The best way to address that issue, Nelson believes, is by illustrating how EMR delivers more information, and more accurate information, to the doctors in a much quicker time frame than they have grown accustomed to over the years. “They appreciate the fact that the more information they have, the better the decisions they can make,” Nelson notes. “And doctors are all about making better decisions.”
When Nelson spoke to a U.S. House of Representatives subcommittee on electronic health records in March, he checked in with IBM’s legislative experts to find out what would be foremost on the subcommittee members’ minds. “They answered, ‘Three things: One is privacy, two is privacy, and three is privacy,’” Nelson recalls.
From the consulting perspective, privacy remains more of a perceptual hurdle than a practical one. The majority of healthcare organizations so far have succeeded in complying with HIPAA — the Health Insurance Portability and Accountability Act of 1996. Although there are some signs that HIPAA enforcement, via U.S. Department of Health and Human Services, may be intensifying, most healthcare consultants echo Fickenscher’s sense that privacy is a fact of life in the sector and “is something that can be dealt with and relates more to culture issues, how information is used, rather than to technology issues.”
That said, perceptions matter, especially to IBM Corpora-tion, whose vice president, corporate affairs, and chief privacy officer Harriet Pearson is closely involved with the firm’s EMR activities, including the HHS-funded NHIH project involving the Taconic Health Information Network and Community in New York.
Pearson serves on that initiative’s privacy committee and is pleased to report that privacy and information security considerations and processes were baked into the initial planning stages of the project. Although she believes that HIPAA will likely cover most of the issues that arise with EMR, she adds that “you had better believe that when you make that kind of data more accessible for the doctor and the patient, you’re going to create questions about the security of that data and whether or not you are keeping it appropriately private.”
Some privacy advocates believe that HIPAA does not provide sufficient consumer protection. Those individuals are likely to oppose the sharing of electronic medical records beyond the patient-doctor exchange.
“I don’t think that anybody has a clear view yet of the potential gaps between HIPAA’s requirements and what might be necessary to change to cover any new issues that crop up as a result of electronic medical records,” Pearson explains. “A balance needs to be struck. HIPAA struck a balance. With the EMR uptake, we will shift to a new balance between expectations of privacy and the functioning of a more efficient and effective medical system. It’s too soon in the cycle to know exactly where that balance will be reached and whether we will reach it via the enactment of new legislation or the implementation of best practices.”
It’s not too soon to see that healthcare consultants will be in demand as a result of EMR projects.
“Our rule of thumb is that for any major software application out there, we need to have 70 to 80 consultants who understand the application to cover all of the different levels of specialization required,” says Nelson, who emphasizes that other skills are also necessary. “It also requires operational experts who understand how processes within healthcare organizations work.”
Specifically, Accenture’s Redd points out, consultants involved in EMR projects need to understand the healthcare operating environment, know the EMR software vendor community, and possess strong business integration expertise.
“You must be able to take your knowledge of the operating process, healthcare, and systems implementation and combine those to drive business outcomes that clients seek,” Redd says.
These specifications apply to consulting forces in technology, strategy, and outsourcing firms — all of which are racing to pply their cures to their healthcare clients.
EMR: The Inside Story
