Monday, April 27, 2009

Dispute Resolution in Healthcare

At the recent Health 2.0 conference, I was asked an interesting question. If there is a dispute about any data in healthcare - PHR, EHR, or Health Information Exchange, how is it resolved?

eBay does millions of transactions via the internet and it has automated, web-based dispute resolution workflows. Can healthcare learn something from eBay?

On May 5, I will be attending a workshop in Washington called "Online Dispute Resolution in a Technology-oriented Healthcare World.”

The attendees are evenly split between representatives of the Healthcare, Dispute Resolution and Computer Science communities.

The goals of the meeting are:
*Identify the key risks of disputes in the networked health information technology environment.
*Identify the best practices in avoiding and resolving such disputes and the need for new dispute prevention/resolution approaches in problem areas.
*Identify the computing and other research challenges inherent in supporting these practices.

You'll find a list of attendees and the conference background materials online.

As the recent work with I've done with e-Patient Dave illustrates, Personal Health Records should have a process for resolving data issues. If such a feature would have been built into Patientsite, Google Health or Microsoft Health, we might have identified the issues with administrative data and PHRs sooner.

I will report back next week with lessons learned from the conference, included recommended next steps for the software we use with patients at BIDMC.


e-Patient Dave said...

Great idea! Don't I *love* the idea of picking up solution technology from areas outside healthcare!

I'm not sure I'd call it a dispute, though, in HC or elsewhere. In my online American Express data, every month or two there's something where I say "Whaa??" They WANT to call it a dispute, but it's just a question: "What was this again??"

In my case, for instance, the "aortic aneurysm" turned out to be a more-or-less legitimate entry, even though "aneurysm" felt misleading.

So on your trip, please take into account the "clarification please" case.

Bill Baar said...

I went for a stretch a few years ago where ever bill from the Hospital was wrong. For starters, they sent everything to my Mother-in-Law because she was the one who brought my wife to the ER when my wife had an allergic reaction to meds.

Everytime I called to get things corrected, the person at the other end of the phone understood the error, and said it was a "computer error".

However things could never get corrected and I finally told that person at the other end of the phone that I was a computer progammer and I knew computers don't make errors; computer progammers put the bugs into the those programs so please find the person to resolve this.

It took a a letter to the Hospital's VP of Finance to finally get some action.

So lets hope the reconciliation process for this grand scheme a'coming works better with numbers about my health status besides the numbers on my financial status.

Donald Green MD said...

The technology does not solve these issues. The patient and the responsible provider is the proper interaction to set the record straight. At a live interaction these discrepancies should be addressed and dealt with then. To expect some reconciliation process in cyber space is only asking for further confusion. We do not want to allow our records to be reconfigured by a reconciliation process. Even now we are told with written records to put a neat line, date it, initial it, and then write any further explanation or correction. The previous data must stand as a legal entry. There are no do-overs.