Cost reduction Information sharing between providers Billing, scheduling, reimbursement Service duplication Quality measurement
Improved care quality Simultaneous chart access Service coordination Patient education Clinical decision support Decreased med errors Disease surveillance Research
Enter our superhero, the EHR… Concerns: Data security Costs of adoption Utility Interoperability Data access Access control Ownership
Patient-centered Care Patient is center of health care team Increases patient involvement in their own care This requires a paradigm shift
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?
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
Arguments in favor Transparency in health care Engaging patients in their own care Patient education Improving patient-provider communication Increased compliance
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
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
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
The Tragedy of the Commons Shared resources are over-used and depleted by individuals acting in their own self-interest
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
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
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
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