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Using Safe Harbors to Reduce Legal Barriers to Implementation of Electronic Health Records and Health Information Networks (pdf)
 
Submitted By:
John R. Christiansen, J.D.
Christiansen IT Law
Abstract:
A key concern for many participating in health information exchange is the lack of legal standards for privacy and security; currently, even well-known best practices are judged for legal adequacy only in hindsight, in regulatory actions or litigation. Risk-averse organizations avoid participation due to fear of liability, or argue for practices more burdensome or costly than others may accept. Health information exchange negotiations among organizations with differing risk appetites become difficult or even impossible. This paper proposes a solution to this problem, though a new regulatory process for developing legal standards of care which provide liability safe harbors.
Averting the Collision: The Importance of Effective Privacy Doctrine to Health IT (pdf)
Submitted By:
William A. Yasnoff, MD, PhD
Managing Partner
National Health Information Infrastructure (NHII) Advisors
CEO
Patient Privacy CertifieTM
Katherine L. Ball, MD, MSc.
Division of Health Sciences Informatics, Johns Hopkins University, School of Medicine
Director of Informatics
Patient Privacy CertifiedTM
Abstract:
Unless privacy risks are controlled and mitigated, the benefits of HIT may not be perceived as outweighing its potential harm, making progress problematic, especially for PHR platforms. Consumer expectations are promoting new enhancements in privacy values and are consistent with the motivating use of these new technologies. Policy challenges arise as a result. Consequences of the of lack of privacy standards include decreased access to care, delayed care, and discrimination. To help address these issues, independent third-party, consumer-based privacy certification can provide patients with assurance of their personal and full control over who can access their health information.
Regulating Personal Health Records – Why HIPAA Won't Work (pdf)
Submitted By:
Richard D. Marks
President
Patient Command, Inc.
Abstract:
The dawning era of patient-controlled health records (PHRs) is producing calls for Congress to extend the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to health record banks. This paper explains health record banks and how their architecture and operations differ from PHRs using other architectures. It reviews HIPAA's origins, and describes HIPAA's failings in the area of transaction standards
as well as in security and privacy. It explains how health record banks are subject to regulation under existing law, and why proposals to extend HIPAA to health record banks and consumer-based PHRs would be selfdefeating.
Mt. Washington Revisited (pdf)
Submitted By:
Jim Klein
Senior Vice President, Chief Technology Officer
QuadraMed
Abstract:
This paper examines changes in the healthcare industry since a contrarian proposal was submitted to CMS in January 2005 for CMS to exercise its commercial power as the market master in the purchase of healthcare in the U.S. to catalyze the emergence of a commercial heath record banking industry as an alternative to building a National Health Information Network (NHIN).
The original proposal, entitled the “Mt. Washington Vision”, was for CMS to provide financial incentives to, and eventually require, healthcare service providers seeking reimbursement from Medicare and Medicaid to create and deposit standard electronic documents, compliant with HL7 Clinical Document Architecture (CDA), into a patient-designated health record bank.
This paper analyzes important trends and changes in the last four years including:
- The limited success of the RHIO and HIE models
- The ascendancy of the CDA standard
- The growing awareness of the health banking model
- The launch of patient-controlled PHRs by Google and Microsoft
...And describes how these developments enhance the prospects for success of the original recommendation. The paper concludes with modifications to the original proposal and suggestions for next steps.
Health Record Banking - Patient-Centric Solution for Electronic Health Records (pdf)
Submitted By:
Eileen Koski, M.Phil.
Director, Informatics Research
Quest Diagnostics Incorporated
Abstract:
This paper describes Health Record Banking, a mechanism to support availability of health records when and where needed, while protecting a patient’s privacy. A health record bank is an independent organization that provides a secure, persistent, electronic repository for maintaining an individual's health and medical records that assures that the individual has complete control over who accesses their information. The critical features that differentiate a health record bank from other electronic health record models are consumer control of access to the data, a patient-centric record – not provider or payer-centric, and the fact that the record is persistent and portable.
The Complexity of Consumer Willingness to Disclose Personal Information: Unraveling Health Information Privacy Concerns (pdf)
Submitted By:
Ritu Agarwal, M.B.A., M.S., Ph.D.
Professor and Robert H. Smith Dean’s Chair of Information Systems
Director, Center for Health Information and Decision Systems
Robert H. Smith School of Business
Catherine Anderson, M.B.A. Ph.D. Candidate
Department of Decision, Operations, and Information Technologies
Robert H. Smith School of Business
University of Maryland
Abstract:
There is little else that is as consequential to an individual as his or her health. As healthcare becomes increasingly digitized, the promise of improved healthcare enabled by technological advances must inevitably be traded off against any unintended negative consequences. In this context, the privacy of one’s personal health information has escalated as a matter of significant concern for the public. The value from drug discovery, medical research, and public health policy can be realized only if consumers are willing to allow their health information to be electronically stored and manipulated. Under what circumstances will individuals be willing to disclose identified personal health information and permit it to be digitized? This question must be answered in order to craft appropriate policy and encourage usage of healthcare technology in the future. We conducted a study to address this question. Using a nationally representative sample of 545 consumers, we measured individual willingness to disclose personal health information under 27 different scenarios, adapted from those developed by the Health Information and Security Privacy Collaboration. We manipulated the type of information (general health, genetic, and mental health), the intended purpose (patient care, marketing, research), and the requesting stakeholder (hospitals, pharmaceutical companies, government). Further, we explored the impact of emotion linked to one’s health condition on willingness to disclose. We find strong significant effects for all the situational factors and emotions on the extent to which an individual is willing to share their personal health information.
Educating Clinicians on a National Scale & Measuring Behavior Change: An Online Method (pdf)
Submitted By:
Destry Sulkes, MD
VP, Medical Affairs & Strategy
Medscape LLC
Abstract:
Online continuing medical education (CME) has grown to represent over 30% of all CME as reported by the 2007 Accreditation Council for Continuing Medical Education’s Annual Report. In addition, physician participants in online CME have been shown to improve their clinical behavior and increase their use of evidence-based treatments by over 50% over demographically-matched control groups of physician non-participants. The “Adverse Events Resource Center” on www.medscape.com, one of the most-visited online CME sites, which incorporates an FDA/MedWatch partnership, has attracted and impacted the behavior of over 200,000 healthcare professionals which may improve AE reporting and help safeguard the public health.
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