Comments on: The Futility of Patient Matching

By: HealthViewX

HealthViewX — Wed, 07 Nov 2018 06:22:33 +0000

The quantity and the quality of patient data are both improved. Technology has always played a crucial role in healthcare innovation. For quality care solutions like patient referral management, chronic care management, and care management are vital for the industry.

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By: Adrian Gropper, MD

Adrian Gropper, MD — Sun, 28 Oct 2018 16:34:32 +0000

In reply to William Palmer MD.

I could not agree with you more that service providers should not share or make copies of any data that they themselves did not originate. That’s obvious for a lab, a genome sequencer, an imaging center, but it should also be true for a surgical team or a specialty practice in a hospital. I might relax that to some extent for primary care practices where the physician is actively responsible for curating an aggregated health record, but even that has to be done with care to avoid prejudice.

Both the standards and the software to do this are available for discussion and testing. The HIE of One Trustee project is an implementation of the Kantara UMA standard for an authorization server. It sits on top of the SMART on FHIR interfaces mandated for 2019 and enables each EHR or other service provider that adds UMA support to their EHR. This standard allows each service provider to post the information they are responsible for and each requesting party to aggregate some or all of that information on-demand, in real time, at the point of care. This architecture has many benefits beyond current EHR aggregation practice. Because it’s patient-centered and patient-owned, the UMA authorization server can provide UMA access to social determinants of health and 42CFR Part 2 sensitive data that would not be accessible in an EHR or HIPAA based regional HIE. The data clinicians request via UMA comes directly form the source and retains its full integrity without complex and often proprietary digital signature and provenance schemes.

As we begin to implement the 21st Century Cures Act, UMA-based interoperability is the simplest and most scalable solution because it avoids patient matching and consent issues that seem to get ever more complex.

By: William Palmer MD

William Palmer MD — Sat, 27 Oct 2018 17:25:20 +0000

A thought experiment: What if you looked at the inverse of interoperability?, the opposite of interoperability: a situation where you could access no data except from what we have recently generated in that particular EHR that serves the hospital ot hospital system that contemporaneously enrolls the patient?

How much funtionality would you lose?

Maybe contemporaneous data is the only valid data? …because patient biology is so rapidly changing, so evanescent and volatile? Maybe we shouldn’t know that last month’s hemoglobin was 9.8? Maybe we shouldn’t know that the ground glass RUL infiltrate measured 3cm? Maybe, all in all, it is better to know and act on what we see today or thereabouts? Because we should not be distracted?

But, of course, this is not the ideal solution. I agree with Adrian about the patient’s essential role in this matching process.

By: pjnelson

pjnelson — Fri, 26 Oct 2018 03:10:23 +0000

One of the most important details under HIPAA was the provision for a person’s ability to define, other than for legitimate healthcare coordination, to whom their information could be released and most importantly to whom it could NOT be released without a court order. In my small group, private practice of @3,000 active person’s (seen once in the prior 18 months), there were usually about 3-6 patients who would define a person/persons who could under no circumstances have access to the person’s status (even to disclose if they were or were not a patient). So, if you wonder why the mental health folks have been slow to adopt an EHR, now you and I both know why! This HIPAA status was defined by a special, loosely filed form for each independent person within the family (we used family charts). This made it accessible to the TRIAGE nurses (an R.N.) who answered the phone, since all of the charts were easily accessible behind the Triage “desk.” Strangely, we never had problems with EHR downtime accessibility for the 41 years of our active practice.

Medical Record Privacy as an ethical standard for healthcare quality seems to be increasingly diminished without any awareness of its important contribution to a person’s autonomy and dignity. Shame on all of us!