If someone would have told me four years ago that I would be where I am at right now, I would have thought that ‘someone’ was crazy. It’s not the idea that I would be majoring in Computer Information Systems with a minor in Business (although that would’ve sounded partly farfetched); it’s the idea that I have had the opportunity to shadow the Head of Neuroradiology at the Cleveland Clinic in an attempt to help pioneer the new Health Information Systems major at John Carroll University.
Now that sounds crazy.
But, that has been nothing but reality ever since I expressed an interest in the Health Information Systems track exactly one year ago. Even then, I knew this was an opportunity that I could not pass up. And that thought has been only been thoroughly reinforced as time passes by. I’m still earning my degree and the opportunities that have been presented to me have exceeded my expectations. Like I said before, I never saw this coming.
On February 10, 2011 I had the chance to shadow Dr. X, the Head of Neuroradiology at the Cleveland Clinic with Dr. Y. Upon hearing that Thursday was his day to operate, nerves started to fly. We weren’t sure what kind of surgery we’d be witnessing, so my mind started to wander. When we arrived to Dr. X's office and were instructed to put on scrubs, reality set in. “Nervous” doesn’t even begin to describe what I was feeling. But upon meeting Dr. X, some of those nerves began to vanish. He showed us around one of the many buildings that compose the Clinic. For lack of a better term, I felt like “a big deal.” But there was still the thought of an operation lingering in the back of my mind.
While walked back towards the operating area, I felt like I was not supposed to be there. I have no certification, no biology experience, and I didn’t even sign a release form. I couldn’t back out now, we had hair nets and masks on and the whole nine yards. We met other surgeons and operating technicians who were very helpful and welcoming. I didn’t expect that at all. Because radiation was being used, we needed to wear lead vests, skirts, and thyroid guards. Again, there was no turning back now, although seeing the patient on the operating table gave me the urge to do so. It was then time for us move past the glass that separated us from the location the surgery was being performed. That glass was my security blanket. It then had no purpose to serve as it was time for us to relocate behind Dr. X and the other surgeons and assistants who were near the patient.
The patient had a brain tumor that was scheduled to be removed the following day. What Dr. X had to do was thread a wire through the patient’s femoral artery to see where the tumor was. Once that was located he sent liquid through the tube that was in the artery which contained small water-balloon type particles to the tumor. That cut the blood supply to the tumor, which eventually would “kill” it so the surgery the following day would be “easy.” While Dr. X was doing this, we proceeded to talk to the technicians about the conflict in Egypt, and then would turn around to Dr. Palmer and I to continue discussing a new HL7 program the Clinic is working on. I was amazed at how lax the operating room actually was. I was stunned about what was happening in front of me. It was an out of body experience, one that I would do again if I had the chance.
After the surgery, which seemed to be successful, Dr. X took us around other departments of the clinic. He showed us an imaging center, a new MRI machine/room, and robots that are programmed to transport pertinent supplies to specific areas.
Upon leaving the clinic, I really couldn’t believe what had just occurred. I was speechless. I never would’ve thought I’d get an opportunity like that; not many people do. All of my nerves and anxieties I had days before the shadowing experience were completely worth it. Like I said before, I’d do it all over again if I had the chance.
Healthcare Information Technology has somewhat of a silent prominence in our society. Many don’t realize how imperative it is in day-to-day operations in offices or hospitals. In 2004, President Bush made this importance visible by stating a ten-year; $100 million plan to convert to Electronic Health Records by 2014 (1). Bush felt that this adoption would drive change to the health care system in America, by evolving with the technology push. The original plan was to advance this even further so that patients would carry key chains that contained their information. This electronic record would easily available for any authorized physician to access when necessary (1). This plan also was designed to create incentives for health care providers to adopt and use electronic medical records. Also with this plan, the Office of the National Coordinator for Health Information Technology (ONC) was created (2). ONC was created to lead the establishment of EMR’S in the nation’s health care systems.
As of 2009, only 25-35% of the 5000 American hospitals are using EMR’S (2). Bush’s 10 year plan has now been extended to 2015 and needs further funding to keep on the track. Obama has now taken the project and pledged to supply $10 billion per year to fund this change. This threatens the budget with a $100 billion deficit over the next ten years. That number is daunting to many; however in an industry that spends over $2.7 trillion per year, it’s rather miniscule compared to other spending (2). Dr. David Brailer, an advocate for EMR’S, claims that a successfully implemented EHR system has the ability to save the nation $200-300 billion per year (2). If the system has the ability to cut down duplications, reduce costly errors, avoid fraudulent claims, and coordinate care between doctors and physicians, the nation’s health care system will display the essence of efficiency.
With this need for efficiency comes the responsibility for maintaining privacy. These records, once in place, cannot and should not be easily accessed. For those who can access them, a standard needed to be put in place for the security of the information being accessed. In 1996, The Department of Health and Human Services was required to establish national standards for electronic health record transactions (3). With the implication of the Health Insurance Portability and Accountability Act (HIPPA), effectiveness of the nation’s health care system would improve along with security of the information attached to it (3).
Title II of HIPAA’S “Administrative Simplification” contains three rules. The first rule is The Security Rule. This rule is self-explanatory; it involves security defenses used with a patient’s Electronic Protected Health Information (ePHI). This rule constructs principles health care providers and physicians should abide by to guarantee ideal confidentiality of all electronic records that are accessed. This rule also ensures proper precautions each provider should employ to defend electronic threats such as viruses or breaches of security by other employees (4).
The next rule is The Privacy Rule. This rule guarantees any health information, paper or electronic, is protected, even including health care payments and insurance information. For this to be properly implemented, those with access to Electronic Medical Records are required to study guidelines, watch a video, and pass a test to become HIPAA certified. (4).
The third rule is the Enforcement Rule. This rule involves penalties against any who violate the previous two rules. Violators are subject to pay hefty fines if any of the following rules are breached. Medical information is very sensitive, and if handled or accessed incorrectly, can create threatening issues to all parties involved. The Enforcement Rule also details the process of an investigation, how penalties are determined, and how to appeal these violations in a court setting (4). Some cases even involve time in jail for those who violate HIPAA laws. A doctor in California was sent to jail for 4 months for inappropriately accessing medical records. He was also fined $2000 (5). However, a nurse is facing a charge of 10 years in jail and a $250,000 fine for inappropriately accessing medical records for personal gain in a case that directly involved her husband (6).