Followup on Dispute Resolution

In my earlier blog about Dispute Resolution, I described the planned gathering of computer scientists, electronic health record experts, and dispute resolution professionals called "Online Dispute Resolution in a Technology-oriented Healthcare World"

I attended the event and enjoyed the multidisciplinary discussion, learning a great deal about possible disputes among the data stakeholders in healthcare - patients, providers, payers, employers, compliance organizations, public health, government, national security, research etc.

Here are a few lessons learned

1. There's a need to web enable dispute workflow in healthcare. As e-patient Dave pointed out, I did not hear about any data concerns regarding personal health records likely because there was no easy way to raise the issue. Hospitals have policies regarding medical record disputes. Generally the workflow involves writing letters, making phone calls, and resolving disputes via committee. As the country implements more electronic records and shares more data (with patient consent), among more stakeholders, we need to embrace automated dispute resolution workflows such as are used by eBay. In healthcare, the issues are complex because the medical record is a legal record and there are many compliance issues involved in annotating it. However, I can imagine adding a comment field to the problem list which could be electronically annotated by the patient, so a clinician examining the record could understand the patient's point of view if data is disputed. In our medication reconciliation application, we give clinicians the ability to make notations about patient compliance with medications i.e. discontinued, taken infrequently, changed to a different medication etc. I can imagine gathering this input directly from patients.

Thus, the work of the dispute resolution community working with the healthcare data community will be to think through the workflow that can be supported via web-based dispute resolution tools, while still ensuring the non-repudiability of the medical record and complying with federal, state, and local medical record policies.

2. For issues that cannot be resolved via automated tools, an electronic escalation to an Ombudsman is a reasonable workflow. Complex issues are generally more easily resolved when two people speak directly rather than virtually. However, a web application could be used to identify the issues, exchange background information, and schedule the discussion.

3. If there is assertion of malpractice or harm caused to the patient, then workflows involving risk management and insurance organizations are appropriate.

The full report of the meeting will be available soon, but in the meantime, I will be more sensitive to the need to consider the modes of failure in electronic health records, especially those which are shared with patients, and the desirability of automated dispute resolution workflow.