EHR & Values Issues

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  1. Does your dermatologist need access to your reproductive health history? Can you limit access to the psychiatric notes in your chart once they have been entered into your provider’s new electronic health record (EHR) system? It sounds absurd, but the adoption of EHRs and health information exchanges could enable this level of access in the future.
  2. Homosexuality has entered the exchange discussion. The exchange is viewed as a valuable tool for data collection. Maryland is already  asking for sexual orientation, gender identity and relationship status in their customer satisfaction tools. Like it or not, everyone will be asked. The liberal Center for American Progress has a  new FAQ on data collection opportunities in the exchanges:   "...[T]he future of health and health care is built on data. Data collection is indispensable to efforts to achieve better health for all by identifying, tracking and eventually eliminating health disparities...Sexual orientation and gender data will facilitate numerous activities of health insurance exchanges...[I]nitiating collection of these data is vital to establishing a baseline and, over time, identifying patterns of practice that point to opportunities for the exchanges to improve efforts to serve their diverse consumer populations...
  3.  http://www.healthit.gov/buzz-blog/meaningful-use/meaningful-use-grids-quick-reference-navigation/ " class="">Meaningful Use Grids Comment:

    We are quite concerned about what a CCD has in it for posting to a patient portal. Our patients are all minors, so their parents are the ones who have access to their portal, and rightly so. However, as a child grows up, other issues come up, such as patient confidentiality in the even of an office visit for birth control pills, concern about pregnancy or treatment for sexually transmitted diseases. Teenagers have a right to seek this care in Kansas without it being disclosed to their parents. Any ideas on this? Is there a way to block this info? The patient (the teenager) has a right to the information, but the parent has access to the portal.


    What about when the child has turned 18 and we must have a release for information to the parents, but the 18-year-old doesn’t change the user name and/or password, because, you know, teenagers ….? We have to make the information available to the patient, but the parent has access.


    This doesn’t even address when a child is taken into custody by the state, or there is a fear and office visit to determine if abuse has occurred. Both parents still have a right to or actual access to this portal and all the information that it shows, including addresses and phone numbers.


    Lab results could be “abnormal” but reviewed (and they are all reviewed) and determined to be “unremarkable” and therefore not a matter of concern. We see patients calling in anxiety about their child’s results.


    And what about litigious parents? Or “second-guesser” internet parents? Wheeeeeee ….

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