Millions at stake with digital medical-record hurdles
TAMPA - It seemed like a good idea, a solid path to better medical care. Why not improve patient and doctor communication by ditching paper health records and collecting every patient checkup, lab test and surgical procedure online? Instead, Florida's creation of an electronic medical record exchange has intensified tensions between local hospitals and doctors, both of whom want control of patient health information. It's supposed to take four years and $20.7 million of state money to launch the Florida Health Information Exchange, intended to connect health care providers and patients via an electronic medical-record sharing system. Two years in, the Agency for Health Care Administration project has selected 17 hospital groups and practices across the state, including a Tampa-area 20-hospital consortium added in September.But backers of a separate local, physician-centered exchange say the project so far is excluding doctor voices, making the process a waste of taxpayer money. Hospitals rarely treat the average patient, and they generate just 10 percent of all patient health records. "How long is it going to take the state to connect to a meaningful amount of patients?" asked Chris Pittman, a Tampa vascular interventional radiologist and president-elect of the Hillsborough Medical Association, which this summer joined the competing for-profit record exchange. Doctors, hospitals and health care practitioners nationwide are facing a federal government deadline to electronically collect and share information with patients and with one another. Missing that deadline could mean losing millions of dollars in incentives or government health care money. The scramble to digitize patient records has unearthed a mammoth power struggle over the ownership — and potential profits — related to personal health data. Those leading the state and hospital-based efforts say they want to establish a large-scale information interstate exchange that smaller groups and individual doctors eventually can join. "We're not making this model so that hospitals make more money. We're doing it to improve health care," said Peter Hobson, acting executive director of the nonprofit Tampa Bay Regional Health Information Organization, which is part of the state project. "Just because patients aren't standing in the front, it should not be construed that they aren't there." But for patients, the competition between hospitals and doctors could mean they still won't have a single electronic storage unit to keep records from their various doctors, essentially defeating the purpose of a multimillion-dollar federal health information technology act passed in 2009. Patient advocates also worry that the way groups are proceeding could compromise privacy. "It's going to blow your data in more places than ever," said Deborah Peel, a physician and founder of Patient Privacy Rights of Austin, Texas. "There is no data map for where your information goes." There's a mountain of health information being corralled into this new electronic records stratosphere, and millions of dollars are at stake for the state's nearly 65,000 licensed physicians and more than 260 hospitals. Consider that there are 19 million residents in Florida, including 2.65 million in Hillsborough, Pasco and Pinellas counties. Each time a resident visits a doctor or is seriously ill, a hospital, the health professionals the patient sees and their organizations create a record. That doesn't take into account the data produced at countless labs, pharmacies and outpatient treatment facilities. The 2009 federal stimulus package offered billions in financial incentives to make virtual all those walls of tabbed manila folders of patient data. Through September, 3,865 of the state's eligible health care professionals were paid $80.7 million in incentives, and 189 eligible hospitals received $170 million, according to the AHCA, Florida's health administrator. That money, however, isn't the only gold that potentially could be mined from patient records. There could be a market for selling clusters of aggregated patient data to insurance companies, employers, even medical research companies trying to decide what new drug or device would be a big seller. It explains why for-profit companies are swarming into the health information technology industry. Insurance carriers such as Blue Cross Blue Shield Association have created technology subsidiaries, as have longtime defense contractors such as the Harris Corp., which won the $20.7 million contract to establish Florida's health exchange. Peel, who has been advocating for patient privacy since the 1990s, said this electronic medical records transition is turning a financially strained health care industry into a "surveillance economy," where patient information can be parsed and sold. The government incentives have made her cynical about how hospitals and doctors will proceed into the future. "They are, by god, going to do it whether patients want it or not, because they want the money," she said. No one in this debate thinks paper medical records should stay. Technology can help streamline health care and reduce duplicative costs, as long as the right people are in control of the information, doctors, hospitals and patient advocates all say. The state's Health Information Exchange is not designed to take over patient records, much less sell the information, said Carolyn Turner, government analyst and policy leader for the exchange. Data will stay local, remaining at the facilities that are creating it now and in the future. Instead, the Florida exchange aims to be a safe online network where hospitals and physicians can look up a new patient's health records, and communicate via secure email with doctors familiar with that patient's care, she said. The idea is that authorized health care professionals will pay a monthly fee to participate. Turner said it's reasonable for people to criticize the state's decision to focus first on hospitals because 90 percent of records are created by physicians. But leaders felt it was safest to start with facilities with an established information technology staff and infrastructure, and grow from there. "We're most concerned that it's something you can use immediately and evolve. It's not a dead-end," she said of the pilot program, which includes facilities that account for 44 percent of the state's hospital beds. After two years, though, that evolution is moving slowly. Officials on Friday said that by the end of October, only 1,037 employees from the pilot facilities have tried the state's secure medical email system, sending just 835 care-related messages to others in the network. And the more anticipated "patient look-up" program, which provides access to records at other hospitals, remains in the start-up phase, according to a Florida International University evaluation of the program's progress. Testing is planned in the coming months. Janet Hofmeister, exchange program manager for Harris Healthcare Solutions, said she expects use to boom as more participants in the pilot learn to use the system. "That's a big start in getting people to use the system," she said Friday during a state exchange coordinating committee conference call. Dan Kaelin disagrees. The chief medical officer of HIE Networks, the Tallahassee-based for-profit company offering a record exchange for the Hillsborough Medical Association, said the exchange neglects the reality that most doctors in Florida still struggle to get their own practices online. "The state is building an interstate highway system. And they have no ability to build an on-ramp or off-ramp," said Kaelin, a vascular surgeon in Tallahassee. The Tampa-area hospital consortium joined the state network so local hospitals will be able to review patient records from other areas of the state, said Charles Phelps, a board member and director for the Tampa Bay RHIO. But before statewide data is accessible, local hospitals in the group need to be connected. By the end of 2013, relevant patient information should be interchangeable among six Florida Hospital-owned facilities, H. Lee Moffitt Cancer Center, Tampa General Hospital, Bayfront Medical Center, All Children's Hospital and 10 of the 16 local HCA Healthcare hospitals, Phelps said. After that, patients, doctors, labs or pharmacies will be invited to join, said Hobson, acting director of the nonprofit created by the Tampa Bay Partnership economic development group. "We want to make sure this improves health care," Hobson said. "This involves patients and doctors … you cannot shun a group." Pittman said this approach is of little help to area doctors frustrated with the financial, time and bureaucratic demands of creating electronic records in their own offices. Also, it potentially shifts the control of records away from the physicians who have been stewards of patient information for decades. "At the end of the day, we're talking about a virtual room of records," he said. "It's coming; that's inevitable. We're trying to manage the tsunami." It isn't only doctors who aren't onboard. The largest hospital group in the area hasn't joinedthe collaborative, said Tim Thompson, senior vice president and chief information officer for BayCare Health System. It has taken years and millions of dollars to electronically connect records between the 10 BayCare hospitals, its ambulatory centers and more than 900 local physicians with hospital privileges. It's too soon to expand the project outside BayCare, he said. It could be two or three years, maybe more, before patients start to notice significant changes in how their health records are kept and shared digitally. But they need to pay attention now, said Micky Tripathi, president and chief executive officer of the nonprofit Massachusetts eHealth Collaborative. Start by finding out if an individual doctor or hospital keeps in-house electronic medical records and read the fine print about health information. Those who want to keep their records private should look for buzzwords such as "opt-in" and "opt-out." "Read those forms you never read before," said Tripathi, whose nonprofit helped launch pilot exchanges in Massachusetts and several other states. Peel, the patient advocate, said she can't recommend any electronic health information exchanges in Florida or elsewhere right now. It might be all right for people with a lot of chronic conditions and a slew of doctors, but few others, she said. The risk is too great that information such as mental health records could get in the hands of the wrong person. "If you don't have anything major, I would stay away. Once the information is out there, you can't get it back," she said. "You are better off staying away unless you are forced to use them." The Tampa Bay RHIO is being methodical to prevent those kinds of problems, Hobson said. The contracts between hospitals will severely restrict what patient information is released and how it can be used, he said. More significant is that patients have access to their health records, which is the intent of the federal health information law, Peel said. If it's available electronically, download it and make sure it's accurate, she said. "Then at that point you don't have to belong to a health information exchange," she said. "You can keep your own damn records."
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