Thought Obamacare was messy? Wait until electronic health records come online

EHRs' laudable openness goals will slam into reality of highly proprietary, secretive, and risk-averse health care industry

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Contradiction 3: Empowered patients and liability for ensuring better health care outcomes
The requirements for EHRs and HIEs scare health care providers and their IT staffs in many ways, not just around complexity, inetgration, data portability, and privacy. There are also mandates around new diagnostics and related billing codes (ICD-10) and information security (HL7), for example.

But my sense is that the mandate that scares them the most is Meaningful Use -- engaging patients as participants in their care, not merely as treatment recipients.

Some of it is cultural: Doctors and nurses fear that patients will rely on the Web for medical data, subjecting them to all sorts of quackery and hypochondria, though that's already happened in the era of Google search. Some also fear a patient will argue and question, which of course is one of the goals of the new regulations -- doctors are often resistant to considering new or modified treatment methods, for example, and a power balance shift is needed to overcome that.

Other concerns are legalistic: Patients are not subject to HIPAA regulations, so they can share their information with anyone. That can put providers at a disadvantage, as their ability to share data is constrained while the patient's is not. For example, although a provider must make a patient's data available for download to wherever the patient wants to store it, that same provider can't use regular email to communicate any health information to that patient, for fear that others may see it. (That's why you're forced to log in to a patient portal to see those messages.) As a result, many providers don't provide patient data on demand as the law requires -- they reason that if email delivery is noncompliant, how can a data dump be compliant?

Then there's the issue of what to do with personal data from the patient, such as data collected by fitness sensors or from other practitioners (your Chinese herbalist or chiropractor, for example). If a provider lets the patient add that information to the formal health record or even to the patient portal, is the provider liable for reviewing it and assessing it? What if it provides a clue as to the patient's condition that could affect treatment? Providers are damned if they review it and damned if they don't.

Also, the feds are encouraging the development of wellness apps that would use patient data, such as from Blue Button data dumps, to help patients manage their health, as well as their family's. Providers fear they'll be on the legal hook if the data from their EHRs is misused, misunderstood, or outdated. Although the Food and Drug Administration will regulate medical apps -- at least the ones that actually treat patients -- it's very murky territory as to what constitutes treatment versus what consititutes information. Who's responsible when harm comes to a patient in that gray zone?

One of the overarching goals of the national health care policy is to reduce costs while leading to better health "outcomes." As the network of providers, information sources, and services -- some regulated, some not -- grows around the empowered patient at the center, we'll get both smartly proactive users and stupidly acting ones. Ambulance-chasing lawyers will love the latter ones, at least as long as liability remains an open question.

This article, "Thought Obamacare was messy? Wait until electronic health records come online," was originally published at Read more of Galen Gruman's Smart User blog. For the latest business technology news, follow on Twitter.

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