Healthcare Savvy

Our new health information exchange went live today starting with the ceremonial transmission of Governor Patrick’s health record from one hospital to another. The best description of the event is on John Halamka’s Blog today and yesterday. The exchange is interesting to the healthcaresavvy for a couple of reasons including its Direct secure email roots and future tie-ins to payment reform.

The Massachusetts Health Information Highway (the HIway) is based on the Direct secure messaging protocols mandated as part of federal EHR Meaningful Use Stage 2. As of 2014, all electronic health records that are eligible for federal incentive payments will have to send and receive Direct messages. Although patients do not have access to MA HIway yet, patients do have access to Direct messaging. Microsoft HealthVault offers free Direct email addresses, for example. I don’t know how long it will be before your doctor can send your health record to your Direct email address but there’s no fundamental reason it could not be done today using the MA HIway. Having your doctor receive a secure message from you, the patient, is also technically now possible. The questions of spam filtering, reimbursement and the doctor’s liability in receiving possibly unsolicited messages from patients (and, for that matter from other doctors) remain to be sorted out.

The tie-in to payment reform will come in future enhancements to the exchange. Read the rest of this entry →

The federal government has been busy trying to get doctors and hospitals to use electronic health records (EHR) and to make appropriate access to the records easier. They do this by issuing regulations for EHRs linked to tens of $Billions in incentives. Stage 1 of this effort began a few years ago and has had almost no visible effect on care coordination and patient access to records. Stage 2 is about to turn up the heat. If things stay on track, by the beginning of 2014 patients will have vastly increased access to their own information and will have a secure email system to communicate with their doctors.

HHS released the proposed Meaningful Use Stage 2 regulations last week. I’ve abstracted the 455 page document to less than 4 pages of items that directly impact patients.  My preliminary conclusion is that Stage 2 is a huge leap toward coordinated, patient-centered care and makes unprecedented efforts toward patient engagement.

By mandating comprehensive structured summaries be available to patients for download as well as on-line viewing, Stage 2 enables patient-directed health information exchange as an alternative to hidden provider-provider transactions that characterized earlier HIE efforts.

Although not mentioned by name, the implied use of Direct secure messaging for physician-physician and patient-physician communications will hopefully finally cause all EHRs to communicate with all other EHRs and PHRs without costly interfaces.

Also, new requirements for accessible imaging should eliminate the hassle of CDs for patients and doctors alike and make referrals and second opinions easier than ever.

All of these privacy, transparency and accessibility enhancements come none-too-soon as ACO payment reforms implicitly drive providers to keep patients in their particular network. Effective patient access to both cost and medical data is essential to preserving informed choice, reducing fraud and enabling the independent assessment of quality.