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Missouri Hospital Association Data Reporting Mandate

03 Apr

Since 1993 all Missouri hospitals have been required to report personal data on all hospital patients receiving care.  Data has been collected beginning in 1986 and Kansas and Missouri are jointly collecting data since 2000.   Reporting data is sent on CD’s (Compact Discs) monthly to member hospitals.  (I would guess without any security or encryption.)  That is a lot of CD’s.  I wonder if all of them are accounted for?  Have any been “thrown away”?

In a recent meeting in February 18, 2010 they have started to enforce rules about a 1% error threshold with the quality of data.  Here is a summary of the February 18 meeting.  I wonder if they have provided any historical data of provider error rates?

HIDI will provide an overview of the guidelines for data submission, including the collection, editing and correction of discharge data.

HIDI recently conduct regional meetings at MHA-member hospitals to review HIDI’s inpatient and outpatient discharge collection process. Staff provided an overview of the guidelines for data submission, including the collection, editing and correction of discharge data. Staff also provided an update on the required discharge data submission to the state.

In November, the Missouri Department of Health and Senior Services notified hospitals and ambulatory surgical centers of its intent to enforce the 1 percent field level error threshold for reporting patient abstract data included in 19 CSR 10-33.010. The rule, effective since Dec. 31, 1992, established procedures for state reporting of patient abstract data for inpatients and outpatients by hospitals and ASCs. HIDI processes and reports discharge data for most MHA-member hospitals and for HIDI-contracted ASCs. According to DHSS, enforcement of the 1 percent error threshold will begin with federal fiscal year 2010’s first quarter data submission — discharges between Oct. 1 and Dec. 31, 2009. Reporting organizations not able to meet the 1 percent error threshold must submit a corrective plan of action to DHSS.

The full report can be found here.  http://www.sos.mo.gov/adrules/csr/current/19csr/19c10-33.pdf

(click on this image to enlarge)

In addition to the personal data required the medical diagnosis, condition, procedure codes, charges, patient disposition, physicians and medical record number were provided.

This information is kept in it’s original form and can be used for other purposes if approved by the HIDI Data Release Advisory Committee appointed by the director.  Unique patient data can be used for detailed studies though subsequent release of data cannot identify patient, physician or provider.

In a letter dated November 18, 1992 from Kenneth L.  Kuebler, Executive Vice President of HIDI,  he provided a concern about this data collection process.

“7.              In addition, legal counsel has brought to our attention the fact that compliance with certain of your reporting requirements will place hospitals in violation of a federal patient confidentiality statute (I will provide the precise citation later when it is provided to me) that precludes the release of the identity of patients treated for drug or alcohol abuse.  The rules will need to reflect this restriction and exempt from the reporting requirements the name or social security number of patients discharged for these types of treament.”

I wonder if compliance to this Federal Patient confidentiality statute was monitored or enforced.  It would have fallen to the reporting hospitals and ambulatory surgery facilities.

HIDI provides many reports to…

The following data are available to MHA-member hospitals.

Hospital Inpatient Reports

These reports contain comprehensive information concerning hospital utilization patterns and patient characteristics and are valuable tools for hospital planning and evaluation. Available since 1986, the reports are mailed to member hospitals that provide inpatient discharge data. Beginning with the 2000 Hospital Inpatient Reports, inpatient discharge data for Missouri and Kansas are combined and reported at the hospital level. Participating Missouri hospitals may purchase reports for Kansas, and participating Kansas hospitals may purchase reports for Missouri. In 2003, the utilization rate tables for Missouri were added to the CD as a convenience to members. The tables report the 500 most frequent principal diagnoses, the 500 most frequent principal procedures and all diagnosis-related groups (DRG).

Interim Hospital Inpatient Reports

Hospital Outpatient Reports

Census Data

Management and Productivity Reports

Monthly Utilization Report

Do all states collect this type of data?

I searched through the 19 CSR 10-33.010. (The rule, effective since Dec. 31, 1992, established procedures for state reporting of patient abstract data for inpatients and outpatients by hospitals and ASCs.)  I did not find the word privacy.  I don’t know what privacy laws protect this data.

Moving applications to the cloud is not cloud computing

30 Mar

It takes more than moving an enterprise software application to an internet data center to make it a cloud based computing application.

Yes, you can make it work on new virtual server technology, new virtual storage, and improve the reliability and performance, but that doesn’t make it a cloud application.

Yes, you can replicate the data to multiple sites and eliminate the risks associated with regional disasters, but that doesn’t make it a cloud application.

In order to make it a cloud application you have to take advantage of new concepts.

Think of putting your data in a cloud that doesn’t need to be tied to a single application but supports many applications.

Think how to make that database massively parallel so that it supports writes and reads for billions of users.

Think how to make the database maintenance non-disruptive.

Think how to backup this data.

Think how your application will be only one of the applications supporting this cloud architecture.

What needs to change to have an on-line medical record?

30 Mar

We need a lot of things to change to have on-line personal data be it medical record or anything else…

1.  We need a system to securely and privately manage, share, protect and integrate the data for a population of 10 Billion or so people. (it does not currently exist and needs funding)  Healthcare is a Global problem.

2. We need a global legal system with laws and protection for personal data.   (There is no organization, group or entity that can protect personal data around the globe.)

3. We need to ensure that only subordinated Governments (those formed to protect individuals rights) have this technology,  else we fall prey to some form of extermination-ism (genocide) using this data.  We have to protect the individual at all times.

4. We need to define what is personal data. (part of this organizations mission)

5. We need to define who is managing our personal data and what control we have on that data. (doesn’t exist)

6. We need systems, people and technologies to audit and enforce any legal issues with the use of personal data. (doesn’t exist)

Is it time for real time data?

30 Mar

Government and private industry efficiencies:

The 2010 Census, the Electronic Medical Record (EMR), and Homeland Security are but three of the many examples where personal information is a major component.  They are also examples of run-away costs, inefficiency, or down-right failure. Information Management can do better.  It has to because it is spending scarce dollars where it should be saving them.  We have to find out why and do so soon as the road we are taking is leading in the wrong direction.

Should we have to collect census data on paper?

Should we have to wait 10 years for an update?

Which is it? Ammendment or Supreme Court?

30 Mar

Rule-of-law under the United States Constitution:

The issue of personal data and its privacy has yet to be adequately addressed by our rule-of-law based democracy, which raises the question,

do we need a new amendment to the Bill of Rights or can the same result be achieved through an interpretation of the U.S. Constitution by the Supreme Court?

Either way, we need something simple like…”Our government should take every measure to protect the significant personal data of every person in their persons, houses, papers, electronic records, and effects.”  This is similar to the Fourth (IV) Amendment which could be “interpreted” to include electronic data.  We believe that personal data including its electronic forms should be defined more clearly, legally.  While this won’t keep data from being collected by others about us — we will still have cameras taking pictures, wire taps for national security, people reading our emails for law enforcement, and social networks that provide  information about ourselves that is very personal – it will give us the same legal rights as we have with our other personal property. .