National Center for Technology and Dispute Resolution

Looking forward to the discussions – will publicise and blog this here:
http://coda-memorypalace.blogspot.com/2009/10/odr-electronic-medical-records-and.html
J

The Cyberweek attendees might enjoy going to the workshop website http://www.umass.edu/eei/2009Workshop/index.html. The final report is still forthcoming, so the attendees ideas have a chance to influence agencies which the Obama Administration is counting on to make significant changes in the American healthcare system. There has been an enormous amount of thought put into medical records worldwide for many years. To put the size of the effort in perspective just the American Health Information Management Association has 53,000 members. The Internet has made remote access affordable. Attendees might work through the demonstrations at either of these site https://www.patientsite.org/default.asp or https://mychart.sutterhealth.org/pamf/. Interoperability has been both an American and European efforts to allow for interchange – here is the most prominent US Effort http://www.hitsp.org/. The US Government is planning on covering Seventeen Billion Dollars of the cost of realizing electronic health records. Yet as Dan points out there has been no effort to encourage the inclusion of facilities for disagreements and disputes in electronic medical record systems, except in the case of security breaches. This is in spite of the inclusion in America’s HIPAA law that says providers must give patients the right to dispute the contents of their health records. Of course common sense has lead the early adopters to allow for feedback. So for example you find on the PAMF site above this note “If you would like to ask health-related questions, please click ‘Send Message to Doctor’ from the left menu.” Presumably if you have an issue with your record you might know to use that link.

Issue will certainly arise. Here’s a very interesting posting to consider: http://e-patients.net/archives/2009/04/imagine-if-someone-had-been-managing-your-data-and-then-you-looked.html Here’s a quote from it: “The really fun stuff, though, is that some of the conditions transmitted are things I’ve never had: aortic aneurysm and mets to the brain or spine.” Fun stuff! For the statistically minded, America’s Defense Department runs many health care facilities. At each there is a data quality officer who publishes his/her monthly audit results. They label about 1 in 11 medical codes wrong. Since their patients safety is at risk, I wouldn’t call this fun.

So how can we in this community help? Here are the goals of the workshop and the report will try to address:
- Identify the key risks of disputes in the networked health information technology systems being proposed.
- Identify the best practices in avoiding and resolving such disputes and the need for new practices in open areas.
- Identify the computing research challenges inherent in supporting these practices.

Perhaps this community can add a lot to reaching the middle goal.
Norm Sondheimer, UMass Amherst

Orna: That is a fascinating observation about the culture in medicine. We have a set of comments from doctors about the relative lack of complaints or the need to make special efforts to deal with them that seems to come from their self image or their view of how healthcare should be provided. Perhaps they also are afraid of litigation in the US.

But the chance of doing harm from bad data is also real. Here is an article from Sunday that Ethan found: http://benton.org/outgoingframe/29153 The article is not that well written, but this quote may reflect a serious issue that will lead to disputes: “More than one in five hospital medication errors reported last year — 27,969 out of 133,662 — were caused at least partly by computers, according to data submitted by 379 hospitals to Quantros Inc., a health-care information company. Paper-based errors caused 10,954 errors, the data showed.”

This suggests to me that any Electronic Health Record Dispute Resolution might make the most progress if it was associated with the global efforts on Patient Safety. In many cases ADR is presented as a way of developing a partnership between the parties – not in fact to “dispute” but to come to a common understanding of the underlying issues and reach the most satisfactory resolution for all parties. Perhaps under the guise of patient safety, we can present ADR and ODR’s methods as a way of establishing a partnership between providers and patients that leads to healthier outcomes.
Norm Sondheimer

Norm’s framing of the use of ODR to include partnering is creative. It speaks to expanding some of the more traditional perimeters of ADR and perhaps, ODR as well. I wonder what ways technology might enhance relationships (between doctors and patients, medical practitioners sharing e-records, etc.)? From a system’s design perspective what would we need to take into account? Are there ways that technology can exponentially increase effective communication and not just increase the number of mistakes, disputes, and complaints once EHR become commonplace?
Leah

Wow, this is indeed thought provoking! My comment is actually a product of a research project I conducted on ADR in hospitals (in Israel). A major finding was that healthcare professionals engage in what I termed “defensive communication” – closed, hierarchical communication due to their fear of legal liability. This mode of communication typically infiltrates all communications (beyond the context of suspected or actual malpractice) with patients and their families. I wonder to what extent the documentation that comes with ODR would actually make this tendancy even more extreme. Healthcare professionals would use the process to create a paper trail clearing them from liability instead of actually communicating with the complainant and addressing the problem.