Page 74 - Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary

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seeing a patient for the first time who finds no allergies listed on the plan
may want to know if the patient really has no allergies or if the patient
has just not yet filled out that section of the Shared Care Plan. It often
takes patients several sittings to fill out the entire plan which means that
there will often be varying levels of completion. The design has to allow
patients to check a box that explicitly states that the patient has no known
allergies so that the answer is not ambiguous to the clinicians.
There were numerous challenges encountered in designing the sys-
tem. One set of challenges related to privacy and security. How, for exam-
ple, can one design the system to safely provide patients access to their
private health care information over the Internet, yet still allow needed
information to be shared in an emergency situation? Other issues in this
area included how clinicians would log in and how usage would be
audited.
The Shared Care Plan was designed so patients can explicitly give
view-only or fully-edit access to their care team members (see Figure 4-3).
In Whatcom County about 99 percent of the physicians participate in the
local health care network which means that patients can easily look up
their various local health care providers and add them to their care teams.
Patients can invite family members and friends to be part of their care
team as well by using the invitation mechanism. Patients are the ones who
determine who is on their care team.
Providing appropriate emergency access was another issue in the area
of privacy and security. In the situation illustrated in Figure 4-3, access
is given to a group called Community Clinicians. This is a way to group
all the community clinicians together whom the patient has not explicitly
listed on the care team. By granting community clinicians access to the
records, the patient is saying that anyone who needs to access the Shared
Care Plan in an emergency may have access. Alternatively, patients can
also block access to anyone who is not explicitly listed on the care team.
Figure 4-4 illustrates the privacy flag feature. In this example, a patient
is adding a new diagnosis (sleep apnea) to the diagnosis list. At the bot-
tom of every record that the patient adds to the Shared Care Plan, there is
the privacy flag indicated by a padlock icon. When the patient checks the
box by the padlock, the team list is displayed at the bottom of the page
and the patient decides who will be able to access that diagnosis. This was
a feature that patients requested. Patients did not want a blanket yes/no
setting for access to a record for the entire care team; they wanted instead
to decide which individuals on the care team would have access.
The system also produces a summary of who has accessed the
record, the health care facility and department of those who accessed
the record, and the date on which the access occurred. Patients can view
that summary access screen at any time. If the patient sees something

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