How to mitigate unintended consequences of data exchange

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Just as health information exchange has the potential to improve care and cut costs, it also could have unintended effects.

A paper published this month in the Journal of General Internal Medicine builds on the HIE Unintended Consequences Work Group's report from last fall to the Office of the National Coordinator for Health IT to discuss seven categories that, if not managed properly, could produce unintended consequences. The categories include:

  • The desire for complete, accurate and timely data for decision-making
  • Data management and presentation
  • Assuring routine use of health information exchange
  • Consideration of patient perceptions and concerns
  • Reputational and financial concerns
  • Technical issues
  • Administrative aspects of health information exchange

The first two categories could have direct impact on patient care, the authors said, while the second two could affect care secondarily. The final three, they added, could have consequences for organizations providing care.

Some of the authors' concerns included:

  • Accuracy and timeliness of data: The level of data completeness and data quality in electronic systems, which may be well understood in a local environment, could be less clear when aggregating data across sites, the authors said.
  • Data management and data presentation: Clinicians could be overwhelmed with too much information from various sources, according to the authors, who called for more research on the best ways to present and summarize data in order for it to be useful.
  • Uses of health information exchange: If health information exchange is not seen as helpful, the authors said, clinicians might not use it and the exchange's potential might not be realized.

Robust user training and checklists to ensure exchanges are being used as planned are among ways organizations can mitigate the outlined unintended effects, according to the authors.

ONC recently released guidelines for Direct HIE implementation, including urging organizations to have a binding legal contract with clients who send and receive patient information. The California Office of Health Information Integrity, for one, has published a trust framework to be used with an HIE's various partners so they don't have to reinvent the legal wheel with each organization that wants to connect.

The Privacy and Security Tiger Team also released security recommendations for exchanges last month. Among its recommendations, the Tiger Team suggested that the Health IT Standards Committee come up with its own recommendations for technical methods to give providers a way to comply with various state laws that are stricter than federal law.

To learn more:
- here's the abstract
- check out the workgroup report (.pdf)

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