Progress still slow on electronic health record adoption

Adopting standards for electronic health records (EHRs) is being slowed by the issues of deciding who controls the patient health data and how that control should be exercised, panelists at an industry forum said today.

“This is one of the thorniest issues in pursuing EHRs,” Joel Slackman, managing director for policy for Blue Cross and Blue Shield Association, said at "Health IT: Improving the Health System with Information Technology," an event held by the U.S. Chamber of Commerce. “It has been debated for years and years. …There are strong partisans on both sides.”

The debate centers on how much control patients should have to segregate and mask their records to protect their privacy. For example, some patients do not want their dermatologists to see their records for substance abuse treatment.

Also, some doctors don't like the the idea that they may be denied access to critical information about patients' health when treating them.

In Europe, governments have developed patient-privacy principles first, and then built those principles into national health information technology architectures for collecting, storing and exchanging patient medical data. “Architectures should follow privacy,” said Dr. Harald Deutsch, vice president of Computer Science Corp.'s health care group.

However, that situation does not appear to be developing in the United States, Slackman said. “We do not have consensus on privacy, yet we are building [health IT] systems and architectures,” he said.

Meanwhile, there appears to be a strong middle ground that most consumers can accept regarding control of their records, suggested Karen Davis, president of the Commonwealth Fund.

Studies have shown that most people want all their health information in one place, with access available to all their physicians, she said.

The debate over patients' control is timely because of the $19 billion in financial incentives in the economic stimulus law. The Health and Human Services Department will issue rules later this year to determine how hospitals and doctors can qualify for the payments by purchasing and showing "meaningful use" of certified EHR systems.

In recent months, a Health IT Policy Committee and Health IT Standards Committee have been advising HHS how to define certification and meaningful use. The definitions are expected to deal with privacy protections and provide instructions on how much control patients will have over their medical data.