AHIMA Summit Attendees Consider Unintended Consequences of EHRs and HIEs
(Editor's Note: This guest blog was written from AHIMA's Health Information Integrity Summit by Sandra Kersten, MPH, RHIA, AHIMA, director of HIM Solutions.)
Kathy Kenyon, JD, senior policy analyst for the Office of the National Controller for Health Information Technology, framed several key issues relating to EHRs and Health Information Exchanges (HIES) on Friday in Chicago.
Kenyon spoke at AHIMA's Health Information Integrity Summit: The Quest for Safe, Usable, Quality Data in EHRs.
Kathy Kenyon analyzed "unintended consequences of HIT EHRs and HIEs."
Defining unintended consequences (UCs) as "events or reactions arising from the introduction of an innovation or a new technology or process that are not part of the intended purpose or goal," she listed potential adverse effects of EHRs in the healthcare setting: unfavorable workflow issues, never-ending system demands, problems related to paper persistence, untoward changes in communications, negative emotions, new kinds of errors, unexpected changes in power structure, and overdependence on technology.
Kenyon said she is well aware that AHIMA members already have participated on the frontlines of "UC cleanup." Many of the unintended consequences we're seeing are the result of inadequate planning for implementations, particularly as external forces have sped up the EHR adoption curve.
Another study, looking at benefits and risks of HIE found the following benefits:
1. improved quality of care
2. cost reductions
3. availability of data for population health management and research
4. personalized health care and patient/family engagement
Unintended adverse consequences of HIE:
1. incomplete, inaccurate or untimely data (poor patient matching)
2. problems related to data presentation, data overload
3. heterogeneity of use of HIE capability
4. potential for negative patient perceptions
5. reputational and financial risks
6. vulnerability to technical UCs
7. UCs related to administration of HIEs
Kenyon had several recommendations for the future of HIEs:
As HIEs continue to expand, there is a need for more clarity on the parameters of the exchange. Physicians need to have reasonable expectations on what is there. Consumers and care providers need to understand its true value in order to assess whether it's delivering it. HIEs can't be all things to all people! It will be critical to determine what it is designed for, whether it's for emergency use, research, transitions of care, etc., in order to optimize their use.
HIE technology plans need to be robust and available even in disaster situations, so that health data is available as a resource during disaster recovery.
And central to this work - AHIMA's members provide needed expertise and a critical perspective in the development and management of HIEs and health data.
Joan Ash, PhD, MLS, MS, MBA, professor and vice-chair of the department of medical informatics and clinical epidemiology, School of Medicine, Oregon Health and Science University, provided additional details on UCs, citing findings from a study on adverse consequences from computerized physician order entry (CPOE). A familiar theme emerged from providers regarding more time for data entry tasks and less time on face-to-face patient communication. A concern about "the illusion of communication" was identified; just because something's been entered in the system doesn't mean anyone has seen it and/or has acted upon it. Regarding functional design, "pick lists" were found to promote juxtaposition errors (a provider picks the wrong item because it's next to the one he/she really intended).
A hopeful finding was a positive correlation between the amount of time a system is in place and providers' positive emotions around the system.
To help mitigate UCs of EHRs, Ash emphasized the need for preparation. The Safety Assurance Factors for EHR Resilience (SAFER) initiative is developing resource guides for proactive assessment of safety in the EHR-based clinical work system. Once developed, the guides will focus on key error-prone processes, provide a list of principles and considerations for systems, use a socio-technical approach (people and processes), and apply to both in- and outpatient settings. She noted that former AHIMA CEO Linda Kloss, MA, RHIA, principal, Kloss Strategic Advisors, is a member of the technical review group, and that AHIMA is providing key input on patient identification issues.
Scott Weinstein, JD, presidential management fellow in the Office of the Chief Privacy Officer at the Office of the National Coordinator for Health Information Technology, shifted the focus to privacy and security, and emerging work on data segmentation. He described an approach that uses metadata to help ensure health information privacy and security can be maintained (specific to the content and/or patient preferences) when exchanged between different systems. Concerns around the impact "omission of key data" related to privacy and confidentiality could have on care provision will need to be addressed.
A panel of practitioners wrapped up the closing session with a recap on some of the main themes of the conference - big data, emerging models of care based on analysis of health data, the need for overall information governance.
As the focus on healthcare data and its role in healthcare quality continues to evolve, HIM practitioners are uniquely qualified and positioned as data stewards to help manage and govern the use of data, and contribute to the innovation and transformation of healthcare.