The current state of interoperability is not unlike Charles Dickens' A Tale of Two Cities: "It was the best of times, it was the worst of times." In the history of clinical medicine, we have more interoperability than ever before — more electronic data is flowing in more places for more purposes. Yet, there's also more frustration about the state of interoperability leading to more attention across our industry and our country than ever before.
I've set up the usual tradeoff between data sharing and patient privacy in Part 1, and discussed a framework for respecting patient preferences by preserving contextual integrity in Part 2 of this series. Now, I'd like to describe how to use the contextual integrity framework to remove the false dichotomy between data sharing and privacy by describing a set of successful health information exchange patterns:
In the first post of this series, I set up a common, but false dichotomy: the supposedly stark choice between enabling data access for high quality care and protecting the privacy of individuals. In this post, I will introduce the concept of contextual integrity, proposed by New York University Professor Helen Nissenbaum, who has written extensively on consumer privacy, as a way of addressing the dichotomy. Contextual integrity was recently embraced by the FTC in its privacy report, which recognizes that commonly accepted data practices do not need explicit consent, and that choices for non-commonly accepted data practices should be presented to consumers in the context within which the decision to supply the data is made.
This blog post was updated on 8/1/12 at 4:47 PM ET to clarify some editing issues.
Every day seems to bring a news article that sets up a false dichotomy of information exchange: We can use data to improve the delivery of patient care, or provide the highest levels of patient choice and participation in information sharing, but we can't deliver both. This has also been posed as the equally false dichotomy between "opt-in" versus "opt-out" forms of patient consent.
Arien Malec, Vice President, RelayHealth Data Platform Solutions, recently returned from a stint with the Office of the National Coordinator (ONC), where he focused on technology requirements and policies needed to support much of the criteria in the health information technology (hitech) portion of the Patient Protection and Affordable Care Act.
This experience gave Arien unique, current – and potentially future insight into the stages of meaningful use criteria. Over the next several months, Arien will share his insights into the stages of meaningful use criteria in a series of blog posts and podcasts. To kick off the series, Arien spoke with HealthLeaders Media editor John Cummins to share tips and strategies for setting up effective transitions of care.