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Electronic health records: Ownership, access, and control Jerusalem Walker, BA, RN, BSN.

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Presentation on theme: "Electronic health records: Ownership, access, and control Jerusalem Walker, BA, RN, BSN."— Presentation transcript:

1 Electronic health records: Ownership, access, and control Jerusalem Walker, BA, RN, BSN

2 Crisis in US health care Spiraling costs Aging of population Fragmented care delivery Uneven quality Inequitable yet expanding access Provider shortages

3 Health Information Technology

4 Cost reduction Information sharing between providers Billing, scheduling, reimbursement Service duplication Quality measurement

5 Improved care quality Simultaneous chart access Service coordination Patient education Clinical decision support Decreased med errors Disease surveillance Research

6 Enter our superhero, the EHR… Concerns: Data security Costs of adoption Utility Interoperability Data access Access control Ownership

7 Patient-centered Care Patient is center of health care team Increases patient involvement in their own care This requires a paradigm shift

8 Patient access to the EHR Fundamental questions remain to be answered: Who has access to the record? Who controls this access? Who owns the information?

9 Access to the EHR Access can mean input or retrieval of data Patient access to paper charts has been limited Electronic access does not pose the same logistical problems But patient access to the EHR has met with varying amounts of resistance from the medical establishment

10 Arguments in favor Transparency in health care Engaging patients in their own care Patient education Improving patient-provider communication Increased compliance

11 Arguments against Increased time and effort – Explaining what was written – Reassuring about abnormal labs Having to “dumb down” the language Frightening the patients Fears of litigation

12 Examining the evidence Increases patient engagement Enhances patient understanding Can increase accuracy of the patient chart – Medication lists – Certain risk assessments Improves quality of care

13 Who owns the EHR? Current regulations do not provide the answer HIPAA allows patients to block access in some situations This is not the same as ownership: patient cannot: – Destroy it – Take it from anyone – Sell it

14 The Tragedy of the Commons Shared resources are over-used and depleted by individuals acting in their own self-interest

15 The Tragedy of the Anticommons Driven by financial, not social interests Allows blocking of access so that it is useful to very few Information is different from a physical resource Value is not diminished when it is used

16 Interoperability So many different systems are now in use Makes sharing of information difficult between and even within organizations Instead of networks, we have “information silos” not unlike old paper systems Old silo New silos

17 Implications for DNP practice We have the skills to shape the “new information paradigm” by supporting: Expanded patient EHR access Patient input into EHR access design Inclusion of underserved, disadvantaged, minority groups Advocating for policies which support meaningful access to health data

18 References Benkert, R., Peters, R., Tate, N., & Dinardo, E. (2008). Trust of nurse practitioners and physicians among African Americans with hypertension. Journal of the American Academy of Nurse Practitioners, 273-280. doi: 10.1111/j.1745-7599.2008.00317.x Bergeson, S. C., & Dean, J. D. (2006). A systems approach to patient-centered care. Journal of the American Medical Association, 296, 2848-2851. Brailer, D. J. (2005). Interoperability: The key to the future health care system. Health Affairs, W5-19-W5-21. doi: 10.1377/hlthaff.w5.19 Cantor, J. D. (2001). Privacy protections for cybercharts: An update on the law. Journal of the American Medical Association, 285, 1767. Christopher, P. (2010). New electronic health record blueprint to call for increased patient participation. Canadian Medical Association Journal, 182, E429-E430. doi:10.1503/cmaj.109-3265 Cimino, J. J., Patel, V. L., & Kushniruk, A. W. (2002). The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records. International Journal of Medical Informatics, 68, 113-127. Delbanco, T., Koplow, R., & Koplow, F. (2011, February 25). Letter to David Blumenthal. Retrieved July 10, 2011, from OpenNotes: Delbanco, T., Walker, J., Darer, J. D., Elmore, J. G., Feldman, H. J., Levelle, S. G., et al. (2010). Open notes: Doctors and patients signing on. Annals of Internal Medicine, 153, 121-125. Devin, E. B., Hansen, R. N., Wilson-Norton, J. L., Lawless, N. M., Fisk, A. W., Blough, D. K., et al. (2010). The impact of computerized provider order entry on medication errors in a multispecialty group practice. Journal of the American Medical Informatics Association, 17, 78-84. doi:10.1197/jamia.M3285 Dorr, D. A., Rowan, B., Weed, M., James, B., & Clayton, P. (2003). Physician's attitudes regarding patient access to electronic medical records. AMIA 2003 Symposium Proceedings (p. 832). Bethesda: American Medical Informatics Association.

19 References, cont. Etzioni, A. (2010). Personal health records: Why good ideas sometimes languish. Issues in Science and Technology, 59-66. Flegel, K. (2008). Getting to the electronic medical record. Canadian Medical Association Journal, 178, 5. Ghaneman, K. G., Hutton, H. E., Zenilman, J. M., & Erbelding, E. J. (2005). Audio computer assisted self interview and face to face interview modes in assessing response bias among STD clinic patients. Sexually Transmitted Infection, 81, 421-425. doi: 10.1136/sti.2004.013193 Hall, M. A. (2010). Property, privacy, and the pursuit of interconnected medical records. Iowa Law Review, 95, 631- 663. Hall, M. A., & Schulman, K. A. (2009). Ownership of medical information. Journal of the American Medical Association, 301, 1282-1284. Hardin, G. (1968). The Tragedy of the Commons. Science, 162, 1243-1248. Haller, N. A., Gil, K. M., Gardner, W. G., & Whittier, F. C. (2009). Patient computer use to prompt doctor adherence to diabetes management guidelines. Journal of Evaluation in Clinical Practice, 15, 1118-1124. doi: 10.1111/j.1365- 2753.2009.01264.x Harty-Golder, B. (2007, July). EMR ownership questions. Medical Laboratory Observer, p. 54. Hassol, A., Walker, J. M., Kidder, D., Rokita, K., Young, D., Pierdon, S., et al. (2004). Patient experiences and attitudes about access to a patient electronic health care record and messaging system. Journal of the American Medical Informatics Association, 11, 505-513. doi: 10.1197/jamia.M1593 Hayes, E. (2007). Nurse practitioners and managed care: Patient satisfaction and intention to adhere to nurse practitioner plan of care. Journal of the American Academy of Nurse Practitioners, 19, 418-426. doi: 10.1111/j.1745-7599.2007.00245.x Heller, M. A. (1998). The tragedy of the anticommons: Property in the transition from Marx to markets. Harvard Law Review, 111, 621-688.

20 References, cont. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., et al. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs, 24, 1103-1117. doi: 10.1377/hlthaff.24.5.1103 Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819-823. Jennings, N. (2009). A survey of patient satisfaction in a metropolitan emergency department: Comparing nurse practitioners and emergency physicians. International Journal of Nursing Practice, 15, 213-218. doi:10.1111/j.1440-172X.2009.01746.x Khan, A., Plummer, D., Hussain, R., & Minichiello, V. (2008). Does physician bias affect the quality of care they deliver? Evidence in the care of sexually transmitted infections. Sexually Transmitted Infections, 84, 150-151. doi:10.1136/sti.2007.028050 Kind, E. A., Fowles, J. B., Craft, C. E., Kind, A. C., & Richter, S. A. (2011). No change in dictation patterns when visit notes are made available online for patients. Mayo Clinic Proceedings, 395-405. doi: l0.4065/mcp.20I0.0785 Mador, R. L., Shaw, N. T., Cheetham, S., & Reid, R. J. (2008). Whose record is it anyway? Putting patient's interest at the heart of the implementation and use of electronic medical records. Healthcare Quarterly, 11, 90-92. Mannino, B. (2010, October 7). Beyond bedside manner: Patients help doctors' plan of care. FOXBusiness. Nutting, P. A., Miller, W. L., Crabtree, B. F., Roberto Jaen, C., Stewart, E. E., & Stange, K. C. (2009). Initial lessons from the first National Demonstration Project on practice transformation to a patient-centered medical home. Annals of Family Medicine, 7, 254-260. doi: 10.1370/afm.1002 Ponemon Institute. (2009, October 15). Electronic Health information at risk: A study of IT practitioners. Retrieved July 7, 2011, from Ponemon Institute: %20Risk%20FINAL%201.pdf Rashbass, J. (2001). The patient-owned, population-based electronic medical record: A revolutionary resource for clinical medicine. Journal of the American Medical Association, 285, 1769. doi:10.1197/jamia.M2273

21 References, cont. Safran, C., Bloomrosen, M., Hammond, W. E., Labkoff, S., Markel-Fox, S., Tang, P. C., et al. (2007). Toward a national framework for the secondary use of health data: An American Medical Informatics Association white paper. Journal of the American Medical Informatics Association, 14, 1-9. doi:10.1197/jamia.M2273 Schaffer, J. L., & Ryan, J. (2010, April). Who owns the data? Managing Your Practice, pp. 33, 36. Schutelaar, M. L., Vermeulen, K. M., Drukker, N., & Coenraads, P. J. (2010). A randomized controlled trial in children with eczema: Nurse practitioner vs. dermatologist. British Journal of Dermatology, 162-170. doi:10.1111/j.1365- 2133.2009.09502.x Scott, R. E., Yeo, M., & Jennett, P. (2004). Access and authorization in a glocal e-health policy context. International Journal of Medical Informatics, 73, 259-266. doi:10.1016/j.ijmedinf.2003.11.020 Siteman, E., Businger, A., Ghandi, T., Grant, R., Poon, E., Schnipper, J., et al. (2006). Clinicians recognize value of patient review of their electronic health record. AMIA 2006 Symposium Proceedings (p. 1101). Bethesda: American Medical Informatics Association. Staroselsky, M., Volk, L. A., Tsurikova, R., Newmark, L. P., Lippincott, M., Litvak, I., et al. (2008). An effort to improve electronic health record medication list accuracy between visits: Patients’ and physicians’ response. International Journal of Medical Informatics, 77, 153-160. doi:10.1016/j.ijmedinf.2007.03.001 Tideman, R., Chen, M., Pitts, M., Ginige, S., Slaney, M., & Fairley, C. (2007). A randomised controlled trial comparing computer-assisted with face-to-face sexual history taking in a clinical setting. Sexually Transmitted Infections, 83, 52-56. doi: 10.1136/sti.2006.020776 Tsai, C. C., & Starren, J. (2001). Patient participation in electronic medical records. Journal of the American Medical Association, 285, 1765. Valdes, I., Kibbe, D. C., Tolleson, G., Kunik, M. E., & Petersen, L. A. (2004). Barriers to proliferation of electronic medical records. Informatics in Primary Care, 12, 3-9.

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