Here's a sampling of comments recently sent by readers regarding Health Data Management stories and blogs:

"Privacy and Security: Are We Looking in the Wrong Direction?"

"Evidently, to really prove to an auditor from KPMG that your HIPAA sanctions are in place, someone has to take a hit for the team. Yesterday, posted "U.S. Department Of Health And Human Services Audits Set To Begin Soon."

Attorney Adam H. Greene, who formerly worked at HHS' Office for Civil Rights and now focuses his practice on HIPAA compliance, suggested that "entities that have never imposed an internal HIPAA-related sanction may have a problem." He adds that not having issued a sanction "doesn't mean you have never had a HIPAA violation." So, Doc, got an employee in mind?

"Patient Documents Found in Employee Home"

"This article points up the fact that, although mass electronic breaches dominate the news, breaches of the old-fashioned paper kind can still occur if we take our eye off the ball and fail to tighten processes that many employees use in performing their jobs. Paper will continue to be around for a long while, and we must not forget that it poses the risk of breach, along with records that are automated."

"The Power of a Chart"

"Another very good call, Gary. Glad you have a capable and caring internist. Truth is, though, you wouldn't have to compile your own PHR if your PCP was using an EHR (connected to a local HIE) instead of paper. It would be automatically created and, if you wished, delivered to you (online, mail or fax). Your internist could also have your specialist referrals, prescriptions, lab tests and X-ray orders automatically delivered, pre-cleared with your insurance company, and paperwork completed when you walk into those facilities. Your internist gets the results immediately and automatically through the same system. If something serious has turned up - and particularly if you are suffering - it's important that your diagnosis and treatment moves much faster. Meanwhile, your internist and staff are saving tons of time handling paper records - time they can devote to your medical care - and you are getting faster and better care with less effort.

"One more thing. Your internist may be coordinating all your care... but if you have a deluxe insurance plan, you may be able to go directly to a specialist. Your internist would be blind to the care and medications you're getting elsewhere.  That's one of the key reasons 90,000 innocent patients in this country die EACH YEAR from "medical mistakes."  Many are caused by competent and well-meaning physicians blindsided by an unexpected drug interaction or unreported outside treatment. Can't happen when ALL of your treatments and medications from ALL providers appear on your medical record at every point of care... and all new Rx orders are screened automatically for dangerous drug interactions. Hope your internist - and particularly, the older and change aversive physicians - discover how much this new technology can do for their practices and their patients."

"10 'Facts' on Accountable Care Organizations"

"It is truly elating to see the quality, intelligence and pragmatism of the medical industry emerging in this conference and in this discussion. Yes, the industry - and particularly its practitioners - must change both their processes and their belief systems.  Yes, it will beneficial - and necessary - to our Nation, population and economy.  And yes, it will be difficult and financially costly to themselves. If it seems overdone, it's largely because it's so overdue. Like all forms of change, it will happen.  The choices are whether to adapt to change in the most farsighted and well-managed ways... or to suffer the massive structural and financial damage when "willful negligence" catches up to you. Congratulations on now choosing the former alternative."

"Why Health Care Reform Won't Work"

"Joe, your observations about health care are correct.  Part of the problem that I see is the very definition of what constitutes health "care" is so ambiguous.  Generally speaking, when definitions are set forth and are not disputed, they become, more or less, the standard against which efforts to produce a specific process or product is measured.  In the case of health care, the definition has meant the delivery system, particularly establishing the qualifications of the individual practitioners and the natures of their medical services.  Only recently has the concept of outcomes been raised as a potential component of the description of health care, but even then, "outcome" is defined in crude terms as "did the patient get well?" What is needed desperately in the description of health care is a component that discusses the coordination of medical services and the business conduct of medical providers.  The hot potato approach now in play that allows patients to twist in the wind while various providers engage in finger pointing is plainly unacceptable from a patient's point of view. 

"The unacceptability of this behavior rises with the percentage of one's medical bill that the patient actually has to pay, so as medical insurance policies incorporate higher co-payment amounts for services rendered, one would expect that the demand not just for better coordination of services but instead the absolute coordination of services will eventually arise. I have spoken with a number of medical professionals about the problem of medical and business coordination with other providers dealing with the same patient.  They respond by saying that their staff takes care of that problem, and when I point out that it doesn't get taken care of, they usually dismiss the objection with a patronizing, "You just don't understand" comment.

"What I do understand is that sole practitioners, while being physicians, are still business entrepreneurs, and the quality of their businesses can be measured fairly by many of the same standards that apply to other businesses.  Do they bill correctly?  Do they follow through on promises made?  Are they courteous?  Do they offer clear choices to their customers?  Are their office operations efficient, and are their communications with their customers accurate and clear?

"Many in the medical community seem to be offended by such expectations, and they are particularly touchy about anyone questioning the appropriateness of their fees.  In fact, the medical community seems not to understand that their fee structures bear no relationship to their customers' abilities to pay for their fees.  This is in large measure due to the fact that from a business perspective, the patient is not the physician's customer; the insurance provider is the real customer.  The patient is simply the person for whom or on whom a procedure is performed.  It is much like a plumber unclogging a sink. While attention is paid to preventing damage to the drain pipe, from a business perspective the compensable task serves only to entitle the plumber to collect from his real client, the home owner. As long as the model of financial protection of patients is based on institutional sugar daddies, which is really what insurance is, getting physicians to clean up their acts will be difficult if not impossible. 

"Eventually, people will tire of trying, and they will simply tell the government to do through legislation.  We will go to a single payer model, everyone will pay high taxes, and doctors and other medical providers will have their incomes reduced and then capped.  If this is what the medical community wants, then I suggest that it continue doing what it now does, and the desired end will come quickly.  If it does not want this to happen, then I strongly suggest that it get very serious about running practices like real, accountable businesses that pay attention to the demands of their customers."



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