Designing a System for Patients Controlling Providers’ Access to their Electronic Health Records: Organizational and Technical Challenges

Leventhal, Jeremy C.; Cummins, Jonathan; Schwartz, Peter H.; Martin, Douglas K.; Tierney, William M.

doi:10.1007/s11606-014-3055-y

Cited by 33 publications

(25 citation statements)

References 17 publications

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“…17,21,22 Affording patients the ability to specify preferences and consent for sharing health information through granular privacy control is now technically feasible, and is actively being studied. 23,24 Granular role-based functionality allows patients the ability to selectively authorize which individuals may interact with the health system on their behalf, as well as what specific privileges they are granted. 17,25 For example, a patient might choose to authorize a paid attendant to schedule appointments or refill prescribed medications, while electing to withhold privileges to view their health information.…”

Section: Capturing and Executing Patient Preferences For Familymentioning

confidence: 99%

Family Caregivers and Consumer Health Information Technology

2015

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Health information technology has been embraced as a strategy to facilitate patients' access to their health information and engagement in care. However, not all patients are able to access, or are capable of using, a computer or mobile device. Although family caregivers assist individuals with some of the most challenging and costly health needs, their role in health information technology is largely undefined and poorly understood. This perspective discusses challenges and opportunities of engaging family caregivers through the use of consumer-oriented health information technology. We compile existing evidence to make the case that involving family caregivers in health information technology as desired by patients is technically feasible and consistent with the principles of patient-centered and family-centered care. We discuss how more explicit and purposeful engagement of family caregivers in health information technology could advance clinical quality and patient safety by increasing the transparency, accuracy, and comprehensiveness of patient health information across settings of care. Finally, we describe how clarifying and executing patients' desires to involve family members or friends through health information technology would provide family caregivers greater legitimacy, convenience, and timeliness in health system interactions, and facilitate stronger partnerships between patients, family caregivers, and health care professionals.KEY WORDS: health information technology; electronic health records; family caregivers.

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Section: Capturing and Executing Patient Preferences For Familymentioning

confidence: 99%

Family Caregivers and Consumer Health Information Technology

2015

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“…There were challenges and complexities when implementing patients' preferences for restricting the viewing of their data; these have been discussed in detail elsewhere in this JGIM supplement. 22 For example, although sensitive coded information and data from sensitive locations (e.g., mental health visits) could easily be redacted, sensitive information could not be redacted from within free-text notes and reports.…”

Section: Careweb Data Displaysmentioning

confidence: 99%

“…20 Articles published elsewhere in this JGIM supplement describe the process of designing the patient preference program, 21 and challenges that had to be overcome to incorporate it into Careweb to control the display of EHR data to clinicians. 22 In this article, we report the results of a demonstration study where we implemented this patientcontrolled EHR access program in a single primary care clinic in Eskenazi Health's large urban primary care network and prospectively assessed its effects on EHR data displays and providers' reactions. A description of the system patients used to record their preferences, as well as their actual preferences for controlling access to their EHRs are contained in a separate article in this JGIM supplement.…”

Section: Introductionmentioning

confidence: 99%

Provider Responses to Patients Controlling Access to their Electronic Health Records: A Prospective Cohort Study in Primary Care

et al. 2014

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INTRODUCTION:Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. METHODS: We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions. RESULTS: Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 %) returned 261 times, during which providers viewed their EHRs 126 times (48 %). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 %) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p=0.01). Although 54 % of providers agreed that patients should have control over who sees their EHR information, 58 % believed restricting EHR access could harm provider-patient relationships and 71 % felt quality of care would suffer. CONCLUSIONS: Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.KEY WORDS: fair information practices; electronic health records; patient preferences; quality of care.

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“…Leventhal et al [10] proposed Electronic Health Records (EHR) which developed a online system for taking patients preferences for an individual for view their EHR. The issue addressed in this paper is to apply fair information practices and balancing the patients personal details wth data providers which needs to deliver safe.…”

Section: Literature Surveymentioning

confidence: 99%

Implementation of E-Health Cloud System Using Timing Enabled Proxy Re-encryption function (Re-dtPECK)

U¹,

D²,

Gunasekaran³

2017

IJMSR

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ABSTRACT:E-Health record system is a major application which provides great convenience to patients and doctors in the field of health care where patient can no longer use paper prescription and keep it in record for future diagnosis. The major concern is security and sensitive personal information of patients which can be easily misused by the third-party users. Thus, we introduce novel cryptographic primitive named as conjunctive keyword search with designated tester and timing enabled proxy reencryption function (Re-dtPECK), which is a time-dependent SE scheme. It provides partial access to operate search function to users for limited period of time. Also, the length of the time period can be controlled for the delegatee to search and decrypt delegator's encrypted documents. The major feature is it supports the conjunctive keywords search and resist the keyword guessing attacks. By this, only the designated tester can provide exsistence to certain keywords. Therefore making Re-dtPECK is efficient scheme for standard model.

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Designing a System for Patients Controlling Providers’ Access to their Electronic Health Records: Organizational and Technical Challenges

Cited by 33 publications

References 17 publications

Family Caregivers and Consumer Health Information Technology

Family Caregivers and Consumer Health Information Technology

Provider Responses to Patients Controlling Access to their Electronic Health Records: A Prospective Cohort Study in Primary Care

Implementation of E-Health Cloud System Using Timing Enabled Proxy Re-encryption function (Re-dtPECK)

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