Regulatory And Policy Barriers To Effective Clinical Data Exchange: Lessons Learned From MedsInfo-ED

Abstract

MedsInfo-ED is a proof-of-concept clinical data exchange project that uses prescription claims data to deliver patient medication history to emergency department clinicians at the point of care. This patient safety initiative, while limited in scope and scale, has been crucial in identifying numerous policy and regulatory barriers to successful clinical data exchange. The lessons learned and strategies to overcome the barriers are the focus of this paper. Through commitment and effective collaboration, MA-SHARE was able to address some of these barriers that are embedded in existing government regulations and corporate business practice.

Information and Communications Technology in U.s. Health Care: Why Is Adoption So Slow and Is Slower Better?

“…Many states have introduced legislation that sets even higher standards for how patient data should be protected and the extent to which it can be shared across providers (Gottlieb et al 2005). The effect of these federal and state regulations is an increase in the cost of adopting the wrong technology.…”

“…Barriers to ICT adoption already discussed in the literature include significant legal issues such as licensure, liability, malpractice, and confidentiality (Kuszler 1999;Spielberg 1999;Stanberry 2000;Gottlieb et al 2005), as well as financial barriers such as the lack of reimbursement (Cutler, Feldman, and Horwitz 2005;Christensen and Remler 2007). However, the last point raises the following question: if ICT in clinical care has such potential to improve health outcomes and lower costs, why do insurers, including the government, then not reimburse for its use?…”

Accessibility versus confidentiality of information in the emergency department

“…However, in many cases, emergency clinicians have no access to patients’ clinical histories at the point of care 2. This can be due to the patient’s condition, or their relatives, who are not necessarily in an appropriate situation to remember or talk about the patient’s clinical history.…”

Patients should have to opt out of national electronic care recordsFORAGAINST

“…If privacy policies are not consistent, sharing data becomes more difficult because stakeholders may have differing views of what can be shared and with whom 2. Since sharing electronic health record data among care givers is new, I believe that patients are best served by prospectively seeking their permission to include data in the regional index.…”

“…The NHS care records service lies at the heart of the national programme for information technology 2. The service will provide electronic summary care records and detailed care records that are available throughout the health service.…”