Since this is baseball's opening week, I read with particular interest the fact that electronic health records are not only being used to treat Major League Baseball players, but have also become instrumental in helping clubs determine whether a particular trade or free agent would be a good investment.
This goes beyond other secondary uses of EHRs in sports, such as population health research. Here, an employer is using the EHR to determine whether a player is healthy enough to be worth a deal. The article, which showcases the Cincinnati Reds but applies to all MLB clubs, notes that the team's medical director is the "last line of defense" when making these crucial decisions and is the "final medical opinion."
While a professional athlete's health and medical conditions have always been integral to deal-making, the EHR now speeds up the process. What used to take days now takes minutes.
Even better is the fact that clubs now have more comprehensive information on a player's health information, calling it "dizzyingly" complete.
The article then goes on to explain that team doctors can provide access to each other's players' EHR for such evaluations for short periods of time.
Whoa! Is that kosher? Where does that come from? Turns out it's in the collective bargaining agreement.
Now, this 311-page agreement is quite compensative. But it raises several questions from an EHR perspective.
For starters, how complete is that EHR, really? What happens if a player gets treated by a non-club provider during the offseason? The collective bargaining agreement states that players are not required to notify their club regarding non-work-related injuries unless they "may affect" the player's services. But who decides whether an injury or some other treatment may affect a player's performance? And advance notification is not required in the event of a medical emergency.
And then there appears to be a dichotomy regarding the sharing of health information. The agreement includes a HIPAA authorization form which requires players to furnish "relevant" information regarding a work-related disability, injury, illness or condition. What is "relevant" and who decides that? Moreover, the authorization also says that the players don't waive other rights they have to privacy. How does that dovetail with the obligation to share health information? And what happened to HIPAA's provision that patients may keep treatment secret if the patient pays a provider in full? Where does that fit in?
Additionally, what about second opinions? The article says that a club's medical director has the final word after reviewing the EHR in determining whether a trade or other deal should proceed. But the collective bargaining agreement allows players to obtain second medical opinions. While the agreement appears to be addressing the ability of players to obtain second opinions regarding treatment and when the club will pay for that second opinion, could a player also obtain a second opinion of someone reading the EHR to determine if a deal should be quashed? And who would pay for that second opinion? If my future was on the line, I might want someone to spend more than a few minutes on my EHR.
I don't have skin in this game. But these appear to be gaps that the collective bargaining agreement doesn't address. Interestingly, the agreement covers 2012-2016. Now that EHRs have become so integral to the sport, perhaps the next version should include these questions in its lineup and make sure that the agreement adequately addresses them. - Marla (@MarlaHirsch and @FierceHealthIT)