Literature Review and Environmental Scan: Evaluation of Personal Health Records Pilots for Fee-for-Service Medicare Enrollees. Gaps In Interoperability Standards

08/01/2009

The National Committee on Vital and Health Statistics of the U.S. Department of Health and Human Services (DHHS) determined that interoperability standards development efforts for PHR systems should focus mapping formal medical terms to consumer-oriented concepts and terms.[176] In addition, the Committee recommended that DHHS should encourage the adoption of standards for PHRs that are currently used to promote the interoperability of EHRs. The Committee also determined that the private sector, vendors, and health care institutions should adopt data content and exchange standards based on standards accepted for EHRs.[177]

Another interoperability standards gap is for workflow processes related to ‘request changes’. According to HITSP, there are no known standards that govern patient-requested changes to the PHR.[178] Request changes involve three key steps. First, the annotated document is transmitted to the original provider or institution for confirmation. Second, the original provider confirms that he/she has received and read the annotation. Third, the annotated document is sent back to the consumer’s PHR and indicates that a change has been made. Standards need to be developed to govern each step of the workflow. Standards also need to be developed to address more complicated situations, such as if the original provider is not available to read/ receive the annotation, or if the provider refuses to respond to the request change.[179]

Standards are also needed to address more complicated situations, such as if the PHR is offered by a health plan. Dr. Archelle Georgiou, an independent consultant, noted that in this case, the ‘request change’ process may be more challenging. If the PHR is offered by a health plan, the originator of the data is actually the provider (hospital/doctor/facility) that submitted the data through claims. In order to change the data, the provider would potentially need to resubmit a claim – which is unlikely to be a feasible approach if the claim has been processed and paid.

Other more complicated situations that need to be considered are if the original provider is not available to read and/or receive the annotation, or if the provider refuses to respond to the ‘request change’.[180]

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