In the course of working on Capitol Hill and with regulatory
agencies on various aspects of health policy, I have found TPJ
to be a valuable source of information for multiple audiences.
The variety of articles, commentary, history, illustrations, artwork,
even editorials has a wide appeal. I often take a copy with me
and leave it behind as an introduction to our medical care principles
and practice. Serendipitously, sometimes the collection of offerings
in the Journal is custom-made for a particular purpose.
Such was the case in a recent encounter with regulators at the
US Department of Health and Human Services (DHHS).
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) included a section on "Administrative Simplification"
which dealt in part with the transfer and storage of electronic
medical information. The Act stipulated that if the US Congress
failed to develop federal policy to protect the privacy and confidentiality
of medical records by August 21, 1999, the Secretary of DHHS would
be instructed to issue regulations in this area within six months
(ie, by February 2000). Congress hasn't been doing so well with
this charge, having failed to reach agreement on any of several
proposals generated over the past three years.
The deadline has passed, and the HHS policy staff have the unenviable
task of drafting sensible rules that will please most stakeholders.
HHS staff members are meeting with interested parties, such as
privacy advocates who seem to distrust any use of medical information
not related to specific treatment goals. Chain pharmacies and
pharmacy benefit managers are advocating their own methods of
disease management, and pharmaceutical companies are lobbying
for more liberal use of medical information for privately funded
research and marketing. During our meeting with HHS regulators,
they were particularly interested in our views about security
of electronic patient records and use of information for creating
patient registries for various purposes, particularly for management
of chronic illness. We were also asked about our research activities,
how we used our institutional review boards (IRBs), and how we
distinguished between research and other activities that we would
classify as quality management or utilization management.
What a cornucopia of delicacies in the Summer 1999 (Vol 3, No
2) issue of TPJ--and how well they support our responses
to the HHS Secretary's questions! The lead series of articles
(on awardees of the James A Vohs Award for Quality) describes
the Comprehensive Computer-Based Patient Record (CPR) Project
at the KP Northwest Region, which addresses many of the questions
put to us on the utility, functionality, and security of an electronic
medical records system and emphasizes our commitment to improving
quality while lowering costs. Regulators could see from the accompanying
article on the Clinical Pharmacy Anticoagulation Service of the
KP Colorado Region how pharmacists, for example, can assume their
clinical role in a way that benefits patients, not just marketing
schemes. And the article about the Diabetes Prevention Care Program
of the KP North Carolina Region gave regulators a wonderful example
of a disease management program that had well-documented outcomes.
The list continues: the article by Drs Oyekan and Kung at the
KP Los Angeles Medical Center on another type of disease management--a
multidisciplinary approach to treating fibromyalgia; Dr Lee Jacobs'
article, "The KP Promise, Permanente Practice, and the Competitive
Edge," which shows diverse examples of excellence throughout
our KP Program; and Dr Ron Copeland's opinion piece, "Pursuing
High Performance," which also gives insight into our values
of quality-oriented and patient-focused care--principles we hope
regulators will try to reflect in the regulations they write.
Doctor Scott Rasgon's interview with Dr Ray Hannah and Dr Joe
Carlucci on Optimal Renal Care shows how we carry our best programs
into the outside world. Can you imagine the delight of federal
regulators at seeing an article that may give them reason to hope
that Medicare might manage its end-stage renal disease program
at lower cost and with superior outcomes?
For those regulation drafters struggling with the quandary of
how to protect information while making it available for much-needed
research, the dessert to this feast of information is found in
the excellent piece by Dr Diana Petitti and Nancy King on Institutional
Review Boards (IRBs). The authors directly address the privacy
and confidentiality of medical information used in various settings.
At the national level, the federal IRB oversight program has recently
received justified criticism and is due for revision soon. Diana
and Nancy demonstrate how the institutional review process can
be conducted the right way.
To intrigue readers further in this bureaucratic world of ceaseless
demands for more federally funded services, we present two excellent
articles on alternative and complementary therapy, currently a
topic of vigorous policy debate. I can foresee that Dr David Eddy,
Dr Les Zendle, and Mitch Sugarman, with their new responsibilities
on the Health Care Financing Administration Medicare Coverage
Advisory Committee, may be struggling with these issues soon.
As they were perusing their copies of the Journal, I'm
sure the regulators noticed the wonderful artwork by Dr Doug Grey,
Terry Laskiewicz, and Marian Savage as well as the thoughtful
historical vignette by Dr Oliver Goldsmith.
And I congratulate Dr Tom Janisse and the editors of TPJ
for producing an issue that was perfect cover-to-cover for distribution
to a critical audience. How could they have known what to include--and
to send it on the day before our vital meeting? And how could
they have known that several of the meeting participants were
proud KP members?
