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Patients can now access all their health records digitally

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Re: Patients can now access all their health records digitally

#91

Post by IG_Semmelweiss »

Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

A larger part is not necessarily the personal thoughts of the doctor - but rather than embarrassment of showing that the clinical note it's actually sometimes a mishmash of copy paste, sometimes done by low-paid wage workers.. Sometimes offshore workers... and yet, all the collected data largely remaines useless information at best, or outright wrong and dangerous at worst.

Re: Patients can now access all their health records digitally

#92

Post by ceejayoz »

antgly wrote: post #45
ceejayoz wrote: post #27

Earlier quoted context omitted.

One of my kids' doctors left their practice, and we followed them to the new. The old practice sent us a letter stating patients were not permitted to do so, and they refused to provide records citing a non-compete. (I had more than one sweary phone call with them over this.) HIPAA has no private right to civil action in these scenarios, so we had to involve the state, and that process took about six months. It's def…

What was it specifically about this doctor that you found it worth to get the state involved? Just curious.

The practice was doing something both wrong and blatantly illegal that impacted my child's continuity of care. That's well worth going to the effort to get them smacked.

Re: Patients can now access all their health records digitally

#93

Post by ceejayoz »

aabaker99 wrote: post #53
ceejayoz wrote: post #27

Earlier quoted context omitted.

One of my kids' doctors left their practice, and we followed them to the new. The old practice sent us a letter stating patients were not permitted to do so, and they refused to provide records citing a non-compete. (I had more than one sweary phone call with them over this.) HIPAA has no private right to civil action in these scenarios, so we had to involve the state, and that process took about six months. It's def…

Im not in a position to produce the section reference right now but the regulation discussed in the comments, 45 CFR, requires providers are able to transfer medical records from the old practice to the new practice.

They were entirely able. They were openly using the records as hostages to attempt to prevent patients from leaving their practice.

Re: Patients can now access all their health records digitally

#94

Post by batty_alex »

Dig1t wrote: post #10

One big limitation of this standard is imaging data. X-Ray radiographs, MRI scans, PET scans, etc are not part of the USCDI standard V1 that'll be available to US patients. The current story for getting these scans still sucks and isn't close to being actually available to patients in the US. The best you can get is a set of DVD's containing that stuff, if you are lucky. The problem is that the protocol used by imagi…

I work on a PACS system. The problem isn’t DICOM, it’s big ass EHRs that don’t need to cooperate with anyone but themselves.

Also, we’ve always had to allow exports in .iso/.zip with a viewer for the image data - going back to 2008. This is mostly forcing the big EHRs to stop playing games with patient data

Calling DICOM ancient is funny, the whole industry has basically been dragging their feet adopting it. FHIR will be “ancient” by the time it’s widely adopted, as well

Re: Patients can now access all their health records digitally

#95

Post by adunsulag »

Before people get their hopes up on this, remember there is no enforcement mechanism currently. OIG has to issue a final ruling on the penalties for HealthIT which I've heard from some insiders could take as long as another year. For providers, a preliminary ruling and then a final ruling has to be made which could take years.

So yes, the law mandates that your entire EHI* designated record set be made available there is NO enforcement mechanism to penalize bad actors at this point in time. Also its important to note that HealthIT and providers can make a claim to continue to block information if it falls under 8 categories (patient privacy, patient harm, financial costs, content exception such as psychotherapy notes, etc). The proposed penalty is 1 million per Information Blocking claim for HealthIT. So HealthIT has a huge incentive once the final ruling is made to make sure there is no information blocking, but providers right now don't have any kind of penalty themselves.

*EHI = Electronic Health Information, note this moves beyond the USCDI V1 standard someone mentioned in another post to the entire Designated Health Record Set including claims, payment information, imaging data, and anything that is used to make a healthcare decision by providers.

* Disclaimer I've done work for an open source EHR and I've been forced to become pretty familiar with this stuff.

Re: Patients can now access all their health records digitally

#96

Post by parineum »

sethammons wrote: post #60
hanklazard wrote: post #44

Earlier quoted context omitted.

“since it means that their personal notes about their patients will be made available directly to the patient, something that was not possible in the past. Doctors often write down their real thoughts about the patient in there and can say some things the patient might not be happy with.” Just when you thought American healthcare couldn’t get worse, our genius leaders have decided to couple full and immediate patient…

"Patient feels nausea when seeing the color yellow; I have proscribed a placebo to gauge the effect." Not something a doc would want the patient to know.

Doctors shouldn't be performing experiments.

Re: Patients can now access all their health records digitally

#98

Post by petilon »

obloid wrote: post #36
petilon wrote: post #21

Earlier quoted context omitted.

My experience is that Doc A sends the thumbnail of the image to Doc B. Doc B is happy that Doc A sent an unusable file because he now gets to charge for a new image. Hospitals track MRIs and other images ordered per doctor, and doctors are under pressure to hit their quota.

Not sure where you got the idea that there are "quotas" doctors have to meet for ordering diagnostic tests. I can't speak for other countries but in the US this is not the case.

You can't speak for other countries, but you can for all of the US? Then explain these articles:

"Doctors Under Pressure to Meet Quotas and Fill Hospital Beds" [1].

"Once hospitals have made such a huge investment, experts like Dr. Zietman say, doctors will be under pressure to guide patients toward proton therapy when a less costly alternative might suffice." [2]

"While payments vary widely, doctors often collect $500 to $700 for a typical M.R.I. done on an outpatient basis in this area." [3]

[1] https://www.thehealthlawfirm.com/blog/posts/doctors-under-pr...

[2] https://www.nytimes.com/2007/12/26/business/26proton.html

[3] https://www.nytimes.com/2004/03/13/business/an-mri-machine-f...

Re: Patients can now access all their health records digitally

#99

Post by 9wzYQbTYsAIc »

encryptluks2 wrote: post #72
9wzYQbTYsAIc wrote: post #28

I occasionally wonder if it would be the cheaper, sustainable approach to just give everyone an iOS device containing their full medical record in HealthKit and require that all data requests go through your device, where you have full control on who gets access and for how long. A simple back-of-the-envelope calculation results in $1 000 per iOS device x 300 000 000 = $300 000 000 000 (three hundred billion). To put…

IOS is the most closed and expensive platform for mobile devices. This sounds like corruption to me.

It wouldn’t be corruption if the technology was claimed by the government under eminent domain or other mechanisms for taking over parts of industry

Re: Patients can now access all their health records digitally

#100

Post by YLYvYkHeB2NRNT »

parineum wrote: post #96
sethammons wrote: post #60

Earlier quoted context omitted.

"Patient feels nausea when seeing the color yellow; I have proscribed a placebo to gauge the effect." Not something a doc would want the patient to know.

Doctors shouldn't be performing experiments.

Respectively they should. This is how they narrow down and diagnose something the right way. Something that your computer algorthims can not do,
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