Compromise On Health Data Access May Be Ugly

The consumer group is correct, especially about hospitalizations: Patients getting access to discharge instructions and other pertinent information about their hospitalization upon leaving the facility--or soon after--is vital for the transition and continuity of care and self-care.

The AHA's argument to extend the turnaround time to 30 days seems to fly in the face of business logic when you consider the pressure hospitals are under to reduce 30-day readmissions of patients. Once patients leave a hospital, bean counters need to cross their fingers that patients and caregivers will adhere to the instructions they're given by clinicians so that they don't suffer complications and end up returning to the hospital with greatly reduced (or no) reimbursement for the next wave of care.

To be fair, not all hospital leaders are opposed to shorter turnaround times to release patient information.

Ray McKee, CIO at Arkansas Heart Hospital, a 112-bed specialty hospital in Little Rock, Ark., thinks that his organization in most cases could likely comply with the CMS rule. "For us, it shouldn't be a big deal," he said.

However, the caveat for hospitals in general to meet the rule depends on "how accurate chart capture is" and whether communication methods with patients "are safe and secure." Given options, McKee's organization likely would favor providing information via a secure portal, rather than "push" information out to patients. "Communication is dicier" in doing that, he said in an interview with InformationWeek Healthcare.

"The reason this has patient advocates so inflamed is that so many have been told in the past: 'You cannot have your data' or 'it will take 2 weeks and you have to pay per page to get it'—AHA brought back many raw nerves at a time when patients feel they had made progress," said Lindsey Hoggle, managing partner at the health informatics consulting firm Health Project Partners, LLC in Gaithersburg, Md.

"Hospital readmissions are a huge cost to Medicare and hospitals--and much work is being done to correct this," said Hoggle in an email interview with InformationWeek Healthcare. "The goal of digital health data is that whoever appropriately needs access can have it at the right time for the right patient."

"In many hospitals--in the paper world--the discharge notes are not ready for a few days, much less immediately," said Hoggle. "Physicians often would dictate discharge notes well after the patient left. While some clinicians get behind in their notes, to think they will remember anything to say 30 days later is suspect," she said. "Having worked in clinical care, the longer you wait to document care--or any summary--the more difficult it is to remember details."

"Perhaps the hospitals are thinking they would need time to 'move'" or get the data to patients--but again, 30 days is certainly not needed," she said.

I predict that the final rule will be a compromise that won't thrill patients and consumer groups or the healthcare providers. Hospitals--and maybe doctor offices, too--will likely be given more time, perhaps several days, to prepare information before it's released to patients. However, extending the turnaround time to more than two or three days isn't doing anyone, especially patients, any favors in the end.

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