HIT Policy Committee Consumer Choice Technology Hearing Recap

Last week, I attended the Privacy and Security Tiger Team Health Information Technology Policy (HIT) Committee Consumer Choice Technology Hearing in Washington, D.C. The gathering brought together an impressive group of healthcare industry leaders, patient data privacy advocates and HIT vendors to discuss technologies that enable consumers to choose whether or not to share their information in health Information Exchanges (HIEs).

The day included sessions from HIT vendors on technology solutions that address the use and sharing of electronic medical records (EMRs), and lively discussion around ownership of EMRs (hospitals vs. consumers). This public hearing included testimony and interactive sessions where presenters fielded questions from the Security Tiger Team and a panel comprised of doctors, CEOs, universities and other advocates spearheading efforts for consumer controls of patient information.

A few things worth highlighting from the conference:

• Ownership of EMR Data in Heated Debate: as EMRs are more widely used, and various organizations seek to touch them for each patient, where does the ownership responsibility of such data reside – with the patient, or with the healthcare organization? This was a hot topic and conversations on this matter spilled into the hallways after the hearing was over.
• Technology Research and Development Timeline Still a Ways Out: many of the solutions for effective sharing EMRs that were presented are in beta stage and/or in early development with aims for full functionality by the end of 2011. There’s still a long way to go.
• Standards Still Need to be Developed, Embraced: There is a clear need for standards in HIT as it relates to EMRs. While some vendors feel that the standards are in place to achieve the necessary solutions for patient privacy, there sure seems to be enough discussion around and challenges in granting patients control over their own medical records to indicate that more work needs to be done in this area. This is critical for widespread adoption and efficiencies as hospitals and health networks seek to integrate EMRs and consolidate between and among systems. Without well-defined, vendor-agnostic standards, the vision for HIEs and the true value of EMRs will remain out of reach for the masses of health organizations, thus limiting the privacy protection that can be afforded patients.
• Patient Consent for EMR Use Poses Complex Challenges, Requires Well-Thought Safeguards: If patients have ownership of EMR consent, it’s critical that safeguards are in place. One such safeguard discussed was the concept of a “break-the-glass” trigger in case a patient is unable to provide consent to the caring physician. In this situation, doctors could override consent requirements to access EMRs with notifications sent to various stakeholders in the system – this may provide the crucial information doctors need to provide care, while ensuring access without consent only occurs when absolutely needed and instances are recorded for auditing and compliance purposes.
• Workflow Matters: As standards are developed and EMRs are more fully embraced by both healthcare facilities and patients, both clinician and patient workflow must be front and center! The need for interoperability between clinical systems and the education of patients on how they can control and use their own patient information is crucial to effective long-term benefit. Studies on user interfaces and usability testing in daily work environments are still needed, but it’s great to see this as a central consideration as vendors and the industry as a whole work toward standards.

Peeling back the onion of EMR use and the patient consent process, it’s clear that there is still much work to be done. Managing EMRs across various HIEs introduces greater need for vendors to get in alignment to create integrated solutions that protect patients regardless of where and when they may be receiving care. These types of discussions are critical to leading our industry to collaborate and innovate to ultimately deliver better patient outcomes.