The healthcare industry already has experienced several unintended issues related to electronic health records, many of which involve patient safety and upcoding. But as implementation of EHRs begins to mature and providers step up integration in response to health reform, there will be additional unanticipated operational and business problems involving EHRs that will arise.
Health law attorneys Michael Kline and Elizabeth Litten with Fox Rothschild in Princeton, N.J., shared some of these forthcoming problems in a recent exclusive interview with FierceEMR.
FierceEMR: Why will providers entering new business deals with each other run into new problems with EHRs?
Litten (right): EHRs are very beneficial, but these new relationships open questions of ownership of the patient information. Who has access to what information and who will pay for it? Then there is the question of what information can be put in the EHR and what can be pulled back out. Once you're in an integrated relationship, say an accountable care organization, who controls the medical records while you try to integrate care?
Kline: There will be a lot of problems as the industry continues to consolidate. Say a physician practice throws in its lot with a larger entity with a great EHR, and 18 months later is asked to leave. Now 18 months of the practice's information is inseparably in someone else's computer system. What if a new patient comes into the practice during the 18 month merger, or a spouse of an existing patient? It may be that who controls the information on the server may be in control of the patient.
FierceEMR: Are there additional concerns arising from entering or terminating these business deals?
Kline (left): The entity holding the EHRs may deny access to the entity or professional leaving the relationship. You may have to beg for the records of an individual patient. It can affect continuity of care.
Litten: This sharing of EHR information can also devalue a practice. Patient lists are an asset to a practice. As your patient lists are more available to others, it may become a question of which doctor has the primary relationship with the patient.
Kline: The move to integration and expansion will also increase the risk of breach of the data as the octopus grows. And with new practice groups and locations, you're potentially subject to multiple state regulations, so you can't be ignorant of their nuances on privacy and security.
FierceEMR: How might a provider avoid these problems?
Kline: You've got to address these issues--exporting the records, using the information, who pays for separating it out--in your contract when you first enter into the relationship, not when you're breaking up or pulling out. It's like a prenup.
This interview has been edited and condensed for clarity.