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Nutrition Informatics Blog



Ripple Effect of “Meaningful Use”: Part III-Patient/Consumer Engagement

“Patient Engagement” or “Consumer Engagement” (meaning those who do not want be considered under treatment for a condition) is a viable part of the HITECH Act.  The Phase I Rules most focused on this include the requirement that those receiving HITECH Incentives must –

“Provide clinical summaries for patients for each office visit.” (Page 59)

As an RD, this is exciting to me! It dredges up from memory from outpatient consults of long ago—trying to determine a patient’s past medical history, asking many probing questions and receiving conflicting information!  Often the only information I had, unless I called the physician to discuss prior to the appointment, was the diet order written on a prescription and/or transcribed into an appointment book.

It also brings up conversations with my parents—both in their late 70’s.  On more than one occasion, they both will be on the phone, giving me details of a medical visit, asking questions and---not agreeing on the exact details from their doctor! Luckily my mother now writes everything down prior to and during the discussion—and luckily there are many patient Internists around!

My impression is that this is one of many areas of the HITECH Act where opportunities for care improvement abound!  As dietitians, we must strive to capture and use them all! Suggestions welcome!!

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Comments (2):
8/9/2010 2:02:32 AM by Fred Buhr, MSSW

Hello Lindsey, My wife Shirley and I are in our early 70's, a little younger than your parents. I graduated from high school (Dubuque, Iowa) in 1956 and my wife graduated from Beloit Memorial High School (Beloit, Wisconsin) in 1957. Shirley was one of 10,300 Wisconsin Class of 1957 high school graduates, randomly selected, to participate in the Wisconsin Longitudinal Study (WLS) ( Periodic interviews with those students, their spouses and siblings have taken place over the past five - now going on six - decades. The WLS began as a project to help the state of Wisconsin prepare for the growing numbers of high school students seeking post-high-school education in the late 1950s. Since that time, the WLS has become one of the longest-running social science studies ever undertaken. In 2007, WLS participants were invited to contribute to the exciting research on the relationship between genes and health or other life outcomes by donating a saliva sample (via kit). The DNA in the saliva was analyzed to study the relationship of genes to health and well-being, including Alzheimer's disease, cancer, and depression. Last week an interviewer from the University of Wisconsin Survey Center came to our house and conducted an in-person interview of Shirley, including recording observations of several physical and mental activities she was asked to perform. The data will help scholars better understand the aging process. Toward the end of the interview, my wife was asked for permission (which she granted) to access her Medicare files in order to obtain information about the services she received that were paid by Medicare. Information will include: diagnoses, clinical encounters, procedures, and treatments. The interviewer described how the WLS protects the confidentiality of personal information. The interviewer further explained that the Federal Government has given the WLS a "Certificate of Confidentiality" that, among other privacy protections, provides that no one can require WLS to disclose any information about participants without their written consent. The Wisconsin Longitudinal Study is but one of Wisconsin's outstanding contributions that has earned the state a reputation for "leading the nation". I worked for the state of Wisconsin for over forty years and during all that time I believed that all Wisconsin's programs were outstanding and covered by strong privacy protections such as those of the WLS. But, since 2007, when I began a volunteer job as a data entry operator for our village's senior outreach program, I have found that the administrators of Wisconsin's state unit on aging (SUA) and area agencies on aging (AAA) have disregarded state and federal laws relating to privacy and security of protected health information (PHI). They have done so by inexplicably contracting for software as a service (SaaS) and utilizing an internet hosted network outside Wisconsin's firewalls and security framework. I believe that Wisconsin generally still has the best health and social services programs in the country, but in regard to privacy and security of the SaaS management information system utilized in the administration of the nutrition programs, I believe Wisconsin ranks as the worst in the country. Bad practices can clearly be seen in the process used by Wisconsin in mandating the use of the DETERMINE nutritional assessment form to show nutrition outcomes at the state and local levels. I have placed documents relating to the process on my website: I am a proponent of personal health records (PHRs) designed to exchange health information with electronic health records (EHRs) and am participating on the HL7 PHR workgroup. When PHRs become available, your mother won't have to write everything down from physician visits and (with her and your father's authorizations) you'll be able to see results of tests and clinical summaries of each of their office visits, first-hand. Lindsey, I have been following the various HIT committees and have heard you speak a number of times. If you haven't already done so, I would encourage you to apply for the Consumer e-Health Policy Analyst position in the Office of the National Coordinator (ONC). Best regards, Fred Buhr, MSSW Metasteward LLC

8/9/2010 10:55:45 PM by Ivonne Cueva_1

Hi Fred, Thank you for sharing! I have spent some time reading of your situation and advocacy. I hope you will continue to advocate for Personal Health Records and the necessary Privacy and Security needs regarding health privacy. We so often consider Privacy and Security "too technical" for understanding by the average citizen, but we all need to remain diligent. I so often feel the "weakest link" can destroy public trust of EHRs due to this unfounded logic. In terms of privacy and security, it by necessity is an "All Hands on Deck" issue--one lapse by any one individual can risk sharing personal health data where it shouldn't be. I have great confidence in the process of the HITECH Policy and Standards Committees, their many work groups and hearings. Improving health care is an overwhelming but worthwhile goal--it is complicated and will take time and great collaboration. I agree with your comments about PHRs and am in the process of working through that for my parents as we speak. Thank you for your kind recommendation on the position at ONC. It does sound very intriguing, however I have spent most of the past 10 years as a consultant. I am often tempted by salaried positions, but love what I do and how I am able to do it. Even though there are definate disadvantages, they pale when I consider my quality of life. I live about 10 minutes from one of the most beautiful parts of our country--the Chesapeake and Ohio Canal. It allows walking, jogging or biking along the "towpath"--without threat of cars or traffic--yet I live 20 miles from our Nation's Capitol. It is not uncommon to see a multitude and variety of plants, Great Blue Herons, and other wildlife. Everyone should have such inexpensive therapy!! Anyway, your vote of confidence is greatly appreciated!! My wish is to make a small dent in health care for the next generation. Please stay in touch and with others, continue advocacy for improved health care. I believe the HITECH Act provides a mechanism for adopting EHR/PHRs in the right fashion and in the best interest of patients. Best, Lindsey

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