Educating Clinicians to Improve Telemedicine Access for Patients with Limited English Proficiency

The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

The 21 Century Cures Act and Multi-User Electronic Health Record Access: Potential Pitfalls of Information Release (Preprint)

UNSTRUCTURED While the Office of The National Coordinator for Health Information Technology’s (ONC) Information Blocking Provision of the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multi-user electronic health record (EHR) access and proxy access concerns emerged over the potential for harm in adolescent care contexts. We describe how the provision could erode the trust and the willingness of patients (both adolescent and older patients alike) to seek care. The rules’ preventing harm exception does not apply to situations where the patient is a minor and the healthcare provider wishes to restrict a parent’s or guadian’s access to the minor’s EHI to avoid violating the minor’s confidentiality and potentially harming patient-clinician trust. This may violate government-developed principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate “shadow charting” will be burdensome (and prohibitive) for healthcare providers. Under the privacy exception, patients have the opportunity to request information not be shared; however, depending upon institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot “improperly encourage or induce a patient’s request to block information”. Fearing being found in violation of the information-blocking provisions, providers may feel unable to guide patients navigating releasing their EHI in the multi-use/proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations who care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multi-user/proxy access situations.

Security/Privacy Perceptions in Patient Use of Online Medical Records

Data breaches expose individuals to economic, mental, and social trauma. Electronic health information of individuals not only includes reports of medical diagnosis, medication histories but also comprises personally identifiable information (PII) (e.g, birth date). We examined the association of vulnerability perception - defined as privacy or security breach concerns and provider encouragement with the use of online medical records (OMR) and moderating effects of provider encouragement and age in the relationship between vulnerability and usage. Data came from a national population-based survey, the Health Information National Trends Survey (HINTS). This study included 1770 adult individuals many of who are chronic disease patients or cancer survivors. The majority of these subjects did report use of OMR. We found security/privacy related vulnerability and provider encouragement significantly predict patients' use of OMR. Healthcare providers and developers should work with patients to mitigate concerns and enable patients to derive benefits from using online medical records.

Perception of data quality and electronic health information system acceptance, reliability and satisfaction: A study at tertiary care hospital in Saudi Arabia

Electronic health information systems (EHIS) are considered a backbone for healthcare planning and quality services. This study was designed to explore the acceptance, reliability, and satisfaction of the end users' experience with the hospital electronic health information system. We also investigated the perception of data quality by the users who were directly involved in data entry. We conducted a questionnaire based cross-sectional survey to collect quantitative data from different EHIS users. The questionnaire contained six sections: demographic user information; general HIS assessment; accessibility and availability of computer terminals in the hospital; EHIS and the patient care; user satisfaction with the HIS and perception of data quality. Desktop computers were available throughout the hospital, but the hospital was lacking handheld computers or computers on wheels. Participants of the study were satisfied with the data entry and retrieval process but they were lacking job training related to troubleshooting. EHIS users were not aware and prepared for the downtime of the system and procedures were also not clear to them. Regarding the perception of data quality, most of the participants responded that data is of adequate quality. There is a need for proper technical support and enhance the hospital's networking speed for better response. Laptops and hand-held computers are the need of time for data entry in critical situations and during wards visit. This can also enhance the quality of data, and reduce the chances of data loss.