Hospitals also need to account for how process changes will affect physicians’ workflows.
That’s one of the areas Dr. Paul Sternberg Jr. oversees at Nashville-based Vanderbilt University Medical Center as chief patient experience and service officer. He splits executive responsibility for implementing the regulations with the system’s CIO for health IT and the executive chief nursing officer.
A major revamp involved the process for releasing laboratory results to patients.
Previously, some lab results were released immediately to patients via patient portal, while others would be delayed to allow the physician time to review and interpret the results. But to ensure the health system is aligned with the new rule—which requires that providers share data without delay once a patient requests it—they’ve adjusted the process to release all results immediately.
It would be too complicated to implement a system that allows patients to request immediate access to results that would otherwise have a delay, according to Sternberg.
“Creating an infrastructure to do that … was too steep a hill to climb,” he said.
Moving to automatic release for lab results was partially an IT project, since it required retooling how data is shared in the patient portal. But there’s also a patient engagement component.
If a patient receives their lab results before a physician has had a chance to add notes on what the data means, the patient could become confused—leading to a bad patient experience.
Vanderbilt opted to add a note to the lab results when they’re released, explaining that the physician has not yet reviewed them and will add an interpretation of the results later, as well as encouraging physicians to discuss the process change with patients, so patients know what to expect when they initially receive results.
Releasing information is even more complicated for adolescents—posing additional challenges, particularly for pediatric hospitals.
Figuring out how to balance sharing health data with pediatric patients and families while also protecting the privacy of adolescents has been a “major concern” and point of discussion at Stanford Children’s Health, said Dr. Natalie Pageler, the Palo Alto, Calif.-based health system’s chief medical information officer.
Pageler leads implemention of the regulations at Stanford Children’s, working closely with the CMIO at Stanford Health Care, so that policies are aligned across Stanford Medicine.
California has “robust minor consent and confidentiality laws,” Pageler said, including the right to confidential treatment related to birth control, pregnancy and sexually transmitted infections.
The EHR doesn’t yet have the technological capability to separate such protected adolescent information from other data held in patient records. So if a patient’s family requests a record that includes sensitive health data, health information management staffers will have to manually redact the information.
Stanford Children’s plans to call on information-blocking exceptions related to “infeasibility” and “content and manner” to justify possible delays, as it works with its in-house informatics team and with its EHR vendor to figure out a process to more easily share non-sensitive data with adolescents and their parents as requested.
“It’s not just about releasing this data,” Pageler said. “It really is about thinking through: How do we educate our patients and families, and help them take charge of their own health as they transition from childhood, to adolescence, to adulthood?”