The recent passage of national health care reform legislation is an important milestone in the process of moving toward providing millions of Americans with access to health insurance. However, significant steps must still be taken in order to achieve the goals established in the legislation.

Specifically, greater clarification is needed to determine how reform will be implemented and, just as important, there is the challenge of effectively dealing with the critical issue of affordability. Health plans and providers have received many questions regarding how they will make the necessary changes within their business to help employers and trading partners comply with the new law.

While most answers are still unclear, we have developed initial comments to many of the questions dealing with the 2010 provisions, including:

Health care business, process, people and technology changes for payor and provider firms:

We will cover these topics in subsequent releases of our blog. We will continue to monitor the detailed discussions during the lengthy implementation process.  Our focus will be on taking the time to make sure we help our clients get the implementation of reform right and addressing the most significant issue facing our industry – affordability.

It is important to remember that most of the provisions in the legislation will not go into effect until 2014 or later.  The details of implementing legislation can take months, even years to work through the regulatory process.  Much of what Congress has passed will require additional regulations to bring further clarity to this new law, and those regulations will truly shape the impact on consumers and employers.

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Yesterday, an important message titled “Don’t Rush eHRs Without Addressing Medical ID Theft” was posted on ModernHealthcare.com by Martin Ethridgehill, formerly a provider training specialist with Blue Cross and Blue Shield of New Mexico.

Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons. Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.

I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient – prohibiting the real patient from examining his or her own health record.

Reasons to Go Slow

Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products. He gives these reasons for the need to slow down in the rush for interoperability:

• “Adding safety and records mitigation protocols ensures patient safety as an ongoing concept and practice.”
• “No industry would be allowed to operate, where the officials in charge of it stated that the market or other bodies would be responsible for creating safety procedures. Can you imagine if the auto industry stated, “We make cars, let the market figure out how to regulate safety”? I doubt that Congress or any other body would consider these people as remotely credible, yet I hear time and time again these statements being made in public and private forums by executives, lobbyists, and even so-called healthcare leaders.”
• “For the public and providers to embrace a product that has no regulation, no built-in safeguards and obviously no importance to safety from the makers of these products, why would Congress expect the American public or healthcare providers to embrace a product or concept that involves the unregulated risk of injury, death, or staggering liability opportunities, let alone without any hope of remedy or proper relief?”

One of the keys to improving life for payors as well as providers and patients will be process innovation. This is accomplished by clearly documenting the existing or “as is” process as well as the “to be” of the desired process. That can only be accomplished with combined disciplines of technicians who know business process modeling (BPM), facilitators who are professionals that can interact with all levels of stakeholders in the health care service chain, and “content” experts who understand legal, medical, and workflow implications of making changes to major functions such as provider management or claims adjudication.

No World Borders has been consulting with several health care payors on process improvement, and preparation of the conversion of systems for electronic health records.

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