Confusing “Consent” Terminology Emerges

In its August 19th letter to the Office of the National Coordinator, the HIT Policy Committee creates the term “meaningful consent” related to the coming choices patients will be asked to make about the sharing and use of their clinical data. In the recommendations, the committee clearly states that the recommendations apply to exchange of identifiable health information in order to meet Stage 1 meaningful use requirements. So now is the perfect time to ensure that the difference between the two types of consent remain distinct in the mind of the patient population. » Continue reading “Confusing “Consent” Terminology Emerges”

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Technology Muddies Informed Consent Part 2

My previous post “Technology Muddies Informed Consent” is an excerpt from a slightly longer piece that examines the dehumanizing effect of information technology as it applies to healthcare, the coming role of personal health records and their potential role in helping manage informed consent, and the bifurcation of the meaning of informed consent itself thanks to the increasingly complicated world of managing data use derived from healthcare encounters. The entire piece is available: Download the pdf here. This will be one of many challenges we face as clinical data, privacy issues and patient control converge. Your comments are welcomed of course!

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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Technology Muddies Informed Consent

The concept of “consent” in healthcare is getting more complex and likely to create confusion not only to patients but also to clinicians and policy makers. Specifically, the term consent can be used in a variety of ways. First, it can refer to the process of determining whether or not a patient understands the clinical procedures and their inherent risks, and whether or not that patient has the capacity to understand and give their consent.

Secondly, EHRs and PHRs play a role in modifying this landscape. The HITECH provisions of the American Recovery and Reinvestment Act, passed February 17, 2009, include substantial financial incentives for the “meaningful use” of certified EHR systems. One of the qualifying requirements of meaningful use, by law, is the exchange of clinical data among physicians and hospitals using EHR systems.

All of these connected systems will eventually feed data across the country through the Nationwide Health Information Network (NHIN), which is still under development. Initially, the meaningful use connectivity requirement will be accomplished through many local and regional Health Information Exchanges (HIE), each of which will likely create very different rules for the exchange of clinical data along the network. The rules will vary by state and organization, since there are no standardized business or legal models for HIE structure.

In this scenario, patients will be asked for their consent to move their clinical data along these networks, as well as to use their information in a variety of ways ranging from mundane billing to clinical research. Consent for this purpose will not be standardized, nor will it be easy to comprehend, since some HIE models will allow patients to opt in while others require an opt out. To further obfuscate the situation, patients will be empowered to allow the movement of some of their data while restricting or withholding other data either under certain conditions or altogether.

We have an obligation to see that the value of information technology plays an appropriate and supportive role, and that we clearly articulate the difference between information consent and clinical consent.

We must make a distinction between information consent and clinical consent. Ethicists, clinicians and technologists make an effort to ensure that the use of information technology does not dehumanize the physician-patient relationship. We must recognize that it plays a role in expanding that relationship. We must take extra care to ensure that technology does not further complicate the process of making treatment decisions under difficult circumstances. If we do these things now, the transition to EHR can be a smoother one for all.

– Rod Piechowski

(See updated piece September 10, 2010)

Copyright © 2010, Rod Piechowski, Inc., Consulting

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“Meaningful” means nothing

I’ve had several conversations now in which someone has used the word “meaningful” and then, (while rolling their eyes) immediately tries to take it back, as if the word has been banned from our vocabulary. Of course, this only holds true if you work in healthcare, and are at all aware of how the American Recovery and Reinvestment Act (ARRA) and its sibling, the HITECH Act, have changed the way we think about information technology. Meaningful use of certified EHR systems is the new goal for all physicians and hospitals in order to avoid payment penalties. While there are many hospitals and physicians that have already implemented this technology over the past decade, those for whom the technology proved too expensive, complicated or otherwise elusive now look at the meaningful use requirements as the lowest bar over which they must jump in order to stay ahead of the payment reductions. Will the concept of meaningful use continue to evolve beyond the requirements that will be in place by 2015? It’s unfortunate Congress did not call this effort “basic use” or “initial use” of technology, for there are few ways to describe what is yet to come without resorting to “more meaningful” and “still more meaningful.”  Don’t get me wrong. I write this as an optimist, and believe that we will still see developments in health information technology that will make what we’re doing today seem like baby steps. Calling it “meaningful” today doesn’t really set that kind of tone for the future. We must accept that this will be a long, exciting journey, and find a new word to plug the hole in our vocabulary. There’s always “visionary.”

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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