Hospitals Ranked on Responsiveness to Patient Record Requests; How Is Yours Doing? | David Raths | Healthcare Blogs Skip to content Skip to navigation

Hospitals Ranked on Responsiveness to Patient Record Requests; How Is Yours Doing?

July 20, 2017
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PatientBank rates medical records departments across four categories: speed, fees, fulfillment and delivery
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One topic that has drawn my interest repeatedly over the last few years is patient access to their own data — perhaps because getting my own health records from doctors’ offices has been like pulling teeth.

I have written a few times about the  “GetMyHealthData” initiative, launched with the idea that a concerted effort to enlist people to ask for their health data would unlock consumer demand. In 2016, Christine Bechtel reported on the first year of that effort at the Health Datapalooza in Washington, D.C. “We thought if we pulled on the rope, it would unravel the knots in the system,” she said. They asked people to fire the first round of “tracers” and report back on what happened to them. “What we found was that when we pulled, there was an elephant sitting on the other end of the rope,” she said. People got messages that they could have their data if they asked correctly or letters asking why they wanted it. Not a single healthcare organization was able to send data to a health app at a patient’s request. People reported getting PDF files on CD-ROMs. “We saw them being charged high fees that stood in the way of data access,” Bechtel said. Some were charged up to $600, with no estimate upfront about how much it would cost. Some providers were even charging for access to patient portals that were subsidized by taxpayer dollars through the Meaningful Use program.

So I was intrigued this week when I saw a Tweet from the folks at the Open Notes initiative pointing to a hospital ranking system on patient record request responsiveness created by a company called PatientBank. The San Francisco-based startup offers a service that helps patients gather, store and share their medical records. The basic service is free. The company makes money by offering add-on services such as having medical experts help people clean up and summarize the data.

Because PatientBank spends so much time helping patients request data, it decided to create a rubric to rate hospital health information management (HIM) departments on four simple categories:

• Speed: How long does the provider normally take to respond to requests for records, ranging from 1 (slow) to 5 (fast)? Under HIPAA, providers are given 30 days to respond to requests.

• Fees: How much does the provider charge patients for medical records, ranging from 1 (very expensive) to 5 (no fee)? Providers are allowed to charge a reasonable, cost-based fee.

• Fulfillment: How capable is the provider in returning medical records in the form and format (e-mail or electronic) patients ask for? The range is from 1 (very limited) to 5 (very flexible).

• Delivery: How does the provider allow patients to submit requests for records (e.g. by fax, email)? These policies are ranked from 1 (strict) to 5 (flexible). HIPAA does not permit providers to require patients to use only certain delivery methods.

PatientBank created performance scores of U.S. hospitals for its own internal purposes but is now making them public to give patients more information and to help hospitals improve. Where does your hospital rank?

I interviewed Paul Fletcher-Hill, the company’s co-founder and CEO, who said one goal is standardizing the experience of requesting records for patients. “Every hospital is a little different in terms of how they release records and what their policies are,” he said. “Our motivation is to be an educational tool for people who are requesting records, but we also certainly hope that hospitals will use this information to benchmark their own programs.”

There is very little transparency in this process, he added. A hospital will have its own policy but not have any idea what a hospital down the road is doing, let alone what the best in their state or in the country are doing. “We want to use the fact that we are a part of so many record requests across the country to learn from that experience and structure that data to say ‘this is what a good medical records department looks like,’” Fletcher-Hill said.

So how would he characterize hospital record request response performance generally? “It is all over the map,” Fletcher-Hill said. “We emphasize and try to learn from some of the best hospitals. Despite all the guidance from the Office for Civil Rights at the U.S. Department of Health & Human Services, PatientBank finds that many records departments are still unclear about some regulations on releasing medical records. For instance, some hospitals don’t charge patients for their records, while others do. “That is one of the big ambiguities with HIPAA — how much you can charge individuals for their records — and every hospital seems to have a different interpretation on what their responsibility is to patients and whether they should or should not charge,” Fletcher-Hill said.

One of the easiest and most important things hospitals can do, he said, is be flexible in accepting requests for records. “In the 21st century, it sounds sort of crazy that this is an innovation, but hospitals that allow people to submit their requests via a central e-mail address or fax instead of requiring them to send it in the mail — that speeds up the process a lot.”

I asked Fletcher-Hill if smaller, rural hospitals that have fewer resources didn’t rank as well as academic medical centers and large health systems.

He said PatientBank hasn't yet done much analysis on the results, but he noted that there does not seem to be a general correlation between a hospital being ranked as one of the best hospitals in the country and also being ranked high by PatientBank. “There are some hospitals that are smaller and have a dedicated staff working on record releases, and maybe don’t receive as many requests as a really big health center, that are the best at this,” he said. (The 270-bed Poudre Valley Hospital in Fort Collins, Colo., is currently ranked highest in PatientBank’s scoring.)

“We want to learn from those hospitals doing this really well and help the larger institutions learn from that, because that contributes to patient experience. We hear from patients who say, ‘this all happened electronically and it was incredible. I didn’t know this would be so easy.’ That experience is something more patients should be having when trying to request their medical records.”

The HHS Office for Civil Rights, the Office of the National Coordinator for Health IT and the American Health Information Management Association (AHIMA) are all working to improve responses to patient health information requests. Earlier this week, ONC published a research report recommending a streamlined and more transparent patient records request process to reduce the burden on consumers.

On July 20, AHIMA made public a suggested model patient access form intended to be used as a template—to be modified with organizational-specific contact information—and given to patients or their designated personal representative when they’ve requested access to their health records.

AHIMA said it developed the form after hearing from several healthcare and patient advocacy working groups that consumers are often confused by the inconsistency of patient access forms given to them by their healthcare providers. 

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Consumer Health Tech Startup Ciitizen Raises $17M

January 16, 2019
by David Raths, Contributing Editor
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Building a platform to help patients collect, organize and share their medical records digitally

Ciitizen, a California-based company working to build a platform to help patients collect, organize and share their medical records digitally, has closed $17 million in new funding in a round led by Andreessen Horowitz and that included Section 32 and Verily.

The Redwood City, Calif.-based company said it would use the proceeds to accelerate platform development and expand commercial operations. The company received a Series A financing round of $3 million led by Andreessen Horowitz in July 2018. As part of the new financing, Vijay Pande, general partner of Andreessen Horowitz's Bio fund, will join the Ciitizen board of directors. Michael Pellini, managing partner at Section 32, and Andy Harrison, head of business and corporate development at Verily, will join the board as observers.

Ciitizen’s co-founders are Anil Sethi, Premal Shah, and Brian Carlsen. CEO Anil Sethi’s last company, Gliimpse, was acquired by Apple. Carlsen was formerly special projects lead at Apple, and serves as director of clinical informatics at Ciitizen. Deven McGraw, who has deep experience in HIPAA and medical data sharing, and was formerly the head of privacy at the U.S. Department of Health and Human Services, also works for Ciitizen.

"We are aggressively hiring to support release of products in partnership with select healthcare stakeholders that will immediately benefit patients—all driven by obtaining and organizing a patient's health data," said Premal Shah, COO, in a prepared statement. "Contrary to what is happening today, we want to facilitate patients gaining maximum direct benefit from what is rightfully theirs: their personal healthcare data."

"We are aggressively hiring to support release of products in partnership with select healthcare stakeholders that will immediately benefit patients—all driven by obtaining and organizing a patient's health data," said Premal Shah, COO and Co-Founder of Ciitizen. "Contrary to what is happening today, we want to facilitate patients gaining maximum direct benefit from what is rightfully theirs: their personal healthcare data."

Ciitizen also has initiated a weekly blog, The Voice of Ciitizens, that offers opinions from healthcare thought leaders on ways to address some of healthcare's most pressing challenges, including patient empowerment with their data.

 

 

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Survey: Consumers Want to Manage Healthcare Benefits, Costs via Smartphone

January 15, 2019
by Heather Landi, Associate Editor
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There is a growing “mobile first” trend, as consumers increasingly want to preform everyday tasks and utilize services on their smartphones, and this trend is moving into healthcare. A recent consumer survey indicates that consumers want more transparency, convenience and control of their own healthcare, particularly through mobile access, and, this demand could be influencing their healthcare decisions.

A survey by Metova, a provider of mobile, connected care, connected home and Internet of Things (IoT) solutions, found that 80 percent of consumers would be more likely to visit a doctor or seek treatment if they could see the exact out-of-pocket cost on their smartphone. And, three-quarters of consumers are interested in viewing and managing their health care benefits using a smartphone.

Metova surveyed 1,000 consumers who have healthcare to gauge their understanding of their health benefits, and to find if technology can improve their experience.

Nearly half of consumers have avoided going to the doctor or seeking treatment due to uncertainty around their benefits, according to the survey. Looking at the role of technology, nine out of 10 consumers said they would like an app that provides notification when a doctor sends a prescription along with pharmacy location and pickup time. In addition, 60 percent would like to purchase eyeglasses or contact lenses using their smartphone.

“It’s impressive to see how having a clear understanding of out-of-pocket cost on a smartphone would have a powerful positive effect on consumers’ deciding to seek treatment or even visit a doctor,” Jonathan Sasse, CMO at Metova, said in a statement. “Our sentiment surveys overwhelmingly demonstrate that the new connected consumer is ready and wanting to manage a wide range of facets of everyday services all via their smartphone, and that a person will choose one business, or even a doctor or insurance providers over another based on this mobile experience.”

Ken Erickson, CEO at Bridge Purchasing Solutions, said in a statement, “The healthcare industry is overdue for disruption. Consumers want more transparency, convenience, and control of their own healthcare.”

Related Insights For: Patient Engagement

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One Thought-Leader’s Look at the New Social Contract in Medicine and Healthcare

January 7, 2019
by Mark Hagland, Editor-in-Chief
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Healthcare thought-leader Michael Millenson shares his perspectives on the emerging new social contract around medical care and healthcare—in a time of accelerating technology disruption

Last week, Michael Millenson, president of Health Quality Advisors LLC, and an associate professor of medicine at Northwestern University’s Feinberg School of Medicine, authored a thought-piece in the online publication STAT, entitled, “Google is quietly infiltrating medicine—but what rules will it play by?” Millenson looked at the emerging landscape in healthcare around the accelerating participation of healthcare consumers in using web search, consumer-facing apps, and other tools, to help them educate themselves about personal health and healthcare delivery issues, as well as the emergence of a number of corporations, including Google, Amazon, and Apple, as disruptors in the healthcare world—both as innovators in technology, as well as, increasingly, players in the care management and care delivery arenas.

“If ‘data is the new oil,’ as the internet meme has it, Google and its Big Tech brethren could become the new OPEC,” Millenson wrote on January 3. “Search is only the start for Google and its parent company, Alphabet. Their involvement in health care can continue through a doctor’s diagnosis and even into monitoring a patient’s chronic condition for, essentially, forever.”

Meanwhile, Millenson wrote, “Suppose you’re worried that you might have diabetes. Googling ‘diabetes’ brings up not just links but also a boxed summary of relevant information curated by the Mayo Clinic and other Google partners. Google recently deployed an app enabled with artificial intelligence for remote professionals to use that can all but confirm diabetes-related retinopathy, a leading cause of blindness. Diabetes is also a diagnosis your doctor might have predicted using more Google AI applied to the electronic health record. Meanwhile, a Google joint venture called Onduo recently announced a partnership to allow a major pharmacy chain to use its “virtual diabetes clinic” to coach patients on managing their disease. And, of course, at home you can get daily diabetes reminders from your Google Assistant.”

And, in some cases, he added, “[Y]our doctor could actually be Dr. Google. The brick-and-mortar Cityblock clinic, whose first site opened in Brooklyn, N.Y., earlier this year, is an Alphabet spinoff. It promises a ‘personalized health system’ experience for low-income patients.”

And with Google hiring the former chief executives of both the Geisinger Health system and the Cleveland Clinic, more and more interesting developments are certain to be at hand.


Michael Millenson

And all of this, Millenson noted, is prompting some in the industry to ask what the implications are of these developments for the social contracts that have long anchored physician-patient/clinician-patient, and patient care organization-patient relationships and interactions. In that context, he spoke with Healthcare Innovation Editor-in-Chief Mark Hagland, following the publication of his STAT commentary, to discuss the implications of some of those current trends, for the future of patient care delivery. Below are excerpts from that interview.

There are so many developments taking place right now involving what might be called “interspecies” business combinations—payers and providers, payers and retail pharmacy companies, employers and providers, and on and on. Do you see some potential dangers in the uncharted territory that’s emerging in healthcare, because of such combinations?

What I was trying to sound as a cautionary note, not an alarm, but a cautionary note, was that, when barriers are breached in terms of definitions, there are new challenges to long-established ways that we do things. We all like to talk about disruption, but there are downsides. And those downsides need to be confronted squarely. And what I was trying to propose in my commentary was a practical ethical framework for dealing with downsides—not a mission statement, or whatever, but practical thoughts. If you have a commitment to accountability and shared responsibility, it brings up issues. Just because you believe you’re committed to patient engagement or lowering healthcare costs, or whatever noble goals you espouse, particularly if you’re working for a not-for-profit entity, or even a for-profit, personal and corporate interests can conflict with noble goals.

And even as all these kinds of partnerships can be wonderful, we also realize we need new ways of dealing with potential negative side effects. No hospitals that merge ever say, thank God we can get rid of the price pressure from insurance companies! And it’s not that individuals making statements about mergers are deliberately telling untruths, but they sometimes make statements that may not be in the best interests of patients.

Healthcare informatics arose from people who were in the HC field, who wanted to apply the benefits of informatics knowledge to improving care, lowering costs, and other problems. That’s a different set of assumptions from when you take people whose expertise is in manipulating data and information, and put them into healthcare. There are cultural issues there. People from within HC tend to say, there are certain problems, and let’s look for solutions.

But people outside healthcare sometimes have the tendency to say, we have this wonderful tool; look at all the ways we can solve your problems.

Looking at the entry into the healthcare delivery process of disruptors like Google, simply because of the near-universality now of web search as a consumer activity in healthcare—will consumers simply start self-diagnosing off the web now?

It’s one thing to look at Google as a search engine. It’s another to look at the issue of Google as an element in care delivery. The issue of “Dr. Google” is a significant one. I wrote an article recently called, “Beyond Dr. Google.” What happens if you’re using the Babylon Symptom Checker with AI? What happens if you’re looking at a mole? Because they’ll have a legal disclaimer. But we’re looking at an entire paradigm shift around how we interact with doctors. Years ago, I said the Information Age is to medicine as the Protestant Reformation was to the Catholic Church. It changed the people’s relationships to the priests; the Church didn’t go out of business, but it had to change. Once the laity could read the Bible, the role of the priests had to change. And I think that the role of physicians as holders of knowledge, has to change. They still have specialized knowledge; but the conversation has to change, and the tone has to change.

What I’m concerned about is when an organization like Google, Amazon, or Apple, starts partnering with physicians, what happens? When Google, Amazon or Apple, starts being a partner to help you with your diabetes, are they helping you have a better conversation? Or are they starting to use gathered information to try to cause behavior change, to manipulate you? And there’s a fine line between doing this for your own good, or because I want you to change?

And then there’s the accountable care issue—when you have attributed patients, and it’s in your financial interest now to collect and use social-determinants-of-health data and other forms of data, as well as apps and tools, to try to motivate your patients towards participating in the enhancement of their health status.

Exactly—now, there’s also a profit motive. I wrote an article about the secret use of the social determinants of health, for care management—and for profit, on the part of vendors that are putting data into algorithms and selling those solutions. LexisNexis found a correlation between someone in the household having completed some kind of professional certification, anything from a plumber’s license to a PhD—with medication compliance and adherence. The point is, you get companies that use information about my life, as raw data for analytics, that are meant to influence my behavior. We need a different kind of safeguard doesn’t go awry. And I’m not saying that what they’re doing might not be wonderful and disruptive in a good way, but nothing turns out as promised, whether Brexit or Google.

The social contract in healthcare, particularly between providers and patients, especially that between physicians and patients—what might that look like, or need to look like, in the coming years?

I see collaborative health as the new social contract. I’m not sure that that patriarchal, hierarchical relationship has changed as much as we might be thinking. I remember writing things 30 years ago that everything would change, and the hierarchies would be totally gone. They haven’t disappeared, though. Your grandmother was probably just grateful to see a doctor. And there are still a lot of people in the country who are still grateful just to see a doctor.

So part of that issue involves socioeconomic class, of course?

Yes, absolutely. That said, I also absolutely agree that a new social contract is going to center around collaborative health. And an explicit one is needed. There’s a lot of talk about that, around Google, Facebook, Alexa. But the medical element is different. When organizations that have tremendous data analytics capabilities, are applying those to the problems of individual patients, that gives us both the potential for unprecedented breakthroughs in patient care, and for the unprecedented ability to manipulate people. The fact that I know everything about your Google searches, your purchasing and eating patterns, and I’m tracing your driving patterns—that can help me improve your health, but also control your life, and manipulate people. And even if the decisions are to your benefit, a social contract demands shared engagement and shared accountability, because that’s the social contract that medicine needs, to retain its soul—even if that doesn’t help increase the value of the IPO or the price-earnings ratio, or the amount of money you get back from meeting your obligations under an ACO contract.

How do you see physicians and other clinicians adapting to this new world?

I think the social contract is even more important, because the power of the individual doctor is often decreasing now. If more and more doctors will be employed, and operating under stricter rules of accountability, that’s good for patients, but the balance between accountability and autonomy is a balance we’ve got to find. And we should welcome Amazon, Apple, and Google—they have an incredible potential to disrupt HC for the better; but the individual doctor, just like the individual patient, is going to be powerless to set a new social contract on their own. That’s why we need a social contract that encompasses clinicians, patients, patient care organizations, payers, pharmaceuticals, and everyone. It may be to my benefit that my doctor is using an app to track population health issues, but with the blurring of lines between different types of organizations, things get complex. Information is power, and the information we’re gathering is extraordinarily powerful, and good things can go awry. So frankly, I see this new social contract as a protection for physicians, and as something that will ensure that the “therapeutic alliance” that doctors like to talk about, will remain strong, even as other boundaries dissolve. And whether my doctor is employed by an insurance company, a hospital, or is a solo practitioner, it should make no difference to certain kinds of relationships.

 

 


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