Tag Archives: electronic medical records

Covering cybersecurity as breaking news and a long-term health care story

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health IT since the late 1990s for a variety of publications.

Photo: Marcie Casas via Flickr

Photo: Marcie Casas via Flickr

Cyberattacks on hospitals and health insurers have become a regular occurrence – and breaking news in communities where the breaches take place.

A new tip sheet on health care cybersecurity seeks to help reporters who find themselves covering a cyberattack at their local hospital, medical group or health plan. Typically, the attacked entity will issue a press release with the number of affected patients, approximate date of the attack and response. Continue reading

How close are we to meeting the promise of electronic health records?

Carla K. Johnson

About Carla K. Johnson

Carla K. Johnson (@CarlaKJohnson) is a medical writer at The Associated Press and has covered health and medicine since 2001. A former member of AHCJ's board of directors, she leads the Chicago AHCJ chapter.

Photo: Carla K. JohnsonA panel of experts discusses health information technology at an AHCJ Chicago chapter event on March 3 in Chicago. From left: Dr. Arnold “Ned” Wagner Jr., chief medical information officer, NorthShore University HealthSystem; Dr. Diane Bradley, senior vice president, chief quality and outcomes officer, Allscripts; Eric Yablonka, vice president and chief information officer, University of Chicago Medicine; and moderator Neil Versel, an independent journalist.

Photo: Carla K. JohnsonA panel of experts discuss health information technology at an AHCJ Chicago chapter event on March 3 in Chicago. From left: Dr. Arnold “Ned” Wagner Jr., chief medical information officer, NorthShore University HealthSystem; Dr. Diane Bradley, senior vice president, chief quality and outcomes officer, Allscripts; Eric Yablonka, vice president and chief information officer, University of Chicago Medicine; and moderator Neil Versel, an independent journalist.

Yes, technology is transforming health care. No, we haven’t come anywhere close to realizing the vision.

Smooth patient handoffs, data-driven performance improvement and real-time analytics are still mostly dreams, although those ambitions have been talked about for years.

Independent journalist Neil Versel, who specializes in health information technology, moderated a panel on March 3. The AHCJ Chicago chapter event was held at AMA Plaza, the new headquarters of the American Medical Association.

Electronic medical record systems “need to play nicer together so they can use each other’s information as if it was natively generated,” said Arnold “Ned” Wagner Jr., M.D., chief medical information officer of NorthShore University HealthSystem. “Can we talk to each other transparently? Well, partly. The success of communication depends on human behavior and (technology’s) job is to help understand the reality of what motivates people to do things.” Continue reading

Electronic records raise privacy concerns

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

On Bloomberg’s Tech Blog, Jordan Peterson has been regularly hammering away and exposing, piece by piece, the privacy concerns that could arise from widespread adoption of electronic medical records. His latest piece addresses medical identity theft, and opens with a simple explanation of just how serious it can be.

Webcast: The status of health IT in your community

Farzad Mostashari

Join us online on Tuesday, Aug. 7, at noon ET for an exclusive on-the-record conversation with Farzad Mostashari, M.D., national coordinator for health information technology, and other officials with the HHS Office of National Coordinator for Health Information Technology.

View and learn how to use an updated “Health IT Dashboard” to find local-level information about where Federal Recovery Act dollars are being spent on health IT programs, the percentage of doctors and hospitals adopting electronic health records, and how many doctors and pharmacies are using electronic prescribing tools.

This is an AHCJ members-only opportunity to learn about health IT and its impact on providers and patients in their own communities.

If your credit card is stolen, it may take a few minutes on the phone with the bank to reverse the fraudulent charges.
But if your identity is stolen and used for medical treatment, it could take a year or longer to undo the damage, a new study released today found. Victims may also get dropped by their insurance provider and end up paying the imposter’s bills just to make the problem go away, potentially to the tune of $100,000 or more.

According to the study, which was commissioned by an identity theft protection outfit, 1.85 million people could be affected by medical ID theft, which is estimated to cost the U.S. economy $41.3 billion this year. According to the article, 41 percent of respondents lost their insurance as a result of the theft, and 45 percent said they simply paid the fraudulent bill in order to make the problem go away rather than commit to the yearlong process of properly resolving it.

And, most, remarkably, Robertson writes, “Thirty-one percent of the survey respondents said they let family members use their information to obtain medical care, up from 26 percent last year. Most said it was because their family members were uninsured, couldn’t afford care or were experiencing a medical emergency.”

Other relevant posts in the ongoing series include:

Essential component of reform will require more staff, training

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

When we think about the growing demands health reform will place on community health centers (assuming that we are thinking about community health centers at all – and we should be) we tend to think about the shortage of primary care doctors in underserved communities, and the increasing numbers of soon-to-be-insured patients needing such care.

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

According to the National Association of Community Health Centers, about 20 million patients get their primary health care needs at more than 8,000 U.S. locations. I’ve seen various projections of how that will grow under health reform (depending on fun ding and other factors) but the NACHC says it could double, to 40 million, within another five years.

There’s another aspect to the community health center workforce – one that, frankly, I had never thought about until I got a release about a set of grants a few weeks ago from a small foundation that focuses on community health. The clinics don’t just need doctors and nurses. They need people who can just run the places – who can make appointments and keep records, and do the coding and billing, and handle the health IT, and do health outreach in the community, and the case management. And they need people who speak a bunch of languages and be culturally sensitive. In other words, they need all kinds of people who can do the work necessary for these clinics to become effective “medical homes.”

So the RCHN Community Health Foundation recently announced grants of about $150,000 to $200,000 each to five very different community health groups, in five quite different settings. (On the foundation’s home page you can find links to some of the coverage it has gotten.)

  1. Aaron E. Henry Community Health Services Center, Clarksdale, Miss.
  2. Charles B. Wang Community Health Center, New York
  3. Penobscot Community Health Care, Bangor, Maine
  4. Seattle Indian Health Board, Seattle
  5. Wai’anae Coast Comprehensive Health Center, Wai’anae, Hawaii

The details vary, but they are developing training programs (which can be done during the work day), partnerships with local schools, community and four-year colleges, internships, outreach to potential entry-level workers who hadn’t thought of this career path, worker retention programs – with an eye both toward their own needs, their workers’ future advancement, and job creation in their communities, including veterans. In some cases, they will be designing their resources and programs with a clear eye toward having them spread, to be available and useful to other clinics, other communities.

Chances are, you won’t be covering these five specific clinics. But the challenges these grants are aimed at exist everywhere and are ripe material for covering:

  • How are clinics in your areas preparing – not just expanding physically (there was a lot of money in the 2009 stimulus package for that), but how are they expanding in other, qualitative dimensions?
  • Have they begun the transition to medical homes?
  • Have they installed electronic medical records? (They are doing so at a faster pace than many more resource-rich practices.)
  • Who is working for them?
  • How are they being trained – and retained – for the coming changes in the delivery and financing of health care?

You – and your reader, listeners, and viewers – may be quite surprised by some of the innovative, change-embracing answers.

How might retail clinics change health care delivery in your community?

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org.

I don’t routinely blog about the work of AHCJ board members (which doesn’t mean you shouldn’t read Charles Ornstein’s latest on Florida’s slow reaction to physicians who treated and prescribed drugs under Medicaid “amid clear signs of possible misconduct.”)

But I’m making an exception to my self-imposed rule for Julie Appleby’s recent Kaiser Health News piece “The Walmart Opportunity: Can Retailers Revamp Primary Care?

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

I’ve read other pieces about the future of retail clinics, including their potential for treating chronic disease. But I thought Appleby did a terrific job of asking – and often answering – many interlocking questions about the delivery of primary care, the management of chronic disease, the quality of care and what this all has to do with health reform.

While asking big-picture questions, she also wove in details that gave the story texture and made it a good read. If you saw my tweet, you’ll know I was particularly taken by the bit about how long-distance truckers can pull up in the parking lot of more than 600 centers to get their mandatory federal checkups.

As Appleby noted, the clinics – which sometimes lose money but bring customers into the stores – started with the low-hanging fruit, the “relatively healthy patients looking for convenient, low-cost care for simple problems.” The next stage is to try to start treating more expensive chronic diseases, such as diabetes and heart disease, which are big drivers of health care spending. Treating chronic disease, however, is definitely a problem in search of a primary care solution. As her story said:

“It’s sad that the existing health care establishment has not figured out a way to make primary care affordable and accessible,” says Jerry Avorn, a professor of medicine at Harvard. “We should not be surprised if someone outside of our world comes in and does it for us.”

Some of the retail clinics are already venturing into aspects of chronic care: diabetes management, weight-loss programs. (I think we can safely say that primary care physicians have not solved the U.S. obesity problem). Some employers are using the clinics for wellness and routine screening programs.

The costs tend to be lower. Appleby cited a study in the American Journal of Managed Care that costs are 30 percent to 40 percent lower than in the doctor’s office and 80 percent cheaper than in the emergency department. Consumers like the predictability and transparency of the costs (although insurance can also pay) . They don’t get pricing clarity up front at the doctor’s office or hospital.

Several provisions of the federal health law may further spur interest in the clinics. For instance, small businesses will have incentives to offer worker wellness program. The clinics may help fill in some gaps in primary care which are expected to get worse before they get better because of the pent-up demand for care that may burst out when coverage expands under the health law starting in 2014. The Association of American Medical Colleges estimates a shortfall of 21,000 primary care doctors by 2015. Not everyone agrees that there is an across-the-board shortage, as opposed to a shortage in specific underserved areas.

How clinics make the jump from flu shots and throat cultures to the far more complex task of monitoring chronic disease is not completely clear. Remember that patients, particularly older patients, often have multiple chronic diseases (i.e. diabetes and hypertension and congestive heart failure and arthritis, etc.). Some questions remain: Will the clinics turn out to be good at managing relatively stable patients in the early stage of disease – where the convenient locations and evening and weekend hours may enhance compliance? What about with the more advanced illnesses? Will the retail clinics add to fragmentation and miscommunication? Or will the clinics somehow form relationships with “new, integrated collaborations between doctors, hospitals and insurers?”

I don’t want this post to get longer than Appleby’s article so, when you read it, pay attention to the other issues she raises, and think about how they are playing out in your community:

  • Scope of practice. What is the role of nurses/nurse practitioners/physicians assistants versus physicians? Turf battles can produce good sources and good stories.
  • Does your state have laws about clinics directly employing physicians?
  • Will clinics “skim off” healthy patients from physician practice and leave them with all the sickest and most expensive ones, without greater reimbursement? Or, by taking on some routine medical tasks, will clinics allow physicians to spend more time doctoring?
  • Who are the patients? (Other than truck drivers and high school students needing sports physicals.) Are clinics just a convenient way for insured middle-class people to get routine care? (I’ve taken my son in for a throat culture at 7 p.m. when he’s feeling scratchy and I know there’s strep in his class. It’s way better than waiting until the next morning to go to the pediatrician when he might be sicker, and he has to miss school and I have to miss work. And, if he does need antibiotics, I’d have to go the drug store anyway.) Or are the clinics avoiding poorer neighborhoods, meaning the underserved stay underserved?
  • Appleby didn’t mention this explicitly but it’s worth adding to the mix: To the extent the clinics are in underserved communities, are they helping low-wage hourly workers who don’t have paid sick leave or the flexibility to take an hour or two off in the middle of the day to get their kid (or their mother-in-law) to the doctor?
  • Are any of the clinics – anywhere – starting to share information with patients’ primary care physicians? Or, in the case of diabetes, heart disease, etc., are they sharing information with specialists? It can be as simply as faxing something, sharing electronic medical records or using secure email. If I take my kid for that throat culture, it’s really not a catastrophe if I forget to tell his pediatrician (and I don’t need to bother if it’s negative). But for things like immunizations, or A1C levels for diabetics, or blood pressure spikes or changes in medications – someone needs to keep track of the big picture. Of course, communication isn’t all that great right now between doctors without the clinics but, since health reform has some incentives for improving coordination, where do the retail clinics fit in?

That question about integration, which Appleby raised, doesn’t yet have a clear answer. Could the clinics end up having some kind of relationship with the “medical home” or the “Accountable Care Organization” or other models of integrated care? I am not sure of all the legal or contractual problems. If someone has written about this, please chime in. But I can envision ways that clinics can be brought into the coordinated or accountable care loop. It may turn out to be in everyone’s interest – patient, physician and clinic – to do the looping.