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Copyright © eHealth Initiative, 2006 Physicians and Health Information Exchange (HIE) The Doctor-Patient Relationship Privacy and Information Sharing
© eHealth Initiative & Foundation, 2006 2 A day in the life scenario Jane is a 45 year old patient of yours in the office for a general physical. At the end of the visit, she asks you for your opinion on a new service offered by her employer’s health plan. According to Jane, her employer now offers her a personal health record that will track all her health data from health insurance and medical visits and she can even enter information herself. She wants to know what you think? Do you have other patients who use this? She wants to know if you can look at it with her jointly in office visits or if you will be entering data. She says that not everything she tells you in the office is information she wants her employer to know. What might you want to discuss with Jane regarding health information exchange?
© eHealth Initiative & Foundation, 2006 3 Today’s Reality… Data is stored in silos, across multiple stakeholder groups Clinical research and public health is hindered by paper- based, fragmented systems – costly and slow processes Data is required from multiple sources to have timely and effective clinical decision support Public health agencies are forced to utilize phone, fax, and mail to conduct public health surveillance, detection, management, and response Physicians spend 20 - 30% of their time searching for information…10 - 81% of the time, physicians don’t find the information they need in the patient record
© eHealth Initiative & Foundation, 2006 4 Why Health Information Exchange… Health information exchange (HIE): The mobilization of healthcare information electronically within a region or community. Facilitate access to and retrieval of clinical data across organizations to provide safer, more timely, efficient, effective, equitable, patient-centered care.
© eHealth Initiative & Foundation, 2006 5 HIE and Privacy: What Do Consumers Think? Americans support the creation of a national Health Information Exchange or network for doctors and patients ( 72% show strong and consistent support regardless of political affiliation, age, education, or socio- economic status) §60% are interested in a secure online personal record Americans believe an electronic exchange of health information would enhance the quality and efficiency of the health care system Markle Foundation : Attitudes of Americans Regarding Personal Health Records and Nationwide Electronic Health Information Exchange, October 2005
© eHealth Initiative & Foundation, 2006 6 HIE and Privacy: What Do Consumers Think? Consumers were asked to rate the attributes of an HIE network and revealed the following “absolute high priorities”: §The identity of anyone using the system would be carefully confirmed to prevent any unauthorized access or any cases of mistaken identity (91%) §An individual would be able to review who has had access to their personal health information (81%) Markle Foundation : Attitudes of Americans Regarding Personal Health Records and Nationwide Electronic Health Information Exchange, October 2005
© eHealth Initiative & Foundation, 2006 7 HIE and Privacy: What Do Consumers Think? Consumers were asked to rate the attributes of an HIE network and revealed the following “absolute high priorities”: §Only with an individual’s permission could his/her medical information be shared through the network (79%) §Employers would not have access to the secure health information exchange networks (68%) Markle Foundation : Attitudes of Americans Regarding Personal Health Records and Nationwide Electronic Health Information Exchange, October 2005
© eHealth Initiative & Foundation, 2006 8 HIE and Privacy: What Do Consumers Think? “There’s a lot of sensitivity about keeping information safe on this network. Consumers need to know that we will have vigorous ways to secure the network and protect their identity. There is a lot of concern about the potential for inappropriate people to see their information—about what we in the industry call ‘authentication.’ David Lansky, Markle Foundation, eHealth Initiative, EPAB Issue Brief #3, October 2005
© eHealth Initiative & Foundation, 2006 9 HIE and Privacy: What Do Consumers Think? “I think the HIE would be for the most part a good thing. As long as certain security access guidelines are set up.” Consumer response, eHealth Initiative, Public Opinion Strategies focus group, June 2006.
© eHealth Initiative & Foundation, 2006 10 HIE and Privacy: What Do Doctors Think? Physician care delivery benefits of HIE include: To improve patient safety by allowing patients and providers to make informed decisions based on a more complete view of a patient’s medical history.
© eHealth Initiative & Foundation, 2006 11 HIE and Privacy: What Do Doctors Think? “I would want my patient to know exactly who might see information that might affect them, especially insurance companies or employers.” Wisconsin Health Information Exchange physician survey 2005
© eHealth Initiative & Foundation, 2006 12 Why Privacy is Important… Privacy is important to consumers §As a fundamental component of high-quality, patient-centered healthcare. When individuals worry about misuse of their personal health information, they take steps to circumvent the system to protect their privacy. Source: California HealthCare Foundation and Consumers Union. Promoting Health, Protecting Privacy: A Primer. Oakland, Calif: California HealthCare Foundation and Consumers Union; January 1999.
© eHealth Initiative & Foundation, 2006 13 HIE and the Doctor-Patient Relationship Trust §90% of patients trust physicians to keep their health information secure* Credibility and honesty §Emphasize the precautions taken to protect their private information. Listening and open communication Privacy and security policies must be agreed upon before electronic exchange of information across organizations begins. §Experts note that breeches will occur even with high level of security. Source: MedicAlert® backs new health privacy rules with Gallup survey showing broad public support. MedicAlert® Web site. March 21, 2001. Available at: http://www.medicalert.com. Accessed July 20, 2001.http://www.medicalert.com
© eHealth Initiative & Foundation, 2006 14 HIE and the Doctor-Patient Relationship “We need to send the clear message that this is a tremendous opportunity to improve their healthcare, and at the same time communicate that we will do what is necessary to protect their information and not gloss over the importance of privacy and security.” David Lansky, eHealth Initiative, EPAB Issue Brief #3, October 2005
© eHealth Initiative & Foundation, 2006 15 HIE and the Doctor-Patient Relationship Providing the best care §HIE benefits for personal and public health Advocacy and Education §Opportunities to voice patient’s concerns Maintaining relationships for the future
© eHealth Initiative & Foundation, 2006 16 HIE and the Doctor-Patient Relationship Do my patients have a choice? §They have the right to ask for opt-out of any information sharing that is not required by law, ask for audits, and ask for access. What if my patient doesn’t want to share data? §Listen first, understand their fears and concerns. §Articulate benefits at an individual patient level. §What is means to the patient and what it means to their family. Improving lives, safer health care, more efficient and higher quality care through improved communication. §Experiences of others show that this is an interactive process that cannot be rushed. §Respect patient choice.
© eHealth Initiative & Foundation, 2006 17 5 Common Principles of Fair Information Practices Notice §The existence and purpose of record-keeping systems must be known to the individuals whose data is contained therein. Choice §Information must be collected only with the knowledge and implicit or explicit permission of the subject, used only in ways relevant to the purpose for which the data was collected, and disclosed only with permission of the subject or in accordance with overriding legal authority (such as a public health law that requires reporting of a serious contagious disease).
© eHealth Initiative & Foundation, 2006 18 5 Common Principles of Fair Information Practices Access §Individuals must have the right to see records of information about them and to assure the quality of that information (accuracy, completeness, and timeliness). In healthcare, records are rarely deleted or replaced, but this principle implies that there is at least a due process for individuals to amend poor quality information about them. Security §Reasonable safeguards must be in place for the confidentiality, integrity, and availability of information. Enforcement §Violations must result in reasonable and consistently applied penalties to deter violators and in reasonable mitigation efforts to offset the effects of a breach as much as possible.
© eHealth Initiative & Foundation, 2006 19 HIE and the Doctor-Patient Relationship Summary: §Both patients and physicians believe there are benefits to be received from electronic health information exchange AND §Both patients and physicians have concerns about privacy and security of electronic health information exchange
© eHealth Initiative & Foundation, 2006 20 HIE and the Doctor-Patient Relationship Summary: §Physician stakeholder role in HIE: Discuss and agree upon policies for privacy and security early in HIE development. Local culture and community acceptance of HIE functionality must be reflected in policies.
© eHealth Initiative & Foundation, 2006 21 HIE and the Doctor-Patient Relationship Summary: §Physician role with patients: Open communication and honesty Understanding patient concerns Expressing benefits to the patient at an individual and family level Trust and respect the patient
© eHealth Initiative & Foundation, 2006 22 Engaging Physicians in Health Information Exchange For More Information Contact
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