Welcome to EMR and HIPAA

The IRS has come out with questions and answers to supplement the IRS guidance on EHR Hospitals’ Health IT Subsidy Arrangements with Medical Staff Physicians (as described in May 11, 2007 Field Memorandum on the IRS website):

Q1 — What if a hospital’s Health IT Subsidy Arrangements with its medical staff physicians
aren’t entirely consistent with the conditions in the Memorandum? Would those arrangements result in impermissible private benefit or inurement?
A1 — Such arrangements will not be covered by the “safe harbor” described in the
Memorandum. However, they will not necessarily generate impermissible private benefit or
inurement, because the Memorandum is not meant to set forth the only permissible Health IT
Subsidy Arrangement between hospitals and physicians. Rather, the facts and circumstances
of any arrangement that does not meet the conditions described in the Memorandum will need
to be reviewed to determine if it results in any impermissible private benefit or inurement.

Q2 — What is meant in the Memorandum by “financial assistance” and “subsidies” to medical
staff physicians to acquire and implement electronic health records (“EHR”)-related software
and services that would enable the physicians to connect to the hospitals’ EHR systems?
A2 – Consistent with the HHS regulations referenced in the Memorandum, “financial assistance”
and “subsidy” do not include cash payments from the Hospital to the physicians. Rather, they
refer to arrangements in which the hospital provides the physician with EHR-related software or
information technology and training services, and the physician contributes a portion of the
cost.

Q3 – What if the hospital provides a Health IT Subsidy to a “disqualified person” as defined in
section 4958?
A3 – Assuming that the hospital meets all the conditions described in the Memorandum, the
agent will not treat such Health IT Subsidy Arrangement as an excess benefit transaction.

Q4 — What if the agent finds inurement to a medical staff physician outside the context of the
Health IT Subsidy Arrangement?
A4 — If the agent finds that the hospital’s net earnings have inured to the benefit of one or
more medical staff physicians outside the context of such arrangement, then the hospital would
not be covered by the safe harbor set forth in the memorandum. Although the safe harbor
would not apply in this situation, a determination of whether the Health IT Subsidy Arrangement
results in impermissible private benefit or inurement will depend on all the facts and
circumstances.

Q5 — What type of restrictions, if any, may a medical staff physician impose on the hospital’s
access to electronic medical records created by the physician using the Health IT Items and
Services subsidized by the hospital?
A5 – A physician may deny a hospital access to such records if that access would violate
federal and state privacy laws or the physician’s contractual obligations to patients. Also, the
hospital and physician may agree on reasonable conditions to the hospital’s access. For
example, their agreement could allow the hospital to access a patient’s medical records only
when that patient becomes a patient of the hospital, and could deny the hospital access to nonmedical
information such as billing, insurance eligibility, and referral information.

Q6 — Does the hospital have to ensure that the Health IT Items and Services are available to all
of its medical staff physicians at the same time?
A6 –The hospital may provide access to various groups of physicians at different times
according to criteria related to meeting the health care needs of the community. The hospital
should establish a plan for providing such access.subsidies.

Elizabeth

I’m happy to announce that EMR and HIPAA will be having a second blogger participating in spreading the EMR and EHR love. Her name is Elizabeth and she’ll be offering a very different perspective on EMR and EHR than I could ever do. I think that most people know that I’m a technical person that just loves working with EMRs. Elizabeth is going to offer more of the legal and hospital perspective of EMR. I’m really interested myself to read her posts and learn more about how doctors can benefit from their hospitals purchasing an EMR. I personally have always heard that things like this were possible, but that sounded like the Holy Grail of EMR to me. Hopefully Elizabeth can help us find that Holy Grail or at least inform us about how it works.

Of course, I don’t want to pigeon hole Elizabeth into one topic. Just like I often get side tracked with other personal and technical concepts, I hope that Elizabeth will occasionally do the same.

Since we may be discussing some legal issues I feel inclined to share the following:

Comments on EMRandHIPAA.com do not represent legal advice and we do not have an attorney-client relationship. If you want legal advice, you should contact a qualified attorney that may help you.

Sorry for the disclaimer, but it’s necessary. In fact, I’ll be posting it at the bottom of my blog as soon as I get a chance.

You can expect Elizabeth’s first post starting tomorrow.

I must admit that when I read the news about Microsoft introducing Surface Computing I really didn’t look at it from a health care perspective. I could think of 100 cool applications for the technology, but I honestly hadn’t considered it for the health care field. Of course, leave it to Dr. Bill Crounse, Microsoft Health Care blogger to point out the advantages of surface computing in healthcare.

Here’s a quote from his post on Microsoft Surface Computing in Health Care:

Yesterday, Microsoft officially launched the first commercial product from a group and technology known as Microsoft surface computing. The product is called Milan; a coffee-table sized PC that takes touch screen technology to entirely new levels and gives users a highly interactive experience with all things digital. For now, you’ll be seeing the technology in business environments such as hotels, casinos, and retail establishments. You can read more about that here:

I first told you about surface computing last July when I met with colleagues at Microsoft Research to produce a video segment for my House Calls for Healthcare Professionals series. In that video, Dr. Eric Horvitz and surface computing guru, Andy Wilson, and I talked about the technology and possible implications for the healthcare industry. At the time Andy’s work was going under the code name Play Anywhere. My head was literally spinning with ideas on how this new user interface could be used in radiology, physical therapy, anatomical pathology, and other disciplines. It also occurred to me that this new way to interact with a computer, manipulate screen images, and navigate through data could be immensely important to clinical work-flows demanding a more hands-free, no-touch solution such as might be desirable during surgery or certain medical procedures.

I think one area that he didn’t seem to mention, but he’s probably considered is interaction with patients. I could imagine the day that a surface computing tabletop is found in every exam room. The doctor could roll this table over to the patient and the doctor and patient could interact with all sorts of patient education. When diagnosing a hernia for example, they could show anatomical drawings or videos that actually show what causes a hernia and the process for fixing it. They could draw on the table as they describe the medical condition. Then, the patient could have the video that was shown by the doctor sent straight to their phone so they can take it home and show their family. Would be pretty neat.

I must admit that as I read about this technology I remembered a video I posted on my technology blog that showed a real life application of multiple inputs on a table top. I was amazed at the technology six months ago and I’m still amazed now. Take a look.

I’m still seriously considering my idea to create a clinical website wrapped in some sort of content management system. I think it’s a scalable idea that would only cost me the cost of designing a new skin/theme/look and feel for the clinic. Next week I’m going to try and make time to visit the doctor’s office that I think will fund the development of the product. Then, I’ll use that product to roll it out to other doctor’s offices.

While thinking about a clinical website for a doctor’s office I started wondering why a doctor might want a website for their clinic. Here’s just a few of the things off the top of my head.

• Market their clinic
• List their products and services
• Show staff information
• Show clinic hours
• Contact information for their clinic
• Link to their Patient Health Record (PHR)
• Provide clinic announcements
• List Health Education materials
• Promote their clinical research

I think the most powerful tool could be marketing their clinic. With the right combination of keywords and an integrated blog where you post local news items, you could find a lot of referrals. I think this could also be true for those doctors who like to sell elective procedures that have high profit margins.

Is there anything I’m missing about what a clinical website could offer a doctor’s office? I expect there are probably a number of them that I haven’t considered.

I started this blog about 1.5 years ago in December 2005. At the time I didn’t really know too much about blogs. I’d kind of worked on my Smuggle Me Blog, but that was mostly just playing around. Thankfully I was bored over Christmas break and so I was found searching the internet for information on EMR. As I accrued all this information I decided that I wanted a way to publish my thoughts on EMR and also share the various EMR related items in one place. It was kind of fun to look at my first EMR and HIPAA blog post.

When I started my blog I hoped that one day I’d make it to the top of Google’s search for EMR. In fact, my first attempts at getting visitors to my blog was finding the highest ranked EMR sites on Google and joining. 1000 posts on EMRUpdate (one of the top EMR websites on Google) and I’m still enjoying my visits to the site. I really want to thank EMRUpdate for giving me lots of great content, keeping me motivated and sending me plenty of traffic when I was just starting. Well, now I guess that my website has finally made it to the front page of Google for EMR (Number 10 to be exact). It feels great to be recognized by Google as one of the top 10 sites for EMR.

I also want to take a second to post a big Mahalo (Thank You) to the various sponsors and advertisers that have supported my EMR and HIPAA blog. It’s been great working with the good folks at EMR Experts and Medical Software Associates. My wife really appreciates the date money. If anyone else is interested in sponsoring or advertising on EMR and HIPAA, then leave a comment and I’ll get a hold of you.

Thanks for all those readers who have left great comments and provided even more ideas for my blog.

I’ve really wondered why there aren’t a ton of popular products out there that capitalize on the now very inexpensive web cams that are out there. When reading through EMRUpdate, I found a post that talks about a company called Whistlebox. They may be getting close to what I’m talking about.

A new potential tech twist to the doctor patient relationship. The Whistlebox Virtual House Call. Smile Whistlebox is a browser based video audio communication program. Nothing to download or upload. The catch appears to be one must have a computer and a web cam the rest is basically automatic. Whistlebox can be integrated into your intranet or portal, or as an add-on to your own products and services. Why is whistleBox different?

Three main reasons: User Speed & Ease - no downloads, no plug-ins, no hassle to watch and enjoy immediately! And, with web cameras, users don’t have to shoot, edit and upload video, your audience is a click away from creating content & participating in an online video community. Integration Speed & Ease – the whistleBox platform is quickly & easily integrated into client servers; and, into client sites as it sits on a layer on top of your site once clicked. No reason to redesign your site, whistleBox is easily skin-able to match the look and feel of your site.

Whistlebox, which is now in beta, was built over the last 12 months by a pair of programmers using Java, MySQL, Flash Media Server, and Flex for Flash 9, and can be made to work with most content distribution networks. The interface can be totally customized and re-branded as needed. The word “Whistlebox” need never appear.

I don’t think this was meant for doctors, but it really would be an interesting way for doctors to connect with their patients. I’m not sure insurances would cover this (which has always been a problem with “online visits”). However, the technology would be great and I’d be interested in using it. I know when I go to the doctor and all I do is get my temperature taken and get a script for Penicillin, I feel quite ripped off and wondered why I had to waste all that time and energy in a sickly state just to see him for 5 seconds and get a script he could have given me over the phone (or online in this case).

Any doctors interested in trying this out? You could even probably capture the video as you go and save it to your EMR. That’s what I call great documentation of a visit. Not to mention, I think that video capture of visits is the future of health care.