Electronic Health Reporter

Guest post by Judy Chan, president, HealthPro Consulting.

Burgeoning EHR implementations nationwide attributable to the meaningful use incentive program have created a surge in HIO and electronic health information exchange (eHIE).

Having health information available for electronic exchange is generally accepted as beneficial to patients, providers and payers. Providers can access patient information from other providers when they need it where they need it. Providers are able to avoid duplicating lab tests, scans and x-rays that save the payers dollars. Additionally, patients don’t need to remember what treatments were administered or drugs prescribed and can avoid unnecessary exposure to radiation.

In emergency situations, the benefits of having a patient’s health information available to emergency room staff are obvious. Patients who have experienced referrals in the course of diagnosis and treatment also readily see the advantage of not having to hand-carry all of their medical records from one doctor’s office to the next. The electronic exchange of health information among providers eliminates faxes, paper work and phone calls.

Patient’s perspective

What makes the exchange of health information frightening to patients?

1. Your health information is available to others who have a legitimate need.

2. Consent must be given by the patient to share their information

3. You must trust the distributor of your information

4. You should monitor your data on a regular basis and make corrections when necessary

5. Information could be accidentally released without your permission.

6. Your consent is electronically recorded by multiple systems.

Do these risks sound familiar? They should because they are not very different from the risks that credit rating agencies that have recorded your financial transactions for years.

HIEs’ fate rests on patients

For HIEs, their success depends on patients making critical choices to exchange their health information.

The sustainability and widespread adoption of electronic health information exchange largely depends upon the level of trust and desire of both healthcare providers and patients to participate in eHIE. Patients often are concerned about the confidentiality of their health information, including information related to substance abuse treatment, mental health, and HIV/AIDS status. This concern keeps some patients from participating in a local, regional or statewide HIE.

Even though the patient health information is part of the provider’s medical record, the decision to exchange the information with another provider belongs to the patient.

The fate of HIEs rests on three critical factors:

• Meaningful choice. Meaningful choice means that when patients provide consent, they understand how their information is shared, with whom and the impact of their choice. Patients may choose to give providers and HIEs full access to their information, limited access, or no access at all.

Patients should understand their choice options and the impact of the choices they make about sharing their health information through eHIE. ONC recommends that the person who has the treating relationship with the patient (in most cases, this is the patient’s doctor) be responsible for educating patients about how information will be shared and with whom, as well as obtaining and tracking the patient’s choice.

A meaningful consent decision has six aspects. The decision is:

1. Made with advance knowledge/time
2. Not used for discriminatory purposes or as condition for receiving medical treatment
3. Made with full transparency and education
4. Commensurate with circumstances for why health information is exchanged
5. Consistent with patient expectations
6. Revocable at any time.

See ONC’s meaningful consent project to educate patients on their consent choices.

• Trust. Patients must be able to trust the provider and that information will be handled in accordance with their wishes. With some HIOs, a provider can submit an electronic query to retrieve information about a specific patient, often without the health care provider who created or holds the record being aware that another provider requested and received information. It is different from a provider directly contacting another to request a patient’s information. Patients often are concerned about the confidentiality of their health information, particularly information that is related to health conditions considered “sensitive” by most people, including information related to substance abuse treatment, mental health, and HIV/AIDS status. This concern keeps some patients from participating in a local, regional, or statewide HIE. The viability, sustainability, and widespread adoption of electronic health information exchange largely depend upon the level of trust and desire of both health care providers and patients to participate in eHIE.

• Single HIE record. Nearly 50 percent of physician groups surveyed planned to join an HIE according to a 2013 HIMSS Analytics report. Most of these will likely be joining a private HIE. In a few years, there will many HIEs—public, private, and regional. Where is the control for establishing a single or master HIE record for an individual? For example, an individual’s health information is held today by a private HIE and has the patient’s consent to exchange information with healthcare organizations. Suppose in a few years, the individual moves to a different healthcare organization that has its own private HIE in another state. Assuming the patient requests the data be transferred to the new HIE, is the individual’s data on the first system destroyed? As long as the individual is the owner of their information, he should be able to make requests that determine where their unique HIE record lives. One HIE record is the simplest way for an individual to control their health data. The requirement to designate a unique HIE record is a policy and standards issue that needs to be addressed at the national level. Otherwise, management of an individual’s HIE would become complicated and chaotic.

Meaningful use as a driver

Stage 2 meaningful use requires that eligible hospital provide 50 percent of discharged patients the ability to download, view and transmit information about their hospital admission within 36 hours via a portal. This data includes vital signs, laboratory test results, discharge instructions, summary of care record and care plan fields.

The Michiana HIE sends lab results to a patient portal and sends an email letting the patient know that the results are available to view. On a practical level not yet implemented, parents would like the ability to request their HIE to send their child’s updated physical information to participate in sports or an immunization record for school entry directly to the school or team. Many parents would gladly pay for this.

There are very good reasons to participate and support HIEs.

HIEs are critical to transformation

HIEs are nearing an inflection point with the buildup and success of HIEs across the country. The plan to tie HIEs together into a nationwide HIE is very feasible as long as local and regional HIEs find ways to be sustainable. The key to each HIE’s sustainability is delivering value to their market—and that varies by location. Regional HIEs will be able to provide population analyses and target health improvements. A national HIE will analyze the country and provide programs for targeted populations such as children and trending diseases. That’s never been done before and would contribute to a healthier population.

But it can’t be done without HIEs. And that’s what’s frightening.