What a brat! Data Ownership and EHR Vendors

Do you recall sharing when you were a kid? I don’t necessarily remember the sharing specifically, but I remember the times I didn’t share and got punished for it. I now hear kids yelling “MINE!” when asked to share a toy and I think … What a brat!

I have the same thought when I speak with practices that are experiencing migration problems. They are trying to get data from their EHR and the EHR vendor keeps throwing up roadblocks. While many EHR vendors have the philosophy that data stored in their system is theirs, the law states something different. Many states have laws concerning the ownership of patient health record data.

A minority of states side with the patient. The majority don’t have laws governing the ownership of data. The rest side with the hospital, practice, or health care professional that generates or maintains the chart.

In none of these state laws does it say that the data is owned by the EHR vendor. The discussion of data ownership between the EHR vendor and the health care professional is a contractual discussion. The EHR vendor does not own the data. They may have contractual use rights authorized through the business associate agreement or contract, but they do not own the data.

The reality is that the EHR vendors are the gatekeepers to the data. They know where the data is, how it is organized, and how to get the data out. There are many horror stories of vendors holding data “hostage.” MINE! Many of these are due to contractual obligations (like outstanding balance issues) not being met by the healthcare professional. There are other instances where the contract between the EHR vendor and healthcare professional did not include data extraction provisions for when the contract was terminated. This is not the EHR vendor’s data.

Data belongs to the patient, the hospital, or healthcare professionals. The trouble is this; many times when practices attempt to take control of their data, they ask questions of the EHR vendor and get the MINE! response. It is time we stop asking for data and start demanding our data.

At HIMSS16, many of the discussions were around INTEROPERABILITY. This means sharing of data between systems. One of the biggest INTEROPERABILITY challenges is when a provider moves from one EHR vendor to another. Migrating discreet data (field by field) can be costly. A practice looking to move should prioritize the data that they want to migrate and evaluate how they are going to use the data. Try to put a dollar value to migrating that data. Then you can decide if the cost for migration is really worth the value you expect to receive. Many practices take a summary approach where they migrate clinical notes as documents instead of discreet data. Then they take the money they save there and use their prioritized list of data items to determine what they want to migrate (problem lists, allergies, histories, etc). This way the practice maximize the value of the data they migrate.

Another INTEROPERABILITY challenge is mining all of the data that is collected in the EHR software. Many EHR vendors provide reporting platforms for reporting on data, but most do not provide a true analytics platform where the healthcare professional can really analyze and manipulate the data to find trends and manage their patient population’s health. This means that if a healthcare professional does not have an analytics platform to do this analysis, a third party analytics package must be integrated with their EHR. Integrating EHR’s into analytics platforms can be a time consuming and costly job since some EHR’s do not provide mechanisms to regularly extract data or provide schemas for their database.

The healthcare professional has gone through major workflow changes and has worked many extra hours entering data (more than they did on paper) all with the expectation that this data can be used to either better treat patients or improve the profitability of a practice. Yet, after all of the time and money spent on implementing EHR’s, the data is many times “stuck” in the EHR. MINE!

Silence the MINE’s! Stand up and take control of your data! If your EHR vendor is not willing to provide your data for analysis or migration, find someone who will!

Recommendation: Next time you negotiate, or renegotiate, a contract with your EHR vendor, make sure you have rights to the data and a provision to get the data when the contract is terminated. If you are not able to get your data for analysis purposes from your EHR vendor, find a consultant that is experienced in that EHR to get the data for you.