accommodating patient request toaapcperfect.s3.amazonaws.com/a3c7c3fe-6fa1-4d67-8534-a3c9c83… ·...

Accommodating Patient Request to

access and amend the health record

Michael J. Warner, D.O., C.P.C.drmichaelwarner@patientadvocacyinitiatives.org

Access & Amend• When it comes to access (looking at, viewing, reading, reviewing)

and amend (correct, contribute to, co-author), who knows the rules?

A. Doctor

B. Nurse

C. Office receptionist

D. Administrator

E. CPC

Access & Amend• When it comes to access (looking at, viewing, reading, reviewing)

and amend (correct, contribute to, co-author), who knows the rules?

• CPC

• Certified Professional Coders have a unique skill set to easily

understand the concepts of access and amend.

• You are the “go to” person for this issue.

Access & Amend

• OBJECTIVES:

1. Understand laws/rules of access & amend

2. Know examples of how to apply access & amend to daily

routine.

3. Be aware of how healthcare is rapidly changing as we enter

the digital age of medicine.

Michael Warner, D.O., C.P.C.

Osteopathic physician (dual board certified family medicine & neuromusculoskeletal medicine)

Certified professional coder

Caretaker & patient

Author

Researcher

Head of non-profit

AACOM Health Policy Fellow

Access & AmendStandards for Privacy of Individually Identifiable

Health Information (HIPAA Privacy Rule)

Compliance required for all providers as of April 14, 2004 as a final

rule of the Health Insurance Portability & Accountability Act of 1996

(HIPAA)

45 C.F.R. § 164.524 = access

45 C.F.R. § 164.526 = amend

AccessHIPAA Privacy Rule

Patient should submit a written “request” to access or amend

AccessProvider has 30 days to respond with written notification.

Provider may deny if content could “harm the patient.”

Provider may request an additional 30 days with written notification.

HIPAA exempt: psychiatric notes, most work comp & MVA

May charge customary fee for photocopy & postage, CD, flash drive

May charge nominal fee for search/retrieval (Act 26 in Pennsylvania)

AmendHIPAA Privacy Rule

Patient should submit a written “request” to access or amend

AmendProvider has 60 days to respond with written notification.

Provider may deny

“link & notify” – check health record activity log to identify who to

notify. Receiver of notification must review record to see if Medical

Decision Making requires alteration.

Provider may not charge to act on request to amend the health record

Access & Amend

HIPAA Privacy Rule Enforcement

Office for Civil Rights (OCR)

complaint investigations www.ocrportal.hhs.gov 800-368-1019

compliance reviews

enforcement of policy – empowered to assign civil money penalties

and criminal prosecution against medical providers

(penalties skyrocket if evidence of “retaliation”)

Healthcare Documentation Timeline

We are entering a new age of healthcare = Digital Age

Pre Digital Age Digital Age

We are currently in transition

Healthcare Documentation Timeline

Sir William Olser

William Osler, M.D.

“Father of Modern Medicine 1849-1919

Egyptian stone carving

up to 3,000 B.C.

“Listen to the patient,

he is telling you

the diagnosis”

Healthcare Documentation Guidelines

S.O.A.P. note

S = subjective

O = objective

A = assessment

P = planLawrence Weed, M.D.

Standardized medical documentation

in the late 1960’s

Healthcare Documentation Guidelines

S.O.A.P. note

S = subjective

O = objective

A = assessment

P = plan

Standardized medical documentation

in the late 1960’s

CMS medical encounter

• History

• Examination

• Medical Decision Making

1995 & 1997 guidelines

data collection focus

The Digital Age

Our government foresaw the digital age of healthcare

The Digital Age Payoff

Digitalized health records will allow for data analysis

beyond claims data (ICD, cpt, HCPCS) and will

venture into the History, Examination and Medical

Decision Making.

Analytics will identify best practices and allow for personalized care.

Predictive algorithms will guide us to drastic improvements in

healthcare quality, cost and satisfaction.

The Digital Age better Payoff

Healthcare in the U.S.A. = trouble

Quality: #42 life expectancy/223#169 infant mortality

64/100 National Scorecard 2011 (67/100 in 2006)

Cost: $3 trillion per year17.5% GDP 2014, projected 34% by 2040

Satisfaction: 66% of Americans approve of the way the healthcare system works for them.

HIPAA

The Health Insurance Portability and

Accountability Act of 1996

Law written to prepare healthcare for information technology

Initial focus on how medical information is stored and transmitted

HIPAA Privacy Rule

The standards for Privacy of Individually

Identifiable Health Information (HIPAA Privacy Rule)

Final rule of HIPAA with compliance required by all providers April 2004

Clarified patient’s role: access and amend the health record

Electronic Health Record Adoption

The Health Information Technology for Economic and Clinical Health

(HITECH) Act of 2009 was enacted as part of the American

Recovery and Reinvestment Act of 2009.

Directed the Office of the National Coordinator (ONC established

2004) to promote the adoption and meaningful use of electronic

health records (EHR’s). $19.2 billion

EHR use is part of the Federal Health IT Strategic Plan.

Electronic Health Record Adoption

HITECH Meaningful Use:

financial incentives to promote the adoption and meaningful use

of interoperable health information technology (HIT) and qualified

electronic health records (EHRs).

MU1 = are you using an EHR? (electronic capture of data and provide patient with

electronic copies of health information)

MU2 = Portal (lists, results), 2 way communication (continuous quality

improvement at point of care and exchange of information)

MU3 = set for 2017, full access portal??, absorbed by MACRA

Electronic Health Record Adoption

Goal: Digitize health records

2008 17% doctors used EHR systems

2012 78%

2015 financial penalty if not using CEHRT

MACRA

The Medicare Access & CHIP Reauthorization Act

of 2015 (data capture started Jan. 1, 2017) calls for

patient access and amendment of the health record

as part of the physician payment formula.

Patient Generated Health Data (PGHD) is part of an

objective to coordinate care through patient

engagement.

Electronic Health Records

How is it working so far?

deleted files

wrong chart

power outage/ loss of Internet

click, type, scroll….

? Interoperable ?

Computers were supposed to make healthcare

more efficient!

Electronic Health Records

How is it working for patients?

wrong chart

inaccurate information

template story

narrative from previous encounters

University of Michigan Kellogg Eye Center Study

Compared waiting room report to EHR

JAMA Ophthalmology January 2017

Access & Amend

Use of Patient-Authored Prehistory to Improve Patient Experience and Accommodate Federal Law

Feb 2017 JAOA

Allowed the patient to complete a replica of the CMS History and we recognized it as a written request to amend the health record. A patient authored History is considered a form of Patient Generated Health Data (PGHD).

Access & Amend263, age 14-94, average age 66, 64% response, 60% male

Invited the patient to complete a PreHistory in preparation for a medical encounter. Invite help from family members, friends and caretakers.

Scanned the document as a pdf.

Transcribed the information into the History – until a PreHx is an automated feature of the EHR patient portal.

Gave patient copy of note at check out window

Patient-Authored PreHistory

Patient-Authored PreHistory

AccessHIPAA Privacy Rule

Patient (and/or authorized patient representative) should submit a

written “request” to access or amend

AccessProvider has 30 days to respond with written notification.

Provider may deny if content could “harm the patient.”

Provider may request an additional 30 days with written notification.

HIPAA exempt: psychiatric notes, most work comp & MVA

May charge customary fee for photocopy & postage, CD, flash drive

May charge nominal fee for search/retrieval (Act 26 in Pennsylvania)

Amend

HIPAA Privacy Rule

Patient (and/or authorized patient representative) should submit a

written “request” to access or amend

AmendProvider has 60 days to respond with written notification.

Provider may deny

“link & notify”

Provider may not charge to act on request to amend the health record

Access & Amend

HIPAA Privacy Rule Enforcement

Office for Civil Rights (OCR)

complaint investigations www.ocrportal.hhs.gov 800-368-1019

compliance reviews

enforcement of policy – empowered to assign civil money penalties

and criminal prosecution against medical providers

(penalties skyrocket if evidence of “retaliation”)

Access & Amend• When it comes to access (looking at, viewing, reading, reviewing)

and amend (correct, contribute to, co-author), who knows the rules?

A. Doctor

B. Nurse

C. Office receptionist

D. Administrator

E. CPC and the patient

Big change is coming to healthcare

Access and Amend laws seem easy, until you try to

accommodate the patient’s federal rights.

Application will require a certified profession coder’s

knowledge to organize and maintain processes to

allow for patients to “request” to access and amend

the health record.

Drills/ScenariosAccess:

What is your protocol or process?

How is the provider notified? Audit trail? Who monitors?

Authorization for release of protected health information form?

How do you identify the person?

What about authorized personal representatives?

What if the patient wants personal access?

What if request is to receive records in paper form vs. electronic?

KEY: Consistent and Referenced in your HIPAA compliance manual

Drills/ScenariosAmend:

What is your protocol or process?

How is the provider notified? Audit trail? Who monitors? Link & Notify?

What happens when the provider receives a “link & notify” notice?

MRI order for wrong shoulder?

Diabetes mellitus diagnosis, yet no Diabetes??

Abdominal pain diagnosis,

yet chart documents “no abdominal tenderness”

KEY: Consistent and Referenced in your HIPAA compliance manual

drmichaelwarner@patientadvocacyinitiatives.org

Patient Advocacy Initiatives Facebook and .org

YouTube: Patient Advocacy Show episode 1 Inaccurate

Health Records (like and comment!)

Thank you!