!!!"#$#!%&!'(&)*+!,!'*-./0)*+ !'1%2/+3/456 !778 After allegedly losing her unborn child due to drugs she was taking, a radiology technician at Community Hospital of San Bernardino began wondering what other expectant mothers did in a similar situation. However, the radiology technician went about her research in an unusual way: she accessed the medical records of 204 hospital patients before being discovered by a supervisor in February 2009 – in violation of both hospital regulations and state and federal laws. The breach cost the radiology technician her job, and the hospital $250,000 – the administrative penalty levied against it last week by the California Department ofPublic Health. That penalty was one of two issued against the hospital on June 10, and among six the agency levied against five hospitals throughout California for breaching patient confidentiality. “Patient confidentiality is a fundamental right, and patients should not have to worry about their medical records and privacy being violated,” said Kathleen Billingsley, the CDPH’s deputy director of its Health Care Quality division. However , the CDPH’s own records suggest and privacy experts conclude that patients have quite a lot to worry about. The patient medical record breaches announced by the CDPH all contained a common element: low-level and even non-medical employees gaining access to sensitive patient records due to casual neglect, or a blatant disregard for an honor system that is often the only bulwark against a patient’s medical records being exposed. “Most hospitals are way , way behind on this issue, and barely come up to the most basic standards of security,” said Deborah Peel, M.D. , founder of the advocacy group Patient Privacy Rights in Austin, T exas. In the second San Bernardino case, for example, the hospital was fined $95,000 when a receptionist allowed a non- employee to sit at her desk, making them privy to confidential patient information. Even more disturbing was an incident at Rideout Memorial Medical Center in Y uba City, north of Sacramento. Rideout was fined $100,000 when a hospital employee failed to properly log out of his computer terminal. As a result, 17 security guards accessed the medical records of 33 patients. The breaches occurred despite recent training Rideout’s staff had received about EMR Security Becomes Vexing Issue Logistics, System Designs Contribute To Basic Lapses 9-1:3)*4!8(2/;-*4/( !'(:/)4:!(40!<(=/2&> 8)4:)*)0!8(*)!8-4;)*)4?)@!7-45!A)(?3! B)=-*/(2!C-+D/:(2@!E3)!?-4;):)4?)! F/22 ! )GD2-*)!:3)!%)+:! F(&+!:-!(?3/).)!;(=/2&> ?)4:)*)0!3)(2:3?(*)@ !HI#>HJ#@ K)5/+:)*!L42/4)M 3::DMNNFFF@3(+?@-*5N).)4:+@?;=O +:(*:*-FP$$,.PQ,:P"#$##J#R,?P#,2?P# 9-1:3)*4!8(2/;-*4/(!CSB99!83(D:)*!82/4/?(2! S4;-*=(:/?+!91==/:6!T87U@!'(:*/?/(!C/4:-4! V(2W)*!/+!:3)!W)&4-:)!+D)(W)*@ !HX#>HRQ@ K)5/+:)*!-42/4)M 3::DMNNFFF@3/=++>+-?(2@-*5 June 23 July 9 Calendar17 June 2010 June 25 C)(2:3!SE!K)+-1*?)!E)(?3>S4@!'*)D(*/45! T40)*+)*.)0!8-==14/:/)+!;-* !C)(2:3!SE! (40!YCK! U0-D:/-4@!8(2/;-*4/(!Y40-F=)4:6! 7-+! U45)2)+@ !Z-!?3(*5)@ K)5/+:)*!L42/4)M 3::DMNN+3/*):)(?3/42(@).)4:%*/:)@?-=N E-Mail [email protected]with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting. Continued on Next Page NON-PROFIT HOSPITAL CEO SALARIES A PAYERS & PROVIDERS EXCLUSIVE WHITE PAPER Publication Date: June 28, 2010 $149 (Executive Summary) $275 (Summary and Salary Data) Call (877) 248-2360, ext. 2 to order, orCLICK HERE California Edition
Transcript
8/9/2019 Payers & Providers – Issue of June 17, 2010
maintaining patient confidentiality,according to CDPH records.
Carl Kesselman, director of the Center
for Medical Informatics at the Universityof Southern California, wasn’t surprisedabout such a lapse. “These (hospital)workstations often have the mostrudimentary security,” he said.
Peel noted that the failure to logoutfrom an EMR system is a common issue.
“These users often have to go through agauntlet of complex passwords and loginscreens, so they just keep it open,” shesaid. “Or, they write it down their usernames and passwords and then lose them,which winds up in someone else’s hands.”
Most hospital employees sign
agreements swearing not to disclose orinappropriately access patient records.However, some ignore them when itbecomes inconvenient, as was the casewith the overly curious radiologytechnician.
That was also the case involving EnloeMedical Center in Chico, which was fined$130,000 when seven people – includingemployees of an outside collection agencyand administrative assistants for localphysicians – accessed the medical recordsof a “high profile admission,” according toCDPH records. At least two of those
people had admitted to signingconfidentiality agreements regardingaccess to medical records. Enloe did nothave a policy in place regarding the risksassociated with off-site businesses havingaccess to the records.
The breach is particularly awkward forEnloe. Just a few months before it wasdiscovered, Carefx, an Arizona-based firmthat distributes and installsinteroperability software products,trumpeted the 382-bed hospital as itslatest client. “This (system) aligns relevantpatient data across multiple applications
to provide clinicians with a complete viewof a patient's health history,” Carefxannounced in a press release.
An Enloe spokeswoman was notimmediately available for comment.
A situation similar to Enloe’s occurredat Ronald Reagan UCLA Medical Center,when two hospital employees and twooutside contractors accessed theinformation of a “deceased patient” out of curiosity, despite acknowledging itviolated agreements they had signed tokeep information confidential. The
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hospital was fined $95,000 for theincident.
UCLA is no stranger to such breaches;
a former employee pled guilty in 2007 toaccessing patient records in order to sellthem.
Billingsley noted that there likely to bsome technological changes in thecoming years to better safeguard hospitaEMRs.
“You are likely to have systems inplace that show warnings if someone isabout to inappropriately access records,she said.
Peel scoffed at such a safeguard. “Popup screens and warnings are notdeterrents,” she said, adding that system
should be redesigned to only allowaccess to caregivers previouslyauthorized by the patient.
Kesselman noted that there systemsavailable to better safeguard patientrecords, but hospital managers are oftendaunted by installing them, eitherbecause of their cost, or the fact they cabe too restrictive.
“It imposes additional administrativeoverhead, and, there are alwayscomplexities,” he said. “If you shuteveryone out of the system without priorconsent, what do you do in an
emergency situation? What kinds of overrides should you have in place? Andwho would get to override them?”
Peel also slammed the major vendorsof hospital EMR systems for being slow timplement such safeguards.
“They’ve made billions of dollars off othese defective products, so why shouldthey change them now?” she asked,adding that there may be some concernsthat too many safeguards may make itmore difficult for hospitals to use patientdata for fundraising or other marketingpurposes.
In the meantime, the volume of penalties and fines levied by the CDPHfor patient security breaches is likely toswell. Billingsley disclosed last week thathere have been 3,766 cases of potentialbreaches reported to her agency betwee January 2009 and the end of last month.The CDPH is currently investigating 324cases. Another 1,489 are pending.
“One would think you would have tostart locking down this stuff better,”Kesselman said.
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In Brief
Inland Empire RHIOEffort SelectsConsultant
The edging group trying to form aregional health information
organization in the Inland Empire hasgrown to 20 participating membersand has selected a Walnut Creek-based consulting rm to assist in itsprogress.
Object Health was selected amongseveral bidding rms to guide theInland Empire Health InformationTechnology Coalition, according toChristina Bivona-Tellez, regional vicepresident for the Hospital Associationof Southern California.
Object is headed by Lori Hack, whopreviously served as the interim chief executive of cer at the now defunctCalifornia Regional Health InformationOrganization.
Bivona-Tellez said the IEHITC andObject would move forward towardthe creation of a RHIO, although notimetable has yet been set.
Bivona-Tellez noted that the factthat so many disparate constituencieshave joined the coalition – includinghospitals, insurers and medical groups– was a positive sign.
“We haven’t been the mostcollaborative group in the past,”Bivona-Tellez said. “This portendswell.”
Survey RevealsDiscontent Among
Hospital WorkersForty-ve percent of hospitalemployees feel distanced from ordiscontented with their work,according to a new survey by PressGaney Associates.
The survey of more than 235,000employees at nearly 400 hospitalsnationwide found that those workingclosest to patients are the least likely tobe satised as employees.
EMRs (Continued from Page One)
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8/9/2019 Payers & Providers – Issue of June 17, 2010
“We found hospital employeeswant to be recognized for excellentwork, but they also want to beinvolved in the decision-makingprocess and have the opportunity toprovide input on issues directlyaffecting their work, so they feelempowered to do their jobs,” said
Deirdre Mylod, Press Ganey’s vicepresident of hospital services. “It iscritical for hospitals to takeconsiderations like these into accountwhen planning employee relationsinitiatives.”
Thomson Reuters MapsOut $3.6 Trillion in
Healthcare Savings
A new white paper by ThomsonReuters concluded that the U.S.
healthcare industry can save $3.6trillion over a decade through avariety of measures aimed atreducing inefficiencies.
"Last year, we published areport concluding that the U.S.healthcare system wastes $700billion a year," said Bob Kelley,vice president for healthcareanalytics at Thomson Reuters andco-author of the paper. "This newreport describes a possible path forsignificantly reducing that waste."
The white paperrecommended that consumers bemore broadly engaged in theirhealthcare decisions, better
coordinate care, use checklists toeliminate medical errors and moveto eliminate fraud.
“It is reasonable to set a goalof constraining healthcarespending to its current share of theGDP,” said Ray Fabius, M.D., chief medical officer at Thomson Reutersand the white paper’s co-author.
The white paper may beaccessed atwww.factsforhealthcare.com.
SCAN Ramps Up Internet CME HoursResponse to Growing Shortage of Geriatricians
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Bracing for what is expected to be aworsening shortage of geriatricians, SCANHealth Plan is turning to the Internet tohelp educate primary care physicians tobetter take care of the Long Beach-basedinsurer’s aging enrollees.
SCAN, which covers 130,000Medicare Advantage members, is in theprocess of introducing a dozen corecourses on geriatric care that its physiciannetwork may access in lieu of continuingmedical education credit. The courses,which range from one to two hours induration, are being offered free of charge.
The online curriculum focuses on suchage-specic topics as managing patientcare to prevent falls and such age-relatedailments as chronic kidney disease,congestive heart failure and chronic
obstructive pulmonary disease. They will betaught by geriatricians and other specialistsfrom Ronald Reagan UCLA Medical Centerand other medical institutions.
“It is sort of our response to the dearth of geriatricians,” said Russell Brower, M.D., SCAN’s medical director and chair of its CMEdepartment.
The shortage is a daunting one – there isabout one geriatrician practicing in the U.S. forevery 5,000 patients over the age of 65. Lessthan a dozen of the nation’s nearly 150medical schools have a department of geriatrics, which is among the lowest-paid
specialties in the medical profession.Although Brower noted that SCAN hasoffered CME lectures in person, the Internetofferings are hoped to be convenient enoughto spur greater interest.
A new study of long term care facilities inCalifornia by the Of ce of Statewide Health
Planning and Development paints ahealthcare sector that is becomingincreasingly lucrative, even though few newaccommodations have been added statewideover the past decade.
According to the OSHPD study, net incomeamong California’s long-term care operatorsincreased more than six-fold between 2003and 2007, to nearly $448 million from $70million. About $250 million of that increase isdirectly attributable to patient care, accordingto OSHPD.
Meanwhile, revenue for long-term carefacilities grew at an 8.2% annual rate during
that period, compared to just 7.1% for acutecare hospitals.
However, the number of facilities thatprovide long-term care declined slightly, fro
1260 in 1997 to 1,215 today. Overalloccupancy rates grew from 80% to 75% duthat same period.
OSHPD attributed the growth in revenueand protability to the passage of AB 16292004. That bill increased Medi-Calreimbursement rates for long-term care. Theslow growth of the facilities occurred even athe number of Californians over the age of 7increased nearly 10% between 2003 and2007.
The OSHPD report attributed thediscrepancy to improved health among theelderly and the availability of less-costly
alternatives such as adult day care.
OSHPD: LTCs Outstripping Acute CarProfit, Revenue Growth Is Topping That of Hospital
The healthcare industry faces anunprecedented opportunity to transformdelivery by helping providers adopt andmeaningfully use electronic medicalrecords (EMRs) to improve quality,efficiency and safety.! !However, there are two critical barriersproviders often site when asked aboutadopting EMRs: !1. Cost and lack of a businesscase to invest their money inpurchasing EHRs.!Starting in 2011, Medicare andMedicaid physicians who showthat they are using EMRs in ameaningful way will be eligiblefor up to $63,750 in incentives,and hospitals will be eligiblefor several million dollars. !According to the Medical GroupManagement Association, EMRpurchase and implementation costsaverage $32,606 per physician, plusan additional $1,177 in monthlymaintenance costs, so this may sound
like a good deal. However, this doesn’ttake into account lost productivity whileemployees are learning how to use thesystem.While these federal incentives will offsetsome of the expenses of implementing anEMR system, the government’s current all-or-nothing approach to meaningful use,may not be enough to convince providersto move forward.Broad adoption and use of EMRs couldyield $261 billion in health care savingsover the next 10 years, according to aMay 2010 report published by the
Commission on U.S. Federal Leadership inHealth and Medicine.But, the savings won’t be realized byproviders alone. Rather, successful EMRimplementation will also benefit federaland state governments, patients,employers and health plans.Since many of the benefits and costsavings resulting from use of EMRs willultimately be realized by public andprivate payers, they should do more tohelp build a strong business case for
providers to adopt EHRs. !This could be in the form of offering
providers incentives for adopting and usinEMRs to improve health care, or other wahelping defray adoption costs. Medicaidproviders in particular have limitedopportunities to earn pay for performanceincentives. Strengthening financial incent
would go a long way towardbuilding a stronger businesscase and a positive ROI.!!2. Providers’ lack of expert
and time to select, purchaseimplement and maintain EHsystems.!Two new Regional ExtensionCenters (RECs) have beenestablished to help provider
California work through thesechallenges and adopt and use EHRa meaningful way. They are theCalifornia Health InformationPartnership & Services Organizatio(CalHIPSO) and theHealth Information Technology
Extension Center for Los Angeles (HITEC-RECs such as these will be particularlybeneficial to small practice providers whoaren’t part of larger organizations that canhelp them through the implementationprocess. Services will include education asharing best practices, HIT needsassessments, EMR vendor selection and gpurchasing, EMR implementation and praredesign, training and ongoing technicalassistance, and more.!
Whether we’re ready for it or not, EHRsgoing to be a part of the future of health cSmart health plans will start working with
providers now on how to make the transita win-win for all.
OPINION
More Barriers Than Success For EMR Money And Time Are Hindrances, But RECs May Hel
