Friday, June 09, 2006

HR 4157: Electronic Health Records Debate

[Cartoon by Steve Greenberg, posted with artist's permission.]

Nick Meyers, the APA Director of Government Relations, sent the following memo out yesterday, alerting psychiatric physician members about pending national legislation on electronic medical records and their impact on privacy and confidentiality of personal health information. I'll try to post more on this later, but in meantime, contact your Senators and Delegates to let them know that privacy is important to you, and that you want to be notified if there is a breach in the confidentiality of your records (see latest VA fiasco here or here or here).

This afternoon, the House Energy and Commerce Health Subcommittee approved its version of legislation to facilitate the development of a national health information technology infrastructure (H.R. 4157). The Subcommittee action follows approval of a different version of the bill by the House Ways and Means Health Subcommittee, whose Chairman, Nancy Johnson (R-CT), is the lead sponsor of the bill.

As approved by the two Subcommittees, both bills codify the Office of the National Coordinator for Health Information Technology (ONCHIT), lay out broad policy goals for the establishment of a nationwide interoperable health information technology infrastructure, and include important “safe harbors” to the Stark II anti-kickback law as the HIT system is developed. The goals of the national HIT system include the promoting of health care quality, reducing medical errors, improving efficiency, facilitating portability of patient information by patients, and promoting health care research. The Ways and Means bill includes as a goal that the national HIT system “ensures that the confidentiality of individually identifiable health information is secure and protected.” The Energy and Commerce bill requires that the system is “consistent with legally applicable requirements with respect to securing and protecting the confidentiality” of patient records.

The Ways and Means bill as introduced included a study of privacy that opened the door to possible weakening of current privacy protections, and would have allowed the Secretary of HHS broad latitude in acting by regulation to “harmonize” privacy laws in a way that could have undercut existing HIPAA rules protecting state privacy laws that were stronger than HIPAA’s basic requirements. APA, both individually and in conjunction with the American Medical Association and mental health groups including the American Psychological Association and the American Psychoanalytic Association, has always sought to include the strongest possible privacy protections as one of the essential elements of any national HIT system. We met personally with Chairman Johnson and her key health staff to outline our concerns and to offer constructive suggestions about how the bill’s privacy language could be improved. With her support, our efforts resulted in an extensive reworking of the bill as approved by the Subcommittee. While not perfect, the changes are a very substantial improvement, and Chairman Johnson certainly deserves thanks for her efforts. A more detailed analysis of the changes is forthcoming.

The bill approved by the Energy and Commerce Health Subcommittee explicitly protects the current HIPAA “non-preemption” language that ensures that stronger state privacy laws will remain in force. While this is an important acknowledgment, additional work is needed to protect patient medical records, as evidenced by recent revelations of data and record loss in the VA system and DOD, among others. During Subcommittee debate, Democrats proposed an amendment that sought to strengthen the enforcement of existing privacy protections and require a privacy breach notification. The amendment failed by a vote of 10 to 12.

What’s next? Next Tuesday, the full Energy and Commerce Committee will consider its amendment to H.R. 4157. We also expect the full Ways and Means Committee to consider the bill as soon as next week. If the two bills continue to have major differences, they will have to be reconciled presumably in the House Rules Committee. Since the House GOP leadership has designated the week of June 18 as “Health Week” it seems very likely that HR 4157 – however amended – will be a centerpiece of the week’s activities.


ClinkShrink said...

Will people be able to opt out of this national health information system? And what happens when law enforcement decides to subpoena aggregate data to investigate patterns of national drug abuse? Or infectious diseases? Or physician's prescribing of controlled substances? The last thing I would worry about is some outside person hacking into the system or losing my personal information. I'd be much more worried about how the government will use the information it legitimately has access to.

Anonymous said...

I wish I had seen this post sooner! I skip this blog for a few days and look what happens! haha! I need to quit being a slave to work so I can get re-addicted to blogs. :-)

Anyways, my line of work deals specifically with privacy and is connected (in a way) to Health IT systems. First of all, the electronic health records are going to be voluntary for people in the private sector. At first, it will only affect those in the government’s system such as military personnel (always the guinea pig!). Everything I’ve been reading on the many proposed bills, states that it will not be mandatory for people to participate. You can stay doing things the old fashioned way. And if you think about it, doctors in private practice are going to have a very hard time affording the technology that will be required. There is a lot of debate going on right now on how to help the solo practitioners make use of electronic records.

I could go on and on and on and on about this subject, but I’ll spare all of you the novel. But it’s really interesting to read the pros and cons to electronic health records. The points you bring up are very valid and Congress is going to have to address these issues in some way. Right now HHS is in the process of creating rules and guidelines for the health side of things. Congress will probably need to address the law enforcement aspect. I have a spreadsheet tracking all the different Health IT related bills, but it's on my other computer so I can't give you which bills are addressing these kinds of issues. Sorry.

ClinkShrink said...

Thanks Jennifer; please stay in touch and keep us updated.

Anonymous said...

Who knows if you'll even see this comment, but to update you, this article just came out:

Opt in or opt out of NHIN? Committee can't decide

It's also a really good website if you want to keep up with what our government is doing with health IT issues.

Anonymous said...

thanks, I'll forward your comment to Roy...

Anonymous said...

None of the links to the VA situation seem to work.

Sunny CA said...

The last thing I'd want is my psych record in a digital data bank.