Jim Schibanoff, Editor-in-Chief of Milliman Care Guidelines; Ron Sims, King County Executive; and Mike Kreidler, Washington State Insurance Commissioner, give their final thoughts at Healthcare Town Hall.
Q: We just have a few minutes left. I’d like to use them to ask you to think for a moment: Is there anything here that you think is important to say about electronic health records that didn’t get said or any final thought you’d like to leave our audience with here in the hall and on TVW?
Jim Schibanoff: Well, I don’t think we’ve touched on the research potential of the electronic health record databases. At huge institutions like Kaiser and the VA, they use EHR as a research tool to look for things like complications of drugs. The best example is, there was this new pain medicine, COX-2, C-O-X 2, that replaced a pain medicine that caused intestinal bleeding. So these COX-2 inhibitors were the great development in pain relief. At Kaiser, they found that, with their very large databases, they found that COX-2 inhibitors caused heart attacks, and most of them were taken off the market. And it was through the power of these very large databases that they became a tremendous research tool, and I think this whole field holds great promise for our research frontier.
Mike Kreidler, John Hammarlund, George Scriban, Scott Armstrong, and Ron Sims discuss EHR as a catalyst for healthcare reform, responding to a question submitted by Cody Augdahl.
For submitting this question, Cody Augdahl is a finalist in our question contest. Congratulations, Cody.
Q: I have another question that came from someone who submitted one before the event; it was submitted via e-mail. It’s kind of an interesting question. It asks us to imagine the day when, in fact, a majority of the U.S. population has adopted personally controlled health records. What kind of impact would that have more broadly on the system potentially, do you think? I mean, it’s a little bit hard to put ourselves out there and imagine the circumstance, Mike, but could you see how that might be a catalyst for other change?
Mike Kreidler: I think you need a great deal more transparency in the system than you have right now, and that’s one of the real problems. You can’t even do any accounting in the system right now because of the variation that you have.
Mike Kreidler, Washington State Insurance Commissioner, discusses Electronic Health Records.
Q: Mike Kreidler, I don’t want to overstate things, although when I was a journalist that was my job, but when we talk about electronic health records, are we to some extent talking about rearranging deck chairs on the Titanic?
Q: Gail Graham, in the case of the V.A., who owns the patient records in your system?
Gail Graham: Well, by statute, V.A., as the custodian of the record. But the information is actually owned by the patient, and the control and the release of that information is owned by the patient. We do have legal parameters for how we keep it and the duration for which we keep it. But disclosures of that information are established in the Privacy Act and in HIPAA. And I think for us, too, our patients have a long history of maintaining a copy of their record that dates back to their military service. So even before provisions of HIPAA allowed for amendment and getting copies of your records, it was a very commonplace thing for the veterans to keep a copy of their medical record as they moved around.
Who owns electronic health records? Gail Graham of Veterans Affairs, Washington State Insurance Commissioner Mike Kreidler, and King County Executive Ron Sims discuss the question of ownership and how electronic health information can and should be used.
“With so much focus being placed on hospitals and clinics implementing electronic patient information systems, what – if anything – can state and/or federal government do to help support/alleviate the sometimes significant amount of time it takes physicians and clinicians to learn and become proficient at using a clinical information system – thus amounting to less time for patient care during that learning-curve period?”
For submitting this question, Ed Boyle is a finalist in our question contest. Congratulations, Ed.
Q: What can the state and/or federal government do to help physicians learn the clinical information systems without detracting from patient care?
Mike Kreidler: The answer is “yes, there is.” We’re working on administrative simplification so that physicians and payers can process claims in a timely fashion in a common format. The current system is antiquated. Even the rules that have been put forth for the various coding (by federal definition) have significant variations. There are format interpretation differences between one carrier or another. You’ve got to standardize that. Continue reading →