14 May DHC 2007: Barriers to electronic data exchange include the law
Madison, Wis. – The state’s mental health statues will have to be updated to accommodate electronic patient data exchange, according to Madison area health technologists.
Patient data exchange was addressed in two sessions at Digital Healthcare Conference 2007, including one that posed the question of whether the electronic exchange of patient data between different health systems would open a Pandora’s Box of liability and risk.
Federal and state laws dictate the circumstances under which patient medical information can be disclosed. Existing state statutes prevent any data about mental health patients from being exchanged without the patient’s consent, but the laws were written in the 1970s, long before electronic medical records – which can be transmitted much farther and faster than paper records – were contemplated.
“There is a problem when standards don’t evolve with the times,” said Dr. Jessica Bartell, director of clinical and service quality for Group Health Cooperative, a Madison-based health maintenance organization.
Paper or electronic?
Beth DeLair, director of compliance for UW Hospitals and Clinics, said the statutes were written very specifically to address a paper world, and it’s a lot easier to comply with those rules in a paper world than it is in an electronic world.
DeLair said under existing law, any information generated from a visit at a treatment facility has to be kept confidential, even name or date of birth. Mental health advocates she’s spoken to would prefer to protect detailed information from a medical consultation, such as information about why a patient suffers from depression.
“There are some people who are going to have problems with having a diagnosis or a medication disclosed, but again I think in the spirit of the law people are more interested in protecting detailed information, not this basic information,” DeLair said.
Advocates for the mentally ill have been the most passionate stakeholders in the privacy issue.
Shel Gross, director of public policy for the Mental Health Association of Wisconsin, said the association’s chief concern with respect to electronic medical records is ensuring that the consent of the patient is maintained.
Gross said state law already has been amended to permit certain mental health data – specifically, information about a patient’s medications – to be transferred within health systems, but transmissions of data between different health systems is another issue.
He said the association and other mental health advocacy groups have been working with the governor’s eHealth Board to resolve the matter, which he believes is related more to best practices than to technology.
“Outside of a health system, current law still applies – you can’t release information without a patient’s consent,” Gross stated. “Whatever information is released should depend on what the patient is willing to consent to.”
The issue will have to be resolved legislatively before mental health information is part of any patient data exchange in Madison or metropolitan Milwaukee.
Kevin Hayden, secretary of the state Department of Health and Family Services, said the state’s eHealth Board is aware of the issues and is working with providers and mental health advocates to address possible modifications to state statues pertaining to privacy and treatment.
“Both [groups] are concerned, and properly so, given the sacrosanct nature of mental health,” Hayden said.
Federal law also was taken to task at the Digital Healthcare Conference.
Judith Faulkner, founder and CEO of Epic Systems Corp., a developer of integrated medical records software, noted that one of the biggest barriers to patient data exchange is the fear of litigation.
The world was much different when many of the existing rules were written, Faulkner said, and when it comes to sanctions, the Health Insurance Portability and Accountability Act (HIPAA) fails to make a distinction between data sent for the purpose of care and data that is intentionally mishandled.
Errors at the speed of light
The justification for patient data exchange is evident in several care scenarios: if someone is unconscious in an emergency room, if someone needs emergency care at a facility outside of their health system, or if a patient decides to change providers or insurance carriers.
In these and other situations, quick access to patient records can be the difference between quality and substandard care, and the electronic transmission of patient data is much faster – and more legible – than the transmission of paper records.
Given the lighting speed at which data is transmitted electronically, will electronic patient data exchange open a Pandora’s box of liability, or help health providers close the lid on a box of horrors that already exists?
“When an error is made, it’s going to fly out at the speed of light,” noted Greg Smith, senior vice president and CIO of Wheaton Franciscan Healthcare.
Several DHC speakers who took part in a case study discussion, one involving a patient whose HIV status was mishandled, noted that paper records bring their share of liability risks.
DeLair (UW Hospitals and Clinics) was among those who emphasized the trade-offs.
She said electronic data exchange probably will add risk when complying with state and federal laws having to do with accessing patient information and disclosing it in the proper way. As the case scenario described, even if there is just one error, it can be immediately disseminated to multiple organizations, whereas in the manual environment, providers might be able to stop it right away and it may only be faxed to one other location.
According to DeLair, the area where electronic data exchange is likely to decrease liability risk is in providing a legible medical record that enables providers to more accurately track the course of care. That way, they will be able to defend themselves or show, in a malpractice case, what exactly happened, when it happened, and who was involved.
Sealing the deal?
When it comes to assessing whether electronic patient data exchange will blow the lid off Pandora’s box, or provide an airtight seal, DeLair believes the answer lies somewhere in the middle.
“I definitely think it’s somewhere in between because we’re increasing risk and potential liability in some areas, but we’re decreasing them in others,” she said. “I think on balance, we’re probably decreasing our overall risk and liability.”
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