The big conversation around the virtual physician lounge this week was about the ONC information blocking rule that took effect this week. The majority of non-informaticist physicians who I spoke to really don’t understand what is required and have been receiving varying degrees of information from their employers and professional societies. The American Academy of Family Physicians had a nice article that summarized the situation for those who might not have been following for the last several years. AAFP points out the difference between HIPAA, which allows sharing of protected health information, and the new rule, which requires information sharing unless a short list of exceptions applies.
The exceptions identify when organizations can legitimately decline to fulfill a request for information, or when the surrounding procedures can be excepted. For most of the physicians I spoke with, their biggest use of the exceptions will be under the “do not harm” provision, which applies to adolescents being treated for things like pregnancy, sexual health issues, or mental health diagnoses. I was on an outstanding webinar earlier this week, presented by the American Medical Informatics Association. Natalie Pageler, MD, MEd from Stanford Children’s Health presented on strategies for managing the sharing of data within pediatric populations, where there are concerns not only about sensitive information, but also the capacity of the minor to consent for sharing. If you’re an AMIA member, it’s well worth tracking down the recording.
In the short term, organizations have to provide access to certain types of information: consultations, discharge summaries, histories, physical examination notes, imaging / laboratory / pathology reports, procedure notes, and progress notes. Additional types of information will be mandated in the fall of 2022, and penalties are in the future as well.
I have a few pointers for physicians who are concerned about patients reading their notes. First, write your plans like you would talk to a patient in the office. Avoid medical jargon and be clear on what you discussed with the patient and what the next steps might be. Physicians who dictate their notes in front of the patient have been doing this for decades. Second, make sure your office has a policy and/or process for when patients contact you with concerns about something they saw in a note. Should they come in for an appointment, schedule a telehealth visit, or wait for a return phone call? Decide this now before there’s a time-sensitive issue in front of you. I’m interested to hear from readers who have had significant fallout from this week’s change, so if you’ve got a great story, let me know.
I always scoop up cut-rate Easter candy and take it to my clinical team, because every urgent care shift is better with the addition of chocolate. We joked about having to go to the local Walgreens to get the best selection of candy, and of course the topic turned to retail pharmacies and their role in COVID-19 vaccination policy. Pharmacy appointments are widely available in my area at the moment, which seems somewhat surprising since my office was recently allocated a measly 100 doses (yes, one hundred) of Johnson & Johnson vaccine despite the fact that we see 2,000 patients a day and could be a force to be reckoned with if the state decided to give us adequate vaccine.
Others have noted the issues with retail pharmacies playing such a big role, including Politico, which featured a discussion of pharmacies using vaccine-related patient data for marketing and other purposes. I was trying to find an appointment at Walgreens or Walmart for a family member, but was stopped when I found that they require you to register for an account before searching for vaccine appointments, which means they have your email address. I didn’t want to create a new account for them in case they already had one, and certainly didn’t want anything tied to my own email. Privacy and consumer advocates are calling on state governments to investigate how the data is used and are asking retail pharmacies to avoid using the data for marketing purposes. At this point, patients are more interested in getting a vaccine wherever they can and probably aren’t reading the fine print when they sign up. We’ll have to see how this plays out in the longer-term.
I had a recent client project around home monitoring of blood pressure, weight, and blood sugar, so I was excited to see this article in the Journal of the American Medical Informatics Association regarding the impact of patient-generated health data on clinician burnout. There is a ton of data out there that patients want to provide us – information from wearables, home glucose monitors, blood pressure cuffs, and more. Many physicians are terrified to let this information into their EHRs for fear it will overwhelm them with data as well as that it might increase their liability. For many conditions it’s not so much the individual data points that are important, but the ranges in which a patient’s data typically falls or how often they have outlier values. For certain conditions such as heart failure, however, individual daily values are important, and action has to be taken if there are dramatic changes from day to day.
The authors identified three factors that they believe contribute to burnout related to the integration of patient-generated health data within the EHR. These factors are time pressure, techno-stress, and workflow-related issues. They suggest mitigating techno-stress through several interventions: ensuring that healthcare providers have clear roles and responsibilities for monitoring and responding to patient-generated data; improving the usability of data integrated in EHR; and greater education and training. They go on to suggest reduction of time pressure through standardized EHR templates, greater financial reimbursement, and incorporation of artificial intelligence and the use of algorithms to review data. Regarding workflow issues, they suggest better usability, policies around reviewing data and responding to patients, and identifying the types of data that are best suited to inclusion in EHR. All of these are easier said than done, so I’d love to hear from readers who have tried to tackle this particular issue.
How is your organization handling patient-generated health data? Leave a comment or email me.
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