In response to my post about the Real HIE Problem, Tim Dunnington provided this powerful insight into a major challenge that are faced by HIEs. However, more importantly, Tim provided some suggestions on how to solve the problems.
I work for an HIE system vendor, ICA. One of the challenges we see our HIE’s face is FUD (Fear, Uncertainty and Doubt) around sharing patient data. The fear arises in sharing data with other participants that are direct competitors. The competition between participants can lead some participants to refuse to share “their” patient data with other participants, creating complex sharing rules based on these relationships, and meaning that the view of a patient’s record will change depending on what facility you happen to be in. This results in the patient’s medical record not being complete. The patient, meanwhile, is not aware of these nuances and is not aware that their record is incomplete due to these competitive issues. I can’t say we have an answer as to how to solve this, but it’s definitely a potentially large roadblock, larger I think that EMR adoption itself.
I would say in response to these issues:
* The EMR determines what data is shared, so you (as a customer of the EMR) should have some control over what exactly is shared and when
* The HIE will not by any means have a “complete dump’ of your database; the EMR sends out a limited amount of data about the patient or the encounter
* The interoperability standards are set up to keep participants from attempting what I call “patient surfing,” keeping the availability of data to those patients for which you have an established relationship. This means that your competition cannot simply download every one of your patient records, as they have no access to a means to query for all your patients.
* Auditing and regulatory measures ensure that attempts to access records for purposes other than direct patient care are caught and properly sanctioned.
I’d love to hear your thoughts and perspectives on the challenge of data sharing in a HIE. Do you think that Tim’s suggestions are good?
I am an RN who went to law school (I am NOT an attorney, just have the education) and works in the HCIT fiield. I think it is worth interjecting the HIPPA discussion. Mining for patient data to be shared that has not been clearly approved by a patient could arguably open up a class act level civil suit action. Patient data is designed to be shared as is approved by the patient, thus there is an additional liability for NOT sharing data that has been authorized and is in the best interest of the patient could exist. The HIE is the pipe to share the data and the valves should be open and shut on the patient level. An EMR that gates sharing of specific data may also have an issue.