y*c
发帖数: 247 | 1 http://www.bostonglobe.com/news/nation/2014/09/21/electronic-he
Billing dispute leads to blocked patient data in Maine
Vendor’s action may point to broader risks
When staffers at a ti1ny medical practice in far-northern Maine arrived at
work one July morning and tried to view medical records for that day’s
patients, they got an unsettling response from their computer.
“Access denied.’’
The staff called a technician, who confirmed what had happened. As part of a
billing dispute, the vendor for the clinic’s electronic health records —
a German corporation with US headquarters in Boston — took the unusual step
of blocking the staff’s ability to look up medical histories on its 4,000
patients.
Nurses and physicians could no longer use the system to review diabetes
records, blood pressure logs, medication histories, allergy reports, lab
results. Nothing.
The company’s aggressive action poses what specialists in the field of
digital health records say is a serious safety hazard for patients.
“It creates patient risk. It is dangerous, in my view,’’ said Dianne J.
Bourque, a health care lawyer at Mintz Levin in Boston who specializes in
regulatory and contract matters and is not involved in the case. “It’s a
horrible, horrible remedy.’’
But the German health technology company, called CompuGroup, likens the
situation to a utility customer who stops paying bills, saying a medical
provider should similarly expect its medical records to go dark. A couple of
weeks after the July morning when the records were shut down, a CompuGroup
lawyer at its US headquarters in Boston delivered an ultimatum, via e-mail:
Until the medical office, Full Circle Health Care, paid $20,000 in overdue
charges, the electronic health records would remain locked.
“I’m incredulous they think it is OK to hold us hostage like that,’’
said E. Victoria Grover, the physician assistant who owns and operates Full
Circle. The financially struggling practice, with about 10 employees, is
located in Presque Isle, a city that has its own hospital but is located in
a rural region that lacks easy access to medical care.
Grover acknowledged that Full Circle stopped paying CompuGroup $2,000
monthly fees about 10 months before the shutoff. But she said that was after
months of fruitless haggling over what she considered exorbitant,
unexpected maintenance fees and charges for hardware that was never
delivered — disputed billings that she said CompuGroup refused to
acknowledge or correct.
This year she hired another electronic health records vendor, but her
practice’s old records, the ones controlled by CompuGroup, hold important
patient information that is vital for making treatment decisions. That
information remains inaccessible on her old servers in a closet in her
office and can’t be moved onto the new system.
“I’m pretty desperate to get these records back,’’ Grover said.
This David-and-Goliath battle, pitting a tiny medical office and a German
multinational corporation, may have broader implications. Physician
practices and hospitals across the country rushed to cash in on $30 billion
in federal subsidies for electronic health records systems starting in 2009,
including Full Circle. As contracts were inked by the thousands in the last
few years, say legal experts, not enough thought was always given to what
happens when the computer systems stop working correctly, vendors or
providers struggle financially or go out of business, or the parties have a
falling out.
The Presque Isle situation represents the worst-case scenario, with
thousands of patients and their doctors finding their records stuck in a
digital limbo, the subject of a hostile dispute.
Since the July 30 shutdown of records at Full Circle, the staff has been
scrambling each time a patient schedules a visit. Nurses hunt down separate
pharmacy and lab reports to piece together what care has previously been
provided. Still stuck in Full Circle’s computer servers are doctor’s notes
about each patient visit, the crucial narratives that document the patient
’s condition and medical history.
Other providers in Presque Isle expressed concern about Full Circle’s
predicament, without commenting on the billing dispute at the core of the
fight. One of the key reasons to computerize patient records is to allow
them to be exchanged among state or local networks, such as Maine’s
HealthInfoNet.
“It’s critical that we can access this information,’’ said Dr. Roger
Pelli, chief medical information officer at Aroostook Medical Center, the 80
-bed hospital in Presque Isle. “It would tie my hands as a physician if I
was trying to care for someone and I couldn’t get their data.’’
CompuGroup, with worldwide revenue of about $600 million in 2013, said it
took action against Full Circle Health Care because the outpatient medical
practice rebuffed its attempts to negotiate a settlement of overdue charges
(Full Circle says the total amount CompuGroup is demanding is $40,000.)
“If you were to stop paying your electricity bill, and a year later someone
shut down your electricity, how would you feel about that?’’ said Tetyana
Buescher, general counsel of CompuGroup Medical USA.
Buescher declined to say how often CompuGroup had shut down records of its
customers for nonpayment.
“It is unusual, because usually providers negotiate with their service
provider,’’ she said. Shutting down access to records ”is absolutely the
last measure that we have.’’
“Full Circle had a lot of opportunities to resolve this, including getting
on a payment plan; they chose not to do that,’’ she said. “You can make
an inference about . . . who is at fault in endangering patients, if that is
the case.’’
It is not clear what legal recourse Full Circle, which contacted the Globe
to tell its story, has to pry open the records. The medical office has not
filed a lawsuit.
Reports of similar cases are rare. A 2013 lawsuit in Wisconsin was settled
after a federal judge denied a temporary restraining order sought by
Milwaukee Health Services against its Atlanta-based vendor. The judge
expressed little sympathy for the medical practice in the decision denying
the restraining order and said the medical group could unfreeze the records
by simply paying its disputed bill.
In Presque Isle, Full Circle first obtained its electronic medical record
system in 2010 from a Georgia company called HealthPort. The price was $72,
000 for the up-front costs including HealthPort’s software and hardware.
Maintenance fees in the original contract were set at what worked out to be
about $300 a month. CompuGroup Medical purchased HealthPort’s electronic
record business for $18 million months later. Grover said CompuGroup soon
began charging maintenance fees of $2,000 a month.
The original HealthPort contract, reviewed by the Globe, says that Full
Circle owns a copy of the HealthPort electronic health record software. But
the contract also says that if the software works in conjunction with the
vendor’s off-site application systems, then the vendor has continued
authority over its use.
“At some point [CompuGroup] implanted a ‘kill switch’ into the software
we bought from HealthPort,’’ Grover said in an e-mail. “The implant
modifies our software so that it sends a message to [CompuGroup] asking for
permission to let us use the system, every time we try to log on. CGM did
this without our knowledge and without our consent.’’
Now Full Circle wants just 48 hours of access so it can move all of its
patient data to its new system, “and CompuGroup’s logo would never cross
our screens again,’’ Grover said. But, she said, she sees no clear path to
that resolution. | M****a
发帖数: 577 | 2 这个诊所财务管理有问题，还拿着patient care的名义来耍赖，颇有“我是流氓我怕谁
”的风范。 | y*c
发帖数: 247 | 3 这个诊所肯定有一定问题，但关键是信息公司可以简单block patient data吗？事关病
人健康甚至性命的事可以类比电力公司来处理问题吗？这次可能是信息公司有理，但也
许下次就只是它自认有理。在现在health care全面信息化的大潮下，让我真的很担心
将来把我病人所以信息都交给这样的公司管理。 | M****a
发帖数: 577 | 4 诊所赖账10个月，就算有理也变成无理了，现在又通过媒体来要挟人家，这事做得相当
不地道。他们应该一开始就及时找另外一家信息公司的，或者接着用纸病历。有钱人，
有有钱的活法，没钱人，有没钱的活法。
【在 y*c 的大作中提到】
: 这个诊所肯定有一定问题，但关键是信息公司可以简单block patient data吗？事关病
: 人健康甚至性命的事可以类比电力公司来处理问题吗？这次可能是信息公司有理，但也
: 许下次就只是它自认有理。在现在health care全面信息化的大潮下，让我真的很担心
: 将来把我病人所以信息都交给这样的公司管理。
| y*c
发帖数: 247 | 5 哈哈，从内心深处我赞成你，都十个月了，早干什么去了，但中间这不还夹着病人吗。
象我们给病人矫正牙齿，一般需要两年左右，我们会在开始矫正前让病人付一定down
payment ,剩下的按月付。如果一病人开始治疗不旧就不付钱了，你觉得我可以停止治
疗吗？我是很想把病人扔出去完事，但dental board的要求是一旦你开始治疗，就要完
成治疗，除非病人主动要求停止，因为你不能伤害病人。既然这家信息公司在参与
health care的业务，是不是也应该遵守同样的规则哪？ | g*n
发帖数: 538 | 6 死猪不怕开水烫。还理直气壮。
a
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step
【在 y*c 的大作中提到】
: http://www.bostonglobe.com/news/nation/2014/09/21/electronic-he
: Billing dispute leads to blocked patient data in Maine
: Vendor’s action may point to broader risks
: When staffers at a ti1ny medical practice in far-northern Maine arrived at
: work one July morning and tried to view medical records for that day’s
: patients, they got an unsettling response from their computer.
: “Access denied.’’
: The staff called a technician, who confirmed what had happened. As part of a
: billing dispute, the vendor for the clinic’s electronic health records —
: a German corporation with US headquarters in Boston — took the unusual step
|
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