The KHIT Blog: The Curious Case of the Missing Final Rule

Sunday, January 6, 2013

The Curious Case of the Missing Final Rule

Well, maybe I'll wake up tomorrow, log into FederalRegister.gov, and the HIPAA Omnibus Final Rule will magically appear at long last.

Hunton and Williams' Head of Global Privacy and Data Security Practice Lisa Sotto, Esq gave a nice recent interview here on the topic. One factor she speculated might be a cause of the delay would be understaffing at OMB -- i.e., backlog.

I'm not buyin' that, in the wake of the deluge of FRs announced post-election. Moreover, while I could see why the administration might want to keep it off the lame duck session "fiscal cliff" radar, what's the excuse now? Keeping it away from the bogus "debt ceiling" carnival that will ramp up and conclude by March 1st?

The other rumor is that the NPRM is undergoing significant revision, hence the delay.

Be nice if they'd wrap it up. A lot of entities are on hold regarding various HIPAA related P&P updates that may be required by the Omnibus.

THIS IS PRETTY INTERESTING

Health Information Industry Code of Conduct

Proposed: To achieve the universally supported objectives of systemic cost reduction and quality improvements, members of the health information industry should agree to maintain, uphold and abide by a uniform set of high standards related to data portability, patient safety, freedom of choice, and meaningful, ethical use by health care providers of health information technology (HIT).

Resolved: The signatories hereto, representing innovative, forward-thinking members of the health information industry, agree that they and their respective companies will adhere to each of the provisions of the following Code of Conduct:

1. Empowering Data Portability and Provider Choice

In the event that any client opts to change to the electronic health record (EHR) of another signatory, we will, at our own expense, facilitate the intact transfer to the latter’s EHR of all of the provider’s clinical data.

2. Building a True Nationwide Information Backbone

We will build, maintain, and curate reliable interfaces on behalf of any qualified healthcare provider that requests one.

3. Protecting Patients

We commit to public reporting of adverse patient safety event information. Within one year of signing, we will affiliate with a Patient Safety Organization (PSO), report all patient safety-related events to that PSO, and work proactively with clients to identify and resolve the causes of any such issues.

4. Preventing Fraud

We will actively monitor, and report to clients, changes in provider billing patterns that could indicate up-coding or fraud.

5. Driving Meaningful Use

We will adjust reporting to accommodate government quality reporting programs, at no incremental cost to clients...

Pretty good. How about...

6. Fundamental Transparency

All vendors shall publish their RDBMS schema / data dictionaries.

I can dream.

MONDAY MORNING UPDATE, 7 A.M. PST

No HIPAA Omnibus Final Rule today. In general, It's been a slow news period of late in Health IT, Lost of articles citing other articles citing yet other articles, etc.A relative dearth of really new topics.

TUESDAY MORNING UPDATE

No HIPAA Omnibus Final Rule. In other news:

CMS: Meaningful use incentives estimated to exceed $10 billion
Kyle Murphy, PhD, January 8, 2013
Early estimates for meaningful use payouts in December 2012 are slated to push the total amount of payments north of $10 billion. During the monthly meeting of the Health IT Policy Committee, which takes place today in Washington, DC, Rob Anthony of the Centers for Medicare & Medicare Services is scheduled to present the update for the EHR Incentive Programs with final figures for November 2012 as well as estimates for last month. With the estimates for December 2012 included, the amount of payments made through the EHR Incentive Incentives is close to $10.32 billion (YTD)...

Once everyone has finished attesting for 2012, (EPs have until Feb 28th) there will be a large December spike.

Also noteworthy:

One might reflect on how timid our “meaningful use” requirements truly are on the cusp of 2013 in light of this headline from the Wall Street Journal in 1959: “Electronic Medicine: Scientists Press Work on Advanced Machines to Aid Medical Care. They See Automatic Nurses Watching Sick, Computers Helping Diagnose Illnesses.”

From The Man Who Brought Computers Into Medicine by Michael Millenson
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More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Sunday, January 6, 2013

The Curious Case of the Missing Final Rule

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