The so-called "AHIMA paradox"

["Meg H. O'Donnell" <mhodonnell@yaz.hca.state.vt.us>]

  On Tuesday, May 21, Metra1001 (Al) wrote about what he perceived as 
  a paradox in that the American Health Information Management 
  Association (AHIMA) advises people not to sign general releases, but 
  general releases are often required by insurers before paying for any 
  health care treatments.  He then recommended that we all " contact Ms.
  Kathleen A. Frawley, JD, Director [of AHIMA]" to pursue this apparent 
  contradiction, saying "[y]ou will find she is very polite, very professional
  and courteous, yet she can be somewhat evasive on occasion... particularly in
  areas of contention such as this."
  
  This is, in my opinion, exatcly the wrong thing to do.  The 
  implication is that AHIMA, and/or Ms. Frawley, are somehow 
  responsible for the dilemma faced by persons who do not wish to share 
  their medical records for any purpose when they are confronted by the 
  realities of our health care system.
  
  Reality #1:  Insurance is not a "right" at this time.  This means if I 
  want to participate in an insurance plan, I may have to give up some 
  things that are important to me -- like some expectations of 
  confidentiality.
  
  Reality #2:  AHIMA is in the forefront of organizations seeking to 
  change state and federal laws to incorporate the excellent practices 
  its members use in dealing with identifiable medical records.  
  Perhaps that is why their brochures warn people as to the 
  consequences of signing general releases.  This does *not* mean AHIMA 
  supports or condones how the insurance system works.  See Reality #1.
  
  Reality #3:  It is exactly this kind of issue that motivates those of us in the 
  trenches who are trying to adopt statutory protections, on both the state 
  and federal levels.  Vermont's proposed health care information law, which 
  was tabled at the end of our recent legislative session after having been 
  endorsed by three of the four committees working on it, and having passed 
  the House, included strong language to the effect that even if an insurer has 
  access to medical records with a patient's written consent, *access was 
  restricted only to the minimum amount necessary to accomplish the 
  purpose for which it was released.*  This means an insurer who needs 
  to pay a claim *gets only what is necessary to pay that claim,* and 
  nothing more.  This principle would have applied to *any* release of 
  information, and would penalize the release or use of information in 
  excess of that minimum.  S. 1360 has similar provisions.  These are 
  far more consumer-friendly than *anything* that exists in common law 
  today.
  
  Instead of personalizing these issues by bothering individuals, like 
  Ms. Frawley, the most constructive approach (IMHO) is to look at 
  proposed laws -- like S. 1360 -- and try to make them the bext possible 
  laws that they can be, given the political and economic realities of our 
  health care system.  The result ain't gonna please everyone, but we'll 
  all be better off if we gain legal protections we do not have at 
  present.
  
  
  
  
  
  _____________________________________________
  Meg H. O'Donnell
  General Counsel
  Vermont Health Care Authority
  mhodonnell@yaz.hca.st.vt.us