HHS: Government-Mandated Electronic Health Records Need ‘NOT’ Include Cancer Diagnoses--As Opposed to Obesity Ratings

October 4, 2010 - 11:27 AM

Electronic Health Record

An Electronic Health Record image. (Wikipedia Commons)

(CNSNews.com) – Physicians will not be required to include a cancer diagnosis on the electronic health records that all Americans are supposed to have by 2014 under the terms of the Democrats' 2009 economic stimulus law, according to the Office of the National Coordinator for Health Information Technology, a division of the Health and Human Services Department that is responsible for setting the rules for the EHRs.

By contrast, HHS is mandating that all EHRs include a person’s Body Mass Index.  BMI is the formula that calculates the ratio between a person’s height and weight to measure their obesity.  

HHS's EHR regulations say that every EHR system must, “Calculate body mass index. Automatically calculate and display body mass index (BMI) based on a patient’s height and weight.”

A cancer diagnosis is not the only significant health event that may be omitted from a person's EHR.  HHS also says it is not mandating that health-care providers include an abortion or a diagnosis of HIV/AIDS on a person's EHR.

A leading oncologist and former chair of the EHR Working Group at the American Society of Clinical Oncology, however, told CNSNews.com that HHS should "know better" than to say that a cancer diagnosis need not be included on a person's EHR and that it only "makes sense" for oncologists, who specialize in treating cancer patients, to include such a diagnosis in a person's federally mandated EHR.

HHS made its statement that EHRs do not need to include whether a person has been diagnosed with cancer in a written answer to CNSNews.com emailed in response to the following question: “Do doctors have to include pregnancies in electronic health records? Cancer diagnoses? Abortions? HIV/AIDS diagnoses?  Is anything required to be included in an EHR?”

CNSNews.com had originally tried to put this question directly to Dr. David Blumenthal, the director of the HHS's Office of the National Coordinator for Health Information Technology, after he testified before Congress on Sept. 30. Blumenthal declined at that time to respond but referred CNSNews.com to his spokesperson.

In response to CNSNews.com's written question, a spokesperson for HHS's Office of the National Coordinator for Health Information Technology, emailed this statement: “Providers will treat health information the same in the electronic world as they have in the paper world. They will record the information necessary to treat the patient in the electronic medical record. HHS's rules for doctors to receive payments for meaningfully using health information do not require the recording of any particular test result or procedure. The Rule does NOT require a doctor to include a cancer diagnosis, abortion or HIV/AIDS diagnosis in an EHR. What is recorded in an electronic medical record remains largely a matter between the physician and the patient.”

The HHS spokesperson who emailed the response on behalf of the department asked that their name not be used in this article.

The statement did not address the question of whether a pregancy--as opposed to an abortion--needed to be included in a person's EHR.

Back in July, Blumenthal did speak with CNSNews.com after testifying before a congressional committee. At that time he said it was up to doctors and their patients to decide what information went into an electronic health record. “Any specific information recorded in the record is an issue between the doctor and the patient,” he said.

Also at that time, Peter Garrett, the communicatins director for HHS's Office of the National Coordinator for Health Information Technology, responded to written questions from CNSNews.com about what information needed to be included in the government-mandated EHRs. “If a physician chooses to participate, they are not required to record any specific type of health information and the physician needs the patient's consent in order to record any of their personal health information,” Garrett said.

However, the EHR regulations published by HHS in July specifically mandate that EHRs must include a person's Body Mass Index (BMI). Those regulations also state that EHRs must “Maintain an up-to-date problem list of current and active diagnoses” and “procedures.”

A problems list is defined in separate federal regulations as:

“(i) Diseases. (ii) Injuries. (iii) Impairments. (iv) Other health problems and their manifestations. (v) Causes of injury, disease, impairment, or other health problems.”

Procedures are defined as actions taken with regards to: “(i) Prevention. (ii) Diagnosis. (iii) Treatment. (iv) Management,” of those things listed on the problems list.

The HHS's Office of the National Coordinator for Health Information Technology is responsible for the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information" that, among other things, "reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information" and "provides appropriate information to help guide medical decisions at the time and place of care,” according to Section 3001 of President Barack Obama's economic stimulus package, which became law in February 2009.

EHR image

Electronic Health Record image. (Wikipedia Commons)

That law calls for every American to have an EHR by 2014 by placing a mandate on health-care providers. Providers that are not making "meaningful use" of the government-mandated EHRs for all their patients by that year will be subjected to diminished payments from Medicare and Medicaid. The law also requires that the records be part of an integrated national system in which they can be electronically exchanged.

Dr. John Cox, a Dallas-based medical oncologist and past chair of the EHR Working Group at the American Society of Clinical Oncology, said that while there were “very few” federal requirements dictating which specific conditions must be recorded in a medical record, it would only “make sense” for a record to contain a cancer diagnosis.

“It certainly would make sense in this country that if you see a cancer patient that you would have to document the diagnosis of what type of cancer it was and the appropriate stage,” he said.

“If you look at the future of electronic health records and CMS’s [Center for Medicare and Medicaid Services, a division of HHS] own criteria under what are called their meaningful use criteria,” said Cox, "one of those criteria are the submission of what are called critical elements ... and though it’s not mandated with the first stage of meaningful use, what is coming is the requirement that a cancer patient would have the stage of their diagnosis defined and that would be part of the medical record that would ultimately have to be shared,” in a nationwide professional registry.

Dr. Cox said that the HHS should “be careful” in how it describes EHRs because eventually EHRs will be as comprehensive as paper medical records. “If you can look at those criteria and see where they’re going, then they [HHS] should know better,” he said. “Clearly, you want a robust system that is allowing information to go from provider to provider and you want a system nationwide that is providing the health care system with information so they can make good decisions.”

Cox told CNSNews.com that in his opinion the stimulus bill and the HITECH act contained within it would be more transformative for American health care than the Affordable Care Act, the health-care reform law enacted in March that is sometimes known as Obamacare. The HITECH Act [Health Information Technology for Economic and Clinical Health] was the part of the overall stimulus law that mandated that all health-care providers adopt EHRs for all their patients by 2014.

“I often say to my colleague that the Affordable Care Act that everybody’s in an uproar about isn’t the transformative--it is transformative in some ways--but it’s not the transformative thing that’s going to hit you this year or next,” he said. “It was ARRA [the stimulus law] and HITECH that really are going to transform our practices in the short term--and I really believe that.”