The mural tells the story of a horrible day back in the spring. Fred was being transferred to a new hospital and Regina needed records of Fred’s many tests and treatments from the old hospital.
“I had gone down to medical records,” [Regina] Holliday says, “and they said, ‘That’ll be 73 cents a page and a 21-day wait.’ I said, ‘My husband is upstairs with Stage IV kidney cancer in your hospital and you’re telling me I have to wait 21 days? Everything’s on the computer. All you got to do is print it out and you’re going to make me wait 21 days?’ And they’re like, ‘Yeah, that’s just the way it is.’ I was floored.”
The story Regina Holliday tells (and paints) about her husband particularly illuminates the need for a masive overhaul of how medical records are maintained and transmitted. There is little excuse for massive paper files that have to be physically carted from place to place. To get a system that works smoothly and is inter-operable, there will have to be some kind of national standard for content and format.
NoVA Scout – I would like to know more about why the delay in the medical records. I suspect I already know the answer and that is HIPAA (Health Insurance Portability and Accountability Act) which was supposed to provide for “portability” but created nightmare delays and added unforeseen costs to the keeping of records. I remember talking with the overseer of a law office computer department and he was telling me that HIPAA required the law office to add certain protocols and safeguards to computer records which were separate and distinct from the attorney-client records which were already extraordinarily well protected. This was incredibly expensive and – moreover – made even inadvertent failure to comply with the law a felony.
In brief, we need to know exactly and precisely what the problem is before we can take action.
Not that long ago, a properly executed consent form permitted medical records to be transferred in a timely fashion. Now there are so many competing interests (not the least of which is the tactic used by insurance companies to delay decisions on eligibility for “services”) that this kind of nightmare situation occurs far too often. As a clergyman, I have encountered some really outrageous situations where people I had been seeing regularly had been transferred to other facilities, but I could not be told where they had gone. In the case of a woman with Alzheimer’s who had no family, I never could find out where she had been taken. The nursing home said they could provide no information because of HIPPA. This in spite of calls and letters to the person(s) in charge.
I agree with 2. I also do not know if the currently proposed legislation does anything about this problem. We sling the words “health care reform” around without bothering to indicate just what part we are reforming. I do like the idea of digitizing medical records and allowing each individual to carry them on a flash drive. There is no valid reason why patients and families cannot have copies of their records.
Hippa imposes draconian penalties for improperly sharing medical information. It used to be that if you signed a release, somebody could walk over to the copier, run it through and hand it back to you in two minutes saying “have a nice day”. Costs would be the cost of paper.
Nowadays, thanks to federal regulation, if one of those pieces of paper get into the hands of somebody else, or even the patient’s wife, and you cannot prove that you accounted for every single piece of paper, then the originator of the record gets a 50,000 dollar fine. Thus, each piece of paper must be scanned, certified as complete, notarized, counted etc., etc. This legal process takes time. It also costs money to have somebody make a certified,notarized document of each page. Nor does having the records help that much (other than lab/X-ray/consult notes). The major reason for the extensive record keeping America requires is because the medical record is the legal record in case of lawsuit. If there is no record that you checked the potassium at discharge, then 3 months later when it is low, it is your fault.
A computerized record also needs to be accounted for. If I transfer a patient to another VA system accross the country, I don’t need to transfer the chart, because any new physician will simply look in the universal computerized record. However if I transfer them to the hospital 3 miles away, well that hospital does have a computerized record but it does not TALK to my hospital’s computerized record. Therefore every page needs to be printed, certified, notarized etc just as before. The health care overview does not insist that computerized records be standard. After all, how could the Democrats pay back the tech industry who helped bankroll them if they insisted on a computerized medical record but just GAVE THEM THE VA SYSTEM’S RECORD WHICH IS PUBLIC DOMAIN? That would bring down costs, and increase efficiency but it wouldn’t make our national overlords any money. It is therefore much better to insist that every hospital have a computerized record but that none of them communicate. That way there will be plenty of money for software engineers, IT personnel, lawyers, accountants, and the like, and when prices inevitably rise , we will blame the greedy doctors and hospitals and slash medicare again.
In Greece, where there is no ability to sue physicians, there are no hospital or physician medical records. Each individual is responsible for keeping their own chart, and bringing it to their various hospitals or doctors visit, where the new consultant will quickly scrawl a few notes when they see the patient (i.e. instead of the usual 3 page US neuro consult you will get “Dx. migraine, exam normal, try propranolol.”
Everything costs money. If the desire is to reduce costs and increase efficiency, then slashing regulation and litigation will need to take place.
HIPPA was one of the worst statues I’ve seen in a long time. Even a spouse can have trouble getting any information unless the spouse has expressly provided (sometimes has to be written, not just verbal) consent. Same goes for medical records.
My company changed insurance providers recently, and the new company has been a complete nightmare. Anything that needs pre-authorization, like non-emergency surgery, requires the doctor to submit the paperwork via regular mail, that’s right, regular mail. Then they have up to 30 days to respond. This new company’s software is now coming out with “claim denied” for my family, not for me, but for my family. The member services says, yes, your family is covered, yes these are in-network providers, and no, we don’t know why the software system is messing up.
Since I’ve been working with state and federal government regulations, permits, paperwork, inspectors for several years, I don’t think a government run system will be any better. In fact, I think it will be worse. Several sections of the House bill and the proposed Senate bills deal with control of costs. Since major insurance providers do this all the time with lengthy eligibility determinations, routine denials then lengthy appeal processes, I feel the government run system would be worse.
This is an example of citing a terrible instance and then insisting that something be done, when what is being proposed won’t really solve the problem in the cited instance. I regret to say that it reminds me of a conversation my daughter had with an ill-informed co-worker who was eager to see health care reform pass so her next visit to the emergency room would be a better experience.
Katherine–I’m glad you said that. What we tend to do in American politics is address macro problems by presenting micro examples. To fix this lady’s problem will require a macro overhaul, none of which is proposed in Obama/Pelosicare. The big four are not addresses at all, yet they are the major cost drivers in medical insurance cost: diabetes, high blood pressure, obesity and self induced maladies (smoking, alcohol etc.); also we aren’t addressing provision of care to illegals, medical malpractice reform and delivery of un-necessary services (i.e. the doctor owns the MRI machine, so everyone gets an MRI, and defensive medecine because of lack of medical malpractice reform). And by the way, the Trial Lawyers were the main drivers behind HIPAA. Guess why.
#6 In Texas (where I grew up)–You are 14 times more likely to be denied services by Medicare (federal government) than you are by private health insurance (private sector). It, for sure, won’t get better if we get a federal take over of the entire medical system.
Actually, there are funds for electronic medical records in the stimulus bill (one of its few provisions that makes sense to me as a stimulus). I have a neighbor who’s in the business of providing electronic records systems to medical businesses. He’s hiring people, and his sales are up. This, plus repeal of HIPPA and its replacement with something less onerous, would go a long way towards solving this problem. It has little to do with the Congressional “reform” package.
Katherine–I am, sadly, more cynical than you. I believe they are fully tied together, so once we have national health care, the Feds can do what the Democrats have long loathed–they will use your records to profile you and determine what care you will get. ps–It’s HIPAA not HIPPA.
I fail to see how a government option is going to change anything about this terrible story. This woman’s problem is with her hospital. I dont think it has anything to do with HIPPA, either. Electronic filing is already in place in many hospitals. All the hospitals in my area already have these systems. We dont need a government option or single payer to fix that.
I agree with Katherine in #7. Horror stories can be twisted into emotional pleas for “solutions” which one cannot support through reasoned argument. This story fails the test of rational argument, and it is surprising to me to find it here on this blog.
Supposition, going back to post #2: The hospitals are probably scared stiff over being sued for the improper transfer of records into someone not authorized to have them, thus the costs and the wait-time. With all the frivolous lawsuits, it is not an unreasonable assumption that it has already happened! Yet Tort reform is in neither the House or the Senate forms of health care reform bills.
Jim Elliott
Who finally has an affordable Health insurance plan he likes and which covers the whole family.
My now motto on political debating:
“Just because I don’t agree doesn’t mean I don’t understand”
#13–That could be our Episcopal Church motto also.
libraryjim, does that mean you’ve got a job? Sorry for the personal comment; I’ve been keeping you in mind.
My sister, who’s an ER doctor in the Philadelphia area, says access to medical records is a major problem physicians face, but she blames it on the federal privacy laws presently in place. If a patient shows up in the ER room unable to sign the necessary paperwork, which is often the case, and even if they can it then still needs to go through the bureaucratic chain to get release of info, in most cases they cannot get timely access to that patient’s medical records even if they know he or she may have previously been a patient at a different facility and they know there are records at that facility. So a lot of times they are working blind, having to guess what is wrong with the patient when the ability to transfer records from institution to institution would resolve a lot of problems.
In the same way, when the patient is transferred out, they are legally prohibited by federal law from telling anyone what has happened to the patient or where they have gone unless the inquirer can show written authorization from the patient to know the information, such as a living will or health care directive.
Parents, you may not know this, but you have the same problem with your kids in college. If your child becomes seriously ill or even if they are dying, colleges are prohibited by federal law from informing the family of the situation without written authorization to do so from the student. There was nearly a riot when the parents who had come to Freshman Orientation Day at my son’s college were told this during an parent information breakout session. Parents started questioning how that could possibly be the case, and all the administrator could say over and over again was the school had no choice, that was the law. Parents then got so upset they actually had to go find the college president, who was talking to other parents down the hall in another information session, bring her into the meeting, and after going through it again she finally stated she would be willing to break the law if this situation actually came up. It wasn’t much comfort to the parents there, however, including us. (By the way, federal privacy laws also prohibit the school from telling you how your child is doing academically, even though you are paying the tuition.)
Blame the federal government on this one folks.
However doesn’t HIPAA give the federal government access to these records? I don’t know and am just asking.
#17–I am not a HIPAA expert, but my understanding is that public health organizations do have access to medical records for the purposes of preventing or controlling disease, injury or disability. Hospitals are supposed to review the records and send the very least amount of records necessary to comply with public health purposes. That sounds like a small exception, but once we have federal health care, I think it will prove to be a very big hole. And don’t forget, any time Uncle Eagle wants to he can change HIPAA, which is what I expect will happen when we get national health care.
Br. Michael,
I happen to work for a state agency under contract to the federal government to inspect federally certified health care facilities, such as hospitals and nursing homes. In the course of our duties, health care providers are required to provide us with copies any records we request to see. HIPAA restrictions do not apply to those transactions, but they do apply to us insofar as our storage and handling of those records ourselves. There are security requirements for the records, heavy restrictions on disclosure of information, penalties apply, all the same things that apply to anyone else who handles medical records. Does that answer your question?
19, Couldn’t the state have had access to the records without HIPAA? In other words was the purpose of HIPAA to restrict access or to give the government access?
If the patient was being transfered from one hospital to another there had to be a treating physcian and a recieving physcian who is aware of the patient’s condition, treatment and medication requirements so he can be recieved and cared for. That information is usually carried with the patient or faxed to the recieving physcian. You just don’t send patient’s willy nilly from hospital to hospital hoping some one will be there to care for him and that there is a bed available! Occasionally, because of bed shortages we go on “by pass”, we will not take any more patient’s even thought we are a level one trauma center. There is something fishy about the story…
Katherine (and all), YES I have a job. I’m back at Florida State University Libraries working with InterLibrary Loan. I started on September 4.
Pay is lower than I was making before, but the benefits are great — full family coverage for $180 a month, much lower than any place I’ve worked before.
Thanks to everyone for all the prayers.
Jim Elliott <><
That’s wonderful! Congratulations! (and yes, we have been praying).
Woohoo, Jim! Thanks for the update.
20, Br. Michael, You’re correct. We didn’t need HIPAA to gain acccess to records. We have always had access to medical records. HIPAA preserved our ability to do that. I was simply trying to answer your question– can the federal government have access to medical records under HIPAA? The answer is yes, at least under certain circumstances. But not because of HIPAA. The federal government and state governments have always been able to look at medical records (and lots of other records, too) in facilities that are state-licensed, federally certified for Medicare reimbursement, or both. They still can.