Sarah Bimber, J.D. and M.P.H. Student, Project HealthDesign Project Assistant, University of Wisconsin-Madison
In August, Project HealthDesign’s current teams met with the National Program Office and other advisers for a workshop that allowed the teams to collaborate in the midst of the evaluation phase of their projects. While the teams shared their successes and challenges, I noted several legal and policy topics and implications:
Policy and legal issues continue to underlie many aspects of Project HealthDesign’s work.
In Project HealthDesign studies, patients and caregivers partner together through the use of new technologies. This work raises a host of legal and policy issues, from data security to clinical licensing. Although policy and legal considerations were foundational to our discussion at the workshop, these issues often were not discussed explicitly.
Data security and privacy requirements remain challenging.
During the workshop, the teams identified how and when data is protected via encryption and/or password protection, as is required by federal law. We also discussed how the teams would respond if a mobile device were lost or stolen. The teams report that patients in their studies do not express concerns about potential losses of health data. One team reported that they could remotely wipe patient data from a lost or stolen device when the device is connected to WiFi. Informing patients about password protection options on their mobile devices may be the best option to alleviate these concerns.
The teams are exploring ways to incorporate patient-sourced data into clinical EHRs.
Several teams reported efforts toward utilizing an EHR to present a hyperlink, store a PDF report or communicate with clinicians. “Inclusion in an EHR” can mean several different things, but it can have legal consequences for clinicians and organizations. For example, if an organization considers the ODL data to be part the legal health record, it could be demanded during litigation. A report of ODL data that is barcoded and stored in a document management system by a hospital is likely part of the legal health record, but communication with a clinician via an EHR-related secure email system may not be. Although none of the Project HealthDesign teams will be feeding patient ODL data into a provider EHR as discrete data elements, the program sees this as a goal for the future.
Project HealthDesign teams are customizing data views based on role and patient preferences.
In addition to designing a mobile application with meaningful data displays, several teams are also customizing data displays for clinicians and patients to account for clinicians’ preference to see data over time in concise formats. One team also reported limiting what providers may view based on patients’ preferences. This is in line with a vision for PHRs that empowers patients to control how and when their data is used. Another team addressed patient safety concerns related to limiting clinician data views by identifying that if a critical value is measured that may indicate an unsafe situation, a clinician alert is automatically triggered.
The teams have involved a range of clinicians in ODL review workflows.
The teams varied in terms of the types of clinicians involved in their projects and the scope of involvement in review of ODL data. School nurses, health coaches, L.P.N.s, R.N.s and physicians are all involved in projects in some capacity. Because an M.D. is rarely the provider regularly reviewing ODL data, the workflows include a front-line provider that may escalate clinical issues to an M.D. If the front-line provider is responsible for triaging potential issues, he or she should have a scope of practice appropriate for this task.
Project HealthDesign teams are using messaging technology to provide reminders and decision support.
Several teams are using secure messaging technology to remind patients to enter ODL information or provide health-related information. Health text messaging can be a beneficial source of health education. Because health text messaging systems are relatively new, questions remain as to how best to integrate these systems with EHRs, address potential privacy and security concerns and build and share libraries of evidence-informed health information. The Project HealthDesign teams currently using messaging services may have some insights to offer.
If these observations spark additional questions, please share your thoughts with us by commenting below or on Twitter @PrjHealthDesign.
Very informative and well written article.
Posted by: Andrew | October 28, 2011 at 05:01 AM