EHR and Health IT Consulting
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EHR and Health IT Consulting
Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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Are EHR Vendor Contracts Hindering Patient Safety Research?

Are EHR Vendor Contracts Hindering Patient Safety Research? | EHR and Health IT Consulting |

Adhering to patient safety standards is of vital importance when using an EHR, which is why proper review and research among different systems are critical for innovation. However, are supposed gag clauses in EHR vendor contracts inhibiting this kind of review and research?

A recent Politico article written by Darius Tahir presents considerable research into the matter. According to Tahir, EHR users are being completely prohibited from sharing adverse events and negative feedback regarding their EHRs. This stems from different gag clauses included in EHR vendor contracts, and seriously affects innovation that can help improve patient safety.

But HealthAffairs article by Kathy Kenyon, JD, MA, tries to clarify many of the legal implications of EHR vendor contracts, and discusses the realities of the “gag clauses.”

According to Kenyon, gag clauses in EHR vendor contracts do not necessarily prohibit users and researchers from offering negative feedback regarding their EHR systems. However, as soon as users or researchers include a screenshot of an EHR screen in their critique, they are breaching the “gag clauses” that actually deal with protecting intellectual property.

Kenyon states that many EHR vendor contracts include clauses that prohibit users from publically sharing screenshots of the EHR while reviewing the product without vendor permission. These clauses exist to protect the intellectual property of EHR vendors.  However, they are actually quite vague and unclear, giving vendors the power to prohibit potentially vital research that could improve the EHR for patient safety.

The true ‘gag clause’ problems with EHR vendor contracts appear to be related to the confidentiality and intellectual property terms, which are overbroad and unclear, and limits on ‘authorized uses’ of the EHR, as those terms apply to research and reporting that requires access to the EHR and use of screenshots,” she writes.

Furthermore, when researchers are able to access screenshots to share information for system improvement, vendors are given a high level of control regarding what system information is released. This potentially prevents unbiased information from being published, hindering the improvement process.

“As long as researchers must ask vendors for permission to do research or to publish screenshots, and as long as vendors can deny permission for any reason, including not liking the results, there is a serious danger that research will be designed and findings presented in ways that garner vendor permission,” she writes.

Kenyon points out that these clauses exist to protect the intellectual property of EHR vendors. The vendors are concerned that should information regarding the look and functionality of their software be released to the public, other vendors may steal these features. This would cause vendors to lose “competitive advantage,” Kenyon says, and would hurt the business of the EHR industry.

Kenyon says that many EHR users state that this fear of vendors is not entirely well-founded considering the ease with which competitors are able to gather information regarding a certain EHR.

“ is not that hard to discover what different EHRs look like. For vendors hoping to improve their EHRs by ‘stealing’ from others, waiting for research with screenshots to be published would be an exceptionally inefficient way to do so,” she writes.

Furthermore, many physicians maintain that no price can be put on the safety of patients, Kenyon reports.

Kenyon maintains that under existing contracts, the provisions made to protect intellectual property are not functional for researchers. To increase patient safety while using EHRs, different standards are going to have to be implemented, Kenyon suggests.

“Stakeholder groups for patient and EHR safety, including parties to EHR contracts, should share interests in making health IT safety-related research and reporting as easy as possible,” Kenyon explains. “EHR vendor contracts should reflect as much consensus on these issues as is possible.”

She continues to provide suggestions for the construction of future EHR vendor contracts, stating that there should be no gag clauses, but rather clauses that encourage research and encourage reporting of adverse outcomes. By identifying these areas for improvement in EHR vendor contracts, research and adverse event reporting may potentially help increase patient safety.

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Alternative Payment Models Prompt More Health Data Sharing

Alternative Payment Models Prompt More Health Data Sharing | EHR and Health IT Consulting |

Providers slowly are increasing their sharing of medical data with patients, partially in response to the shift from fee-for-service payment models to alternative payment systems, the New York Times reports.

According to Ben Shneiderman, a University of Maryland professor and health IT expert, many providers long have sought to withhold data out of a desire to keep their patients. Further, health IT vendors in the past have sold health IT systems that are closed and proprietary. Shneiderman said some organizations have "business models [that] do not favor sharing information, either with other hospitals or patients."

However, the shift toward accountable care models -- in which providers are paid to care for a certain patient population -- has created financial incentives to increase data sharing.

Beth Israel Deaconess Chief Information Officer John Halamka said, "In the fee-for-service world, the incentives for data-sharing were not there. But with accountable care, providers cannot survive unless they share data" to limit unnecessary tests and improve care.

Some advanced medical centers are beginning to share more data with patients, the Times reports. For example, Partners HealthCare Group now provides more than 500,000 patients with access to some of their data via the Internet.

According to the Times, other examples of data sharing initiatives include:

  • The OpenNotes program, through which nearly five million patients have been provided with online access to their doctors' notes; and
  • The Argonaut Project, which is designed to advance the adoption of technical standards to improve the electronic exchange of patient data among providers. The Advisory Board Company, which publishes iHealthBeat, is a founding member of the project.
Potential Benefits of Increased Data Sharing

Medical experts have said that providing patients with more access to their medical data could help them to:

  • Make healthier choices;
  • Adhere more to prescription drug regimens; and
  • Detect early warning signs of diseases.

A year-long study of the OpenNotes project at health organizations in three states found that more than two-thirds of patients using the initiative said they had:

  • Adopted healthier habits;
  • An improved understanding of their medical conditions; and
  • Increased their medication adherence.

In addition, about 20% of the physicians in the study said that the initiative led them to alter how they wrote notes about particular conditions, such as obesity and substance use disorders.

Further, a study by patient network PatientsLikeMe found that among members of the network's epilepsy community:

  • 55% said that sharing experiences and information with others in the network helped them learn more about seizures; and
  • 27% responded that sharing experiences and information helped increase medication adherence.
Potential Downsides of Increased Data Sharing

According to the Times, increasing data sharing has also raised several concerns among stakeholders, including:

  • Patients increasingly asking physicians time-consuming questions;
  • Increased legal risks; and
  • Potential privacy issues.

However, the OpenNotes study found that just 3% of physicians said they had spent more time responding to patient questions that came up outside of visits after starting the initiative.

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