- With technology continuing to evolve at a rapid pace, working towards more seamless healthcare interoperability remains a top priority for healthcare organizations. Having a stronger patient data access process is often hailed as a way to improve patient care, but there can still be hesitancy in how much access should be given.
Back when meaningful use started and with some of initial patient engagement requirements, there was a lot of initial concern with some providers, Tufts Medical Center Chief Medical Information Officer Dr. William Harvey explained.
Harvey is also a practicing rheumatologist and serves as the clinical director of the Tufts rheumatology clinic. He noted that there was concern within his specific line of work because a fairly large percentage of the patients that seek such care are older adults who may not be very technologically literate.
“There was a lot of concern that they might not be able to engage in things like patient portals,” Harvey told EHRIntelligence.com.
“I would say the last five years or so has taught us that there’s actually a growing number of people of all ages who want or prefer to interact with their physicians electronically,” he continued. “To some extent, that is being driven by a rising generation of people who conduct almost all of their business on their cell phone or tablet.”
That connection to technology has reached patients’ parents and grandparents, Harvey suggested, as older patients are also very interested in using technology to interact with the healthcare system more now than five years ago.
“[Patients] want to be able to do things with medicine the way they do them with other parts of their life,” he said.
Part of that is that the world itself has just evolved more. For example, individuals do not go to travel agents anymore to book an airplane flight and hotel, Harvey posited.
“The healthcare system is starting to understand that they want that same kind of accessibility and ownership of the process,” he said. “That relates to accessing things like booking appointments or downloading copies of their medical records, without having to charge to the basement of the hospital.”
Patients also have a growing interest in understanding what their doctor is saying about them, Harvey stated. With OpenNotes, for example, patients are interested in engaging in their own healthcare and want to understand exactly what their doctor is doing.
Harvey added that he will have patients now who open their patient portals from other doctors and show him their doctors’ notes about them.
“It’s not uncommon now for someone to walk into my office and say, ‘Did you get a copy of my records from my doctor?’ And I say, ‘No I haven’t received them yet.’ And they’ll just whip out their phone and show me all the labs I need to see or all the x-ray reports, or even in some cases, the notes from their doctor’s office visit,” he explained.
That type of patient data access is very empowering, Harvey stressed. It can also speed up the patient care process and reduces wasted time.
“If the patients can access their portal and show me the data I need to see, then I’m less apt to repeat testing they’ve already had or do something that’s already been thought of or tried by their other doctors,” he observed.
Language can be a barrier with patient data access, even with evolving technologies, Harvey said.
Tufts Medical Center has a very large Asian population, and approximately 15 to 20 percent of the patients at Tufts do not speak English, he noted.
“It’s very difficult for them to interact through technology because it doesn’t yet support multiple languages,” Harvey stated.
Interoperability issues are a much larger issue for healthcare right now, he continued. It is a major problem and is definitely an area where EHR vendors have not held up their part of the bargain.
The current rules for 2015 Certified Electronic Health Technology require vendors to have APIs in order to pass data in and out of the system, Harvey said. Vendors have that but many of them do it in a less than authentic way. It’s either so cumbersome or difficult to set up that organizations have to make a business decision about whether they’re going to expend all the extra resources to make their less than ideal solution work practically.
For example, Tufts has a system even within its own campus that can export continuity of care document (CCD) files that contain a summary of health information, he explained. “But when it’s imported into another system it can only be imported as a PDF.
That means the data can no longer be extracted, manipulated, or trended with other patients’ data. Safety features, such as clinical decision support or medication interaction checking can also not be applied because it is basically just an image file.
“That’s not something that hospitals and providers have control over,” Harvey said. “It’s to the extent that it’s difficult for us to change EHR vendors on a whim. We’re somewhat stuck because vendors haven’t really been putting in the effort that they need to in this space to make their systems truly interoperable.”
Overcoming potential patient data access obstacles
It is definitely a good thing that federal agencies have attempted to reduce the number of, and the redundancy of a wide range of quality measures, Harvey stated.
With CMS renaming the EHR Incentives Program to “Promoting Interoperability” in April 2018, the government continued to show its focus on improving health data exchange and patient data access.
The proposed rule also would implement a 90-day EHR reporting period for providers participating in the EHR Incentive Programs in 2019 and 2020. There would be a mandate stating providers use 2015 edition certified EHR technology (CEHRT) starting in 2019 to demonstrate meaningful use and avoid a reduction in Medicare reimbursement.
“It’s refreshing to hear them at least talk and do some action around reducing administrative burden,” he said. “I think that’s excellent and I hope that trend continues.”
However, it is sometimes challenging as a provider in being held accountable for functionality that is not directly under his control, Harvey countered.
“Most of the barriers related to interoperability are not related to the provider or the hospital not wanting their data to be shared with other people,” he posited. “It’s related to the vendor not being able to seamlessly integrate and transmit that information back and forth.”
“It’s concerning to me that hospitals and providers are being held accountable for interoperability,” Harvey said. “Yes, we do have the ability to choose our vendor, but that’s a large and expensive decision that’s multi-faceted. If your vendor happens to not do this thing really well, then you’re the one that’s held liable. More emphasis should be placed on the vendors themselves.”
With patient data access though, the proposed rule is also on the right track, Harvey noted.
“As physicians we do a better job when our patients are knowledgeable and empowered, but it’s really the systems that are holding us back from doing that, not our own intent and desires,” he said.
Tufts Medical does not have OpenNotes for example, but Harvey said that he has still heard positive things about it but providers still remain hesitant.
“Part of that has to do with the medical legal climate,” he stated. “If you go back 10 or 15 years ago, the primary purpose of writing a note on a patient was to transmit information back to yourself when the patient comes back later or to another provider of care.”
“Since then the note has transformed to being used overwhelmingly for billing purposes, for regulatory purposes, for things like new employees, for medical legal purposes. Notes have grown in terms of the content in which we feel obligated to put into them, but they haven’t gotten better in terms of actually helping us take care of patients.”
Providers are potentially nervous because it’s just “one more thing” being added to the note. Part of the issue is whether or not the patient will understand what is being written in the note, or if a provider uses certain abbreviations.
“You may be nervous about speculating about what might be going on if the diagnosis is unclear,” Harvey explained. “You may inject some lack of faith on the part of the patient if you equivocate too much about what might be going on.”
“From the people I’ve talked to, and the places that have implemented this system, all of those fears are real but dissipate very quickly after it happens,” he added.
There is added benefit with an engaged and empowered patient. For example, a patient may be able to point out to her doctor that a note had the chronology of something slightly wrong. The patient was then able to provide correct information and make her record more accurate.
Or a patient could realize that the dosage of a medication was wrong, and he was able to help a clinician correct that information. That is a “mutual exchange” at that point, Harvey said.
“That is very beneficial and from what I’ve heard, providers get over the fear and the trepidation pretty quickly.”