Observations about the changing nature of health information practice

By Linda Kloss

Arriving for her mammogram, she is told that the radiologists will not read her digital mammography without the historical files. In following up, the staff at the “most wired” health system acknowledged that they had received the request, but the fax number didn’t work and they had called once to follow up but didn’t connect to a live person. The ROI team didn’t know about the digital files because those were handled elsewhere and they had no information or responsibility for that aspect of the request. Anxious follow up calls produced fairly quick responses and the mammography test results were interpreted and were normal. You have probably also guessed that I was the patient in this story. Ironic, eh?

This simple story is repeated over and over again. In this case, there were no quality of care consequences, just a frustrated delay and some worry. In other instances, such errors have real consequences. Getting access and disclosure right in the current environment is a complex systems challenge requiring coordination of three elements of change: technical, political, and cultural:

  • Technical systems include workflow procedures, transaction and analytic technologies, guiding policies, business practices, regulations, and standards.
  • Political systems are the ways that authority and responsibility for administering technical systems are assigned among stakeholders. Today there is a drive toward greater standardization and even centralization of ROI to improve accuracy and efficiency.
  • Cultural issues include the shifting organizational and societal values and pressures for change. The emphasis on patient access, patient-generated health information and use of apps at the same time there is growing concern about personal privacy and breaches demonstrates cultural dilemmas.

The technical systems failed in this example. There was no accountability baked into the processes of either organization. Obviously, their technology did not include any flagging about open requests. For a care coordination issue, they were way outside the range of efficient information sharing. The interpretation and digital records were not handled in a coordinated manner; these were unlinked transactions with no responsible party. While I did all the right things to start the process, I made the assumption that given enough time—5 months—the systems would work on my behalf. I did not follow up. But should I have to?  We live in a world where trillions of transactions across all aspects of our lives are handled reliably on line with feedback to the initiator and the ability to track transactions.

This blog, sponsored by Verisma, represents the company’s core commitment to serving patients with game-changing disclosure management technology and innovative management solutions designed for accurate, timely, and compliant disclosure management. At its 4th Disclosure Management Summit held in May, Verisma challenged participants to be working toward a goal of “your records in 5 minutes.” In the coming months, we are going to explore what it will take to meet this challenge. We look forward to your engagement and participation.