Thursday, April 26, 2012

A Serious Commentator Makes Some Smart Points About Responsibility and Consultation In E-Health System Delivery.

Joseph Conn - reporter and blogger at Modern Medicine in the US - who has been reporting on all this for decades has got a bee in his bonnet. I think he is spot on.
The first blog is here:

IT Everything

A witness to history in healthcare information technology.
By Joseph Conn

A bad blueprint for behavioral-health records

Earlier this month, the Colorado Regional Health Information Organization released what its authors must hope will become a blueprint for sharing behavioral-health records via health information exchanges.
I hope not.
The 34-page report, "Supporting Integration of Behavioral Healthcare through Health Information Exchange" (PDF), is part of CORHIO's Behavioral Health Information Exchange Project.
The project erroneously supposed that patient consent laws are "barriers" to exchange. In fact, these laws are the opposite. They're vital foundations to sharing accurate patient records.
For its project, CORHIO rounded up the usual "stakeholders" at six focus groups around the state. That’s how it's done—wrapping "consensus" around a policy—in this case, to eliminate patients' rights to control their behavioral health records.
The feds have quietly supported multiple efforts to wipe out state consent laws, but they want to do it without the clamor of seeking pre-emptive federal legislation. I'll talk about that tomorrow. In the CORHIO case, it meant ending Coloradans' control over the movement of their mental-health records.
Colorado once had a stringent privacy law in its Mental Health Practice Act. Like similar patient privacy laws in multiple states, it barred Colorado mental-health professionals from disclosing "any confidential communications made by the client, or advice given to the client" without patient consent.
More here:
Here is the second bite at the same issue.

More on the folly of removing patient consent protections

Previously, I blogged about the Colorado Regional Health Information Organization's blueprinton how patients' behavioral-health records might be linked to other medical records in health information exchanges.
The word "barrier" in the CORHIO report in referencing patient consent laws sounded familiar. A scan of our archives reminded my why.
In 2002, HHS rewrote the Health Insurance Portability and Accountability Act privacy rule, eliminating patient consent as a requirement for most healthcare records disclosures.
In 2005, HHS awarded a $17 million contract to RTI International and the National Governors Association with the aim, in part, to provide ammunition for then-Rep. Nancy Johnson (R-Conn.), whose health information technology bill called for federal pre-emption of state privacy laws in favor of one uniform federal law.
Johnson's bill enjoyed broad health IT industry support. I was in Washington in mid-2006 for a Healthcare Information and Management Systems Society-sponsored IT summit that dispatched more than 400 IT users to lobby their legislators for it. The bill included a HIPAA amendment to pre-empt state consent laws.
But pre-emption was stripped out by the House Energy and Commerce Committee, chaired by Rep. Joe Barton (R-Texas). Johnson's bill, and her political career, soon died.
Undeterred, RTI and the NGA pushed on with dozens of state committees, including one in Colorado. Each was presented with an RTI-delivered framework that presumed state patient consent laws were "barriers" to health information exchange and that tilted toward removing—not accommodating—them.
To be sure, improving health information exchange is a worthy goal, and the CORHIO folks, citing the opinions of its focus group members, listed the many advantages of adding behavioral health records to HIEs. The same benefits are so often cited by proponents of records exchange that they don't need repeating here.
Full blog here:
There are two important points here:
First - and less important to a degree are the comments on dodgy consultation in e-Health. Boy have we seen a lot of that here.
Second - and most important is this paragraph.
“Providing safe, high-quality, high-value healthcare services requires patient consent. For patients who have conditions that could stigmatize them, cost them a relationship or a job or prevent them from obtaining affordable health insurance if their medical records were not kept private, the right of consent is akin to the right of social and economic survival. Without security and control, patients will lie or withhold information even more than they do now, which is often.”
All I can say is never was a truer word written.  I hope the proponents of the NEHRS realise this is just as true in Australia as it is in the US.
Thanks Joseph!  Well put indeed.