the final draft of the report.

Thorny issues continue to be physician engagement, adoption, sustainability and governance.  Ongoing questions also exist about whether the government should own and/or control the HIE infrastructure.  Educating health care consumers and providers about the benefits of health information exchange is also crucial.  For patients, E.H.R. adoption provides them with better continuity of care and enhanced safety.  For providers, it allows them to deliver care more efficiently and consistently.

As more and more providers race to meet meaningful use requirements, we will continue to see evolving and spirited dialogue about how HIE may meet the needs of all stakeholders, and whether one HIE can serve them all.

How do you feel about what you have read?  Leave a comment below and enjoy your day!

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