Workshop Report

 

The complete report is available for download here [pdf]

 

Executive Summary

A great deal of attention has been given to efforts to improve the United States health care system by increasing the use of electronic health records (EHRs). Implicit in the plans to share electronic medical records among the health care community and with patients are new patient-provider dispute risks that can undermine medical and public confidence in the endeavor. The issues that are receiving the most public attention currently are privacy and legal liability from data breaches.  Data quality problems, however, such as accuracy, comprehensiveness and clarity of the health care records have been largely unnoticed but are likely to vastly outnumber privacy disputes in frequency. The new-networked health information technology environments must address problems that rarely or never surfaced previously due to the inefficiencies and inaccessibility 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.
To address this need a workshop and follow on efforts were carried out with the following goals:

  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.

This report provides our conclusions and recommendations in these areas.  Several conclusions from the workshop on how to engage dispute resolution to ameliorate the risks were summarized in postings made by John Halamka on his blog. Paraphrasing Halamka, the workshop concluded that:

  1. There is a need to develop workflows for web-enabled dispute resolution processes. As the country implements more electronic records and shares more data, the healthcare world needs to embrace automated dispute resolution workflows such as are currently in use in many e-commerce contexts.
  2. For issues that cannot be resolved via automated tools, an electronic escalation to an Ombudsman would be a reasonable alternative. Web applications could be used to support the ombudsman and help facilitate the process by identifying issues, managing the exchange of information, scheduling interactions, etc.
  3. If there is an assertion of malpractice or harm caused to the patient, then workflows involving risk management and insurance organizations are appropriate.

In order, to achieve the workshop’s vision, a series of research activities are required.

  1. Recommendation:  Continue to support research to avoid privacy, data quality and misunderstanding.
  2. Recommendation:  Support research in online dispute resolution and prevention approaches and models that can be applied to a range of problems and disputes likely to arise in the networked electronic medical records environment.
  3. Recommendation: Support research in the utility of computer forensic technology to preserve and enhance data quality of electronic medical records, with a special focus on the issues of data provenance.
  4. Recommendation: Support research and evaluation of technological approaches to  correcting and amending EHRs, while still preserving access to historical versions of the record.
  5. Recommendation: Support research in methods of improving online patient-provider communication.