With electronic health records, a new controversy always appears to be on the horizon. First there was the September brouhaha about EHRs and billing. This month, the uproar appears to center on providers' use of EHRs to determine which patients should be contacted about their health.
Studies have shown that EHRs are a wonderful tool to alert providers about patient issues and to identify patients who may benefit from targeted intervention. In one study published last week, EHRs were used to automatically sift through patient information to flag those who were at risk for cardiovascular disease, enabling physicians to send personalized messages to their patients suggesting that they make an appointment to discuss their condition. In the study, the messages doubled the number of patients placed on cholesterol-reducing medications; many of the patients lowered their cholesterol.
At the same time, hospitals also are being castigated for using this same data mining functionality to identify and contact patients. According to a recent Columbus Dispatch article, two Ohio hospitals were using their EHRs to alert patients about scheduling mammograms and colorectal screenings. Officials also admittedly used income data to target patients who would be more likely to afford the procedures and respond to the messages.
The argument is that the hospitals are inappropriately using their EHRs to increase revenue.
So what's the difference? That it's okay to data mine if it's on a smaller scale, or if it's done by physicians, who have a more personal relationship with their patients (keeping in mind that they also benefit financially when the patient responds to the message and comes in for an office visit)?
The real problem is that there's not enough guidance as to what are the "acceptable" uses of one's EHR. The industry remains in a state of flux.
That's why I applaud the American Health Association's suggestion to the U.S. Department of Health & Human Services last week that among other things, there needs to be more guidance as to what is acceptable.
The AHA also suggested that there be a "greater understanding of functionalities that vendors embed into EHRs and other automated tools used by hospitals" to lead to "mutual understanding" of what's acceptable (and that EHR vendors be subject to a code of ethics to ensure that their products meet the acceptable guidelines).
We can't play by the rules if we don't know what they are, especially with so much at stake. When is automatic coding good and when is it bad? When is data mining good and when is it bad?
Someone needs to share the rulebook. Otherwise it's too confusing--and a tad hypocritical. - Marla