Market surveys suggest that 20 to 30 percent of providers could switch EHR vendors in the next two years, yet the difficulty of migrating between vendors can be a barrier to switching. It can also be a barrier to the continuity of care for patients who are switching providers. At its Nov. 6 meeting, the Health IT Policy Committee asked that the Standards Committee begin work on defining the elements of a core clinical record that would establish a first step on the path toward improved data portability for patients and providers.
Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, reported on two use cases that he said need addressing: providers switching from one EHR system to another and a patient requesting the movement of their complete record to a new primary care provider.
Tripathi argued that establishing the elements of a core clinical record would inspire greater market dynamism by lowering barriers to exit for providers and patients, and promote safety and continuity of care by reducing opportunities for errors. At the same time, he said, there is a lot of work ahead to reach these goals and his work group recommends a multiple-step path to get the healthcare community there.
Several policy committee members mentioned how difficult it would be to identify common elements that could move easily between systems, especially if the goal were to include something in Stage 3 of meaningful use. Terry Cullen, M.D., director of informatics at the Veterans Health Administration, noted that her agency’s efforts at a similar project with the Department of Defense have been notoriously difficult. “It is a slow-moving animal and this will take a lot of work,” she said. Even though she views it as important work, Cullen recommended focusing on one small, encapsulated use case and see how difficult it is. “I am worried we will push something out that people will not be able to do.” Yet the committee voted to seek input from the standards committee.
A separate presentation dealt with the privacy and security considerations for data intermediaries such as quality registries. The Privacy and Security Tiger Team reported that third-party service providers don’t have clear rules for their use of data beyond the service they are hired to perform. There is little transparency about the business associate agreements they sign with providers.
Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology and a co-chair of the Tiger Team, said the discussion raised concerns that the superior bargaining power of large data intermediaries results in providers feeling “forced” to grant the business associates broad rights to future uses and disclosures of provider data. Yet ultimately, the Tiger Team could not identify an appropriate policy lever to hold business associates accountable for greater transparency to providers around their uses and disclosures of identifiable health information.
“We think this is an important issue, although we have only anecdotal evidence,” McGraw said. “We just haven’t figured out how to resolve it.”