About the workshop

I. Introduction

Implicit in the plans to share electronic medical records among the health care community and with patients are dispute risks that can undermine medical and public confidence in the endeavor. The issue that has received the most public attention is privacy and the resultant legal liability from breaches.  Other problems, such as inaccuracy, incompleteness and inconsistency of health care records have been largely unnoticed but are likely to overwhelm privacy disputes in frequency. Such problems should be receiving attention as systems are developed and the focus of attention should be on non-court based avenues for error correction and problem solving. Many such disputes can be anticipated and, with proper planning and development of sets of Best Practices, are preventable. On the other hand, if not addressed in advance, such problems will reduce confidence in the systems and can be expected to decrease usage.

The new networked health information technology environments must address problems that currently go unnoticed due to the inefficiencies of paper based record systems.   Misunderstandings and mistakes must be corrected before they become complaints, complaints must be responded to before they become disputes and disputes resolved before they become legal actions. Discovery of issues must become occasions for continuous improvement. It is time for a systematic effort to characterize the challenges and develop a responsive plan. We have therefore organized a workshop focused on dispute prevention and dispute resolution that will lead issuance of recommendations for policy, standards and research.

 

II. The Challenges

A great deal of attention has been given to improving the United States health care system through the use of information technology.  This has ranged from the financial and administrative processes to patient care management to patient care delivery and support services.  The discussion includes information technology for patient self-management of chronic conditions through personal health records integrated with care givers’ electronic medical system.  Supporters hope to improve outcomes by reducing redundancy, avoiding errors, reducing delays, and providing better diagnoses.  Projections of costs savings are substantial.

The public is highly sensitized to the potential for breaches of privacy and the protection of information from unauthorized dissemination.  Many mass market publications have discussed it and cases of theft of personal data are not uncommon. Other potential areas of dispute, unfortunately, have received much less attention.

The correctness and completeness of medical records, for example, refers to the percentage of the data that accurately records the observations made and the degree to which those observations are available. Incorrect data is especially problematic for networked health information technology since the existence of incorrect records can, when tied to adverse treatment outcomes, be seen by the patient as indications of malpractice.  Studies showing 5% incorrectness and similar incompleteness are common.  Certainly, the path from an incorrect entry in an electronic medical record to inappropriate care is mediated by other evidence, the judgment of the care giver and many other controls on the health care system. The patient observing the mistaken entry, however, can not help but lose some faith in the health care provider and the health information technology. 

A more indirect issue is dealing with complaints that arise from misunderstandings.  Networked health information technology plans may require that the general public be exposed to the complexity of medical data. The general level of health literacy for the average citizen falls well below the level required for general health care material.  Many electronic medical records that patients will encounter in networked health information technology were created for trained professionals. Unintentional misunderstandings will inevitably lead to disputes.  The use of computing systems adds another level of complexity that has not existed before.  For example, the proposals for consent agreements to allow electronic distribution of records without violating a patient’s privacy desires are certain to expose the patient to complex care processes shielded from him or her in the past.   Steps should be taken to ameliorate these problems.

There may be other areas of risk which will be uncovered in the course of planning for the workshop and working with participants.

 

III. Scope

We are carrying out a series of activities involving leaders of the healthcare information technology, the alternative dispute resolution and computer science communities whose goals are to:

    1. Identify the key risks of disputes in the networked health information technology systems being proposed.
    2. Identify the best practices in avoiding and resolving such disputes and the need for new practices in open areas.
    3. Identify the computing research challenges inherent in supporting these practices.

     

IV. Timing, Sponsors and Organizers

The physical workshop was held in Washington, DC on May 5-6, 2009. Workshop affiliates are currently conducting interviews with providers who offer online access to patient records, and a report is in preparation.

The workshop was sponsored by the National Science Foundation, the Office of National Coordinator for Health Information Technology, the Agency for Healthcare Research and Quality and the National Mediation Board.

The organizers come from the Electronic Enterprise Institute (EEI) and the National Center for Technology and Dispute Resolution (NCTDR) at the University of Massachusetts Amherst. These organizations are internationally recognized leaders in the field of online dispute resolution and have assisted eBay, the National Mediation Board, the U.S. Army and others in developing online systems to respond to disputes. Support for these efforts has come from the National Science Foundation, the eBay Foundation, the National Mediation Board and the Hewlett Foundation.  Our co-organizer is Chief Information Officer of the CareGroup Health System, Chief Information Officer and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.

Ethan Katsh
National Center for Technology and Dispute Resolution and Department of Legal Studies
University of Massachusetts
Amherst, MA

Norman Sondheimer
Department of Computer Science and Co-Director, Electronic Enterprise Institute
University of Massachusetts
Amherst, MA

Leon Osterweil
Department of Computer Science and Co-Director, Electronic Enterprise Institute
University of Massachusetts
Amherst, MA

Lori Clarke
Department of Computer Science
University of Massachusetts
Amherst, MA

John Halamka
CareGroup Health System and
Harvard Medical School
Cambridge, MA