Again... please do not misunderstand my recommendation to give payers direct access to EHR information to be a recommendation of *unrestricted* access. I'm not sure exactly how we will control it, but I would argue for payers having access to no more information than they have access to today.
Here's the dilemma I see for doctors. In the US, a patient essentially gives the payer a "blank check" to ask his doctor for any health data required to support any claim... which the doctor must spend human and system resources to send to the payer. Because doctors like to get paid, they usually do not question payers or make them explain WHY any particular health information is needed. Providers, as the principal custodian on behalf of their patients, probably SHOULD force payers to justify such requests, but there is no mechanism, venue, or guidelines for that... so we don't do it. We also know that if push comes to shove, the payer in most cases can send an audit team to your office and rifle through every record you own. In general, making it easier for the payer to get the data by its own effort removes cost from provider AND payer operations because much of the claim process is eliminated. So that's a good thing for the doctor. Depending on the security/access policies, however, this might also allow the payer to more easily look at MORE information... something most patients and provider would consider a bad thing. This privacy/fear issue will have to be resolved eventually. Doctors and patients must help us to develop a formal model of security and access requirements for health records (as Dr. Cohen has described in his paper, mentioned last week: http://www.soi.city.ac.uk/~bernie/hsp.pdf) and that model should be tested against real-life scenarios to be sure that we are really willing to pay for and live with the level of security that doctors and patients [think they] want. Obviously, the issue of what payers REALLY need to know or are implicitly allowed to ask for (or dig up on their own) will be critical to this discussion. The discussion, by the way, should take place in an accredited standards body, rather than in Congress or an administrative rule-making authority like DHHS. All the law should have to say is "respect the standard"... the chapter and verse of how to do that should be developed and maintained by a consensus-driven SDO, in which payers and providers have equal voice. Christopher J. Feahr, O.D. Optiserv Consulting (Vision Industry) Office: (707) 579-4984 Cell: (707) 529-2268 http://Optiserv.com http://VisionDataStandard.org ----- Original Message ----- From: "Karsten Hilbert" <[email protected]> To: <openehr-technical at openehr.org> Sent: Tuesday, August 12, 2003 8:17 AM Subject: Re: HISTORY DATA SET IN EPR > > Well... yes... I'm dreaming a little... I'll grant you that. > Nah, what I mean is ... > > > If we could point today (in the US) > > to the system that I am imagining... one in which payers could reach out > > as needed and query EHR systems for data to support adjudication, > ... that this is nothing I am going to support in any way. The > payor has no business reading my EHR at will. Although ... > > > At the end of the day, each payer wants a virtually unique data set to > > support its claims. I think we should point them to the EHR-landfill > > and hand them a shovel... I have patients to see! > ... I do acknowledge this reason for wishing we could just do so. > > Karsten > -- > GPG key ID E4071346 @ wwwkeys.pgp.net > E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 > - > If you have any questions about using this list, > please send a message to d.lloyd at openehr.org - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
