17 June 2010
California Edition
Calendar
June 23
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E-Mail
info@payersandproviders.com with
the details of your event, or call
(877) 248-2360, ext. 3. It will be
published in the Calendar section,
space permitting.
EMR Security Becomes Vexing Issue
Logistics, System Designs Contribute To Basic Lapses
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 of
Public 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 CDPHs deputy director of its Health
Care Quality division.
However, the CDPHs own records
suggest and privacy experts conclude that
patients have quite a lot to worry about.
The patient medical record breaches
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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 patients 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, Texas.
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
Yuba 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
Rideouts staff had received about
Continued on Next Page
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In Brief
Inland Empire RHIO
Effort Selects
Consultant
The edging group trying to form a
regional health information
organization in the Inland Empire has
grown to 20 participating members
and has selected a Walnut Creek-
based consulting rm to assist in its
progress.
Object Health was selected among
several bidding rms to guide the
Inland Empire Health Information
Technology Coalition, according to
Christina Bivona-Tellez, regional vice
president for the Hospital Association
of Southern California.
Object is headed by Lori Hack, who
previously served as the interim chief
executive ofcer at the now defunct
California Regional Health Information
Organization.
Bivona-Tellez said the IEHITC and
Object would move forward toward
the creation of a RHIO, although no
timetable has yet been set.
Bivona-Tellez noted that the fact
that so many disparate constituencies
have joined the coalition including
hospitals, insurers and medical groups
was a positive sign.
We havent been the most
collaborative group in the past,
Bivona-Tellez said. This portends
well.
Survey Reveals
Discontent Among
Hospital Workers
Forty-ve percent of hospital
employees feel distanced from or
discontented with their work,
according to a new survey by Press
Ganey Associates.
The survey of more than 235,000
employees at nearly 400 hospitals
nationwide found that those working
closest to patients are the least likely to
be satised as employees.
Continued on Page 3
NEWS
EMRs (Continued from Page One)
maintaining patient confidentiality,
according to CDPH records.
Carl Kesselman, director of the Center
for Medical Informatics at the University
of Southern California, wasnt surprised
about such a lapse. These (hospital)
workstations often have the most
rudimentary security, he said.
Peel noted that the failure to logout
from an EMR system is a common issue.
These users often have to go through a
gauntlet of complex passwords and login
screens, so they just keep it open, she
said. Or, they write it down their user
names and passwords and then lose them,
which winds up in someone elses hands.
Most hospital employees sign
agreements swearing not to disclose or
inappropriately access patient records.
However, some ignore them when it
becomes inconvenient, as was the case
with the overly curious radiology
technician.
That was also the case involving Enloe
Medical Center in Chico, which was fined
$130,000 when seven people including
employees of an outside collection agency
and administrative assistants for local
physicians accessed the medical records
of a high profile admission, according to
CDPH records. At least two of those
people had admitted to signing
confidentiality agreements regarding
access to medical records. Enloe did not
have a policy in place regarding the risks
associated with off-site businesses having
access to the records.
The breach is particularly awkward for
Enloe. Just a few months before it was
discovered, Carefx, an Arizona-based firm
that distributes and installs
interoperability software products,
trumpeted the 382-bed hospital as its
latest client. This (system) aligns relevant
patient data across multiple applications
to provide clinicians with a complete view
of a patient's health history, Carefx
announced in a press release.
An Enloe spokeswoman was not
immediately available for comment.
A situation similar to Enloes occurred
at Ronald Reagan UCLA Medical Center,
when two hospital employees and two
outside contractors accessed the
information of a deceased patient out of
curiosity, despite acknowledging it
violated agreements they had signed to
keep information confidential. The
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Page 2
hospital was fined $95,000 for the
incident.
UCLA is no stranger to such breaches;
a former employee pled guilty in 2007 to
accessing patient records in order to sell
them.
Billingsley noted that there likely to be
some technological changes in the
coming years to better safeguard hospital
EMRs.
You are likely to have systems in
place that show warnings if someone is
about to inappropriately access records,
she said.
Peel scoffed at such a safeguard. Pop-
up screens and warnings are not
deterrents, she said, adding that systems
should be redesigned to only allow
access to caregivers previously
authorized by the patient.
Kesselman noted that there systems
available to better safeguard patient
records, but hospital managers are often
daunted by installing them, either
because of their cost, or the fact they can
be too restrictive.
It imposes additional administrative
overhead, and, there are always
complexities, he said. If you shut
everyone out of the system without prior
consent, what do you do in an
emergency situation? What kinds of
overrides should you have in place? And
who would get to override them?
Peel also slammed the major vendors
of hospital EMR systems for being slow to
implement such safeguards.
Theyve made billions of dollars off of
these defective products, so why should
they change them now? she asked,
adding that there may be some concerns
that too many safeguards may make it
more difficult for hospitals to use patient
data for fundraising or other marketing
purposes.
In the meantime, the volume of
penalties and fines levied by the CDPH
for patient security breaches is likely to
swell. Billingsley disclosed last week that
there have been 3,766 cases of potential
breaches reported to her agency between
January 2009 and the end of last month.
The CDPH is currently investigating 324
cases. Another 1,489 are pending.
One would think you would have to
start locking down this stuff better,
Kesselman said.
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In Brief
We found hospital employees
want to be recognized for excellent
work, but they also want to be
involved in the decision-making
process and have the opportunity to
provide input on issues directly
affecting their work, so they feel
empowered to do their jobs, said
Deirdre Mylod, Press Ganeys vice
president of hospital services. It is
critical for hospitals to take
considerations like these into account
when planning employee relations
initiatives.
Thomson Reuters Maps
Out $3.6 Trillion in
Healthcare Savings
A new white paper by Thomson
Reuters concluded that the U.S.
healthcare industry can save $3.6
trillion over a decade through a
variety of measures aimed at
reducing inefficiencies.
"Last year, we published a
report concluding that the U.S.
healthcare system wastes $700
billion a year," said Bob Kelley,
vice president for healthcare
analytics at Thomson Reuters and
co-author of the paper. "This new
report describes a possible path for
significantly reducing that waste."
The white paper
recommended that consumers be
more broadly engaged in their
healthcare decisions, better
coordinate care, use checklists to
eliminate medical errors and move
to eliminate fraud.
It is reasonable to set a goal
of constraining healthcare
spending to its current share of the
GDP, said Ray Fabius, M.D., chief
medical officer at Thomson Reuters
and the white papers co-author.
The white paper may be
accessed at
www.factsforhealthcare.com.
NEWS
SCAN Ramps Up Internet CME Hours
Response to Growing Shortage of Geriatricians
Bracing for what is expected to be a
worsening shortage of geriatricians, SCAN
Health Plan is turning to the Internet to
help educate primary care physicians to
better take care of the Long Beach-based
insurers aging enrollees.
SCAN, which covers 130,000
Medicare Advantage members, is in the
process of introducing a dozen core
courses on geriatric care that its physician
network may access in lieu of continuing
medical education credit. The courses,
which range from one to two hours in
duration, are being offered free of charge.
The online curriculum focuses on such
age-specic topics as managing patient
care to prevent falls and such age-related
ailments as chronic kidney disease,
congestive heart failure and chronic
OSHPD: LTCs Outstripping Acute Care
Profit, Revenue Growth Is Topping That of Hospitals
A new study of long term care facilities in
California by the Ofce of Statewide Health
Planning and Development paints a
healthcare sector that is becoming
increasingly lucrative, even though few new
accommodations have been added statewide
over the past decade.
According to the OSHPD study, net income
among Californias long-term care operators
increased more than six-fold between 2003
and 2007, to nearly $448 million from $70
million. About $250 million of that increase is
directly attributable to patient care, according
to OSHPD.
Meanwhile, revenue for long-term care
facilities grew at an 8.2% annual rate during
that period, compared to just 7.1% for acute
care hospitals.
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Page 3
obstructive pulmonary disease. They will be
taught by geriatricians and other specialists
from Ronald Reagan UCLA Medical Center
and other medical institutions.
It is sort of our response to the dearth of
geriatricians, said Russell Brower, M.D.,
SCANs medical director and chair of its CME
department.
The shortage is a daunting one there is
about one geriatrician practicing in the U.S. for
every 5,000 patients over the age of 65. Less
than a dozen of the nations nearly 150
medical schools have a department of
geriatrics, which is among the lowest-paid
specialties in the medical profession.
Although Brower noted that SCAN has
offered CME lectures in person, the Internet
offerings are hoped to be convenient enough
to spur greater interest.
However, the number of facilities that
provide long-term care declined slightly, from
1260 in 1997 to 1,215 today. Overall
occupancy rates grew from 80% to 75% during
that same period.
OSHPD attributed the growth in revenue
and protability to the passage of AB 1629 in
2004. That bill increased Medi-Cal
reimbursement rates for long-term care. The
slow growth of the facilities occurred even as
the number of Californians over the age of 75
increased nearly 10% between 2003 and
2007.
The OSHPD report attributed the
discrepancy to improved health among the
elderly and the availability of less-costly
alternatives such as adult day care.
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Payers & Providers
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OPINION
More Barriers Than Success For EMRs
Money And Time Are Hindrances, But RECs May Help
The healthcare industry faces an
unprecedented opportunity to transform
delivery by helping providers adopt and
meaningfully use electronic medical
records (EMRs) to improve quality,
efficiency and safety.! !
However, there are two critical barriers
providers often site when asked about
adopting EMRs: !
1. Cost and lack of a business
case to invest their money in
purchasing EHRs.
! and time to select, purchase,
Starting in 2011, Medicare and
Medicaid physicians who show
that they are using EMRs in a
meaningful way will be eligible
for up to $63,750 in incentives,
and hospitals will be eligible
for several million dollars. !
According to the Medical Group
Management Association, EMR
purchase and implementation costs Batchlor, California Health Information
average $32,606 per physician, plus
an additional $1,177 in monthly
maintenance costs, so this may sound
like a good deal. However, this doesnt
take into account lost productivity while
employees are learning how to use the
system.
While these federal incentives will offset
some of the expenses of implementing an
EMR system, the governments current all-
or-nothing approach to meaningful use,
may not be enough to convince providers
to move forward.
Broad adoption and use of EMRs could
yield $261 billion in health care savings
over the next 10 years, according to a
May 2010 report published by the
Commission on U.S. Federal Leadership in
Health and Medicine.
But, the savings wont be realized by
providers alone. Rather, successful EMR
implementation will also benefit federal
and state governments, patients,
employers and health plans.
Since many of the benefits and cost
savings resulting from use of EMRs will
ultimately be realized by public and
private payers, they should do more to
help build a strong business case for
!!!"#$#!%&!'(&)*+!,!'*-./0)*+!'1%2/+3/456!778
Page 4
providers to adopt EHRs. !
This could be in the form of offering
providers incentives for adopting and using
EMRs to improve health care, or other ways of
helping defray adoption costs. Medicaid
providers in particular have limited
opportunities to earn pay for performance
incentives. Strengthening financial incentives
would go a long way toward
building a stronger business
case and a positive ROI.!
!
2. Providers lack of expertise
implement and maintain EHR
systems.
!
Two new Regional Extension
Centers (RECs) have been
established to help providers in
By California work through these
challenges and adopt and use EHRs in
Elaine a meaningful way. They are the
Partnership & Services Organization
M.D.
(CalHIPSO) and the
Health Information Technology
Extension Center for Los Angeles (HITEC-LA.!
RECs such as these will be particularly
beneficial to small practice providers who
arent part of larger organizations that can
help them through the implementation
process. Services will include education and
sharing best practices, HIT needs
assessments, EMR vendor selection and group
purchasing, EMR implementation and practice
redesign, training and ongoing technical
assistance, and more.!
Whether were ready for it or not, EHRs are
going to be a part of the future of health care.
Smart health plans will start working with
providers now on how to make the transition
a win-win for all.
Elaine Batchlor is the Chief Medical Officer
for L.A. Care Health Plan. She is a member
of the Payers & Providers Editorial Board.
Op-ed submissions of up to 600 words are
welcomed. Please e-mail proposals to
editor@payersandproviders.com, or call
(877) 248-2360, ext. 3.
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