In a recent letter from a PRO, responding to a request for appeal for Medicare continued coverage, permission had to be obtained from the provider to release information to the patient. There is still a pervasive paternalism in health care, that consumers do not have access to information. There is nothing in the proposed standards pertaining to consumer access to this information. This makes it difficult for consumers and their advocates to appeal denials. Even if the information is incomplete, the consumer should be able to obtain their own health care information, in order to determine the basis on which coverage continues or discontinues.
Electronic autographs are useful.
However in certain contexts, like nursing homes, physician signatures should be conditional on actual contact with patients. To delegate Medical observation to less trained eyes and ears can be risky. Many residents of nursing homes complain they never or rarely see their physicians. The essential communication from the frightened elderly patient and doctor is already minimal. I am afraid that allowing electronic signatures in certain contexts might even more minimize this essential patient -doctor contact.