Author Interviews / 13.05.2020 Interview with: Celine Latulipe PhD Associate Professor University of Manitoba What is the background for this study? What are the main findings? Response: We wanted to find out how many hospitals offer proxy accounts for caregivers of adult patients. Most patient portal systems allow proxy accounts for parents of pediatric patients, so we know the underlying systems support the creation of proxy accountsWhen we were starting this research, the two big healthcare systems where I was located did NOT offer such proxy accounts for caregivers of adult patients, and a staff person at one of those hospitals suggested adult patients share their passwords with their caregiver, if the caregiver needed access to the portal. As a computer scientist, I am well aware of the security and privacy risks associated with password sharing, and I was appalled by this advice. So we did this survey across the US and we found that 45% of the staff contacted in our study gave similar password sharing advice. This is hugely problematic. Caregivers using a patient's password means the caregiver can see everything in the medical record, including things the patient might not want the caregiver to know, such as past diagnoses of stigmatized illnesses, substance abuse or reproductive health decisions. Also, because password re-use is common across systems, a caregiver with a patient's portal password may now have access to the patient's online banking. (more…)
Author Interviews, Electronic Records, Outcomes & Safety, Surgical Research, UCSD / 09.11.2014 Interview with: Jamie Anderson MD MPH Department of Surgery University of California, San Diego Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population. Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel. With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements. We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records. (more…)