Thread by @SavageLucia

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy Been stewing on this actually @ePatientDave .
It's the same problem @claudiawilliams and @HITpolicywonk raised.
In sum, a state can require certain behavior of a #licensed #professional that may be inconsistent with #HIPAA right of #access, or #CLIA rules, or (1/several)

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk Or even @ONC_HealthIT. The issue is which rules win?
The first principle is that accessing your own health info is a privacy right.
There's a clear rule about state laws that give fewer rights, like making it cost more than #HIPAA says it should. Those are preempted 2/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT The second principle is that legislatures dictate license terms to keep patients "safe."
So here, some states are adding physician requirements about labs to keep patients safe. It's a theoretically different line of law entirely, but it's crashing into the first principle 3/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT (We can argue about the are part but that's what the legislatures need to hear, not me.
So, does delay to keep a patient safe trump the right of access. Unfortunately that will have to be sorted out.
It's not as clear as a per page charge of $1. That has zero to do with safety 4/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT Or #privacy. The $1 fee is just cost recovery.

The third principle is that @ONC_HealthIT rules also don't trump state law. In other words, if delayed lab results are not #preempted on #HIPAA privacy grounds, #infoblocking rules won't trump those #lab results rules 5/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT So what to do?
IMHO, best thing is #Doc or #NP and patient decide together what's best. Surely there's an E&M code for this & 70% of care is still #FFS.
It's clear there are #patients who want to wait to hear from their #healthcare #Professional.
I'm not in #clinic daily and 6/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT Don't know why there is NOT a #lab results planning conversation, esp the really #scary stuff like #cancer.
But let's #strengthen the doc/patient relationship by encouraging a convo instead of dueling #laws that are so #complex and fact-specific that people don't know what 7/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT to do.
The "go big" remains an option; that is a counter narrative in the state legislatures. (Kind of like the decades-long #HIE/privacy discussion in MN, right @claudiawilliams?) But obviously some states already acted and that is a harder conversation.
What about a 8/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT Discussion with state #medical #societies and patients who don't want to wait as well as those who do? Flesh out the story where the decisions are being made? Yes, a TON of work for already #exhausted, #frightened, and #overwhelmed #patients. But remember, 9/

@ePatientDave @janoldenburg @MightyCasey @HealthPrivacy @claudiawilliams @HITpolicywonk @ONC_HealthIT #physicians and #nurse #practitioners and #PAs also are #overwhelmed, burnt out, feeling under attack for trusting #science.
How do we get the labs quickly into the hands of those that want them ASAP without unduly burdening the professionals? 10 (End I think. . .)