Rocha Beatriz H, Pabbathi Deepika, Schaeffer Molly, Goldberg Howard S
Beatriz H. Rocha, MD, PhD, Brigham and Women's Hospital, General Medicine, 1620 Tremont Street, Boston, MA 02120, USA, Email:
Appl Clin Inform. 2017 Feb 8;8(1):137-148. doi: 10.4338/ACI-2016-07-RA-0120.
The Centers for Medicare & Medicaid Services' Stage 2 final rule requires that eligible hospitals provide a visit summary electronically at transitions of care in order to qualify for "meaningful use" incentive payments. However, Massachusetts state law and Federal law prohibit the transmission of documents containing "sensitive" data unless there is a new patient consent for each transmission.
To describe the implementation and evaluation of a rule-based decision support system used to screen transition of care documents for sensitive data.
We implemented a rule-based document screening system to identify transition of care documents that might contain sensitive data. The transmission of detected documents is withheld until a new patient consent is obtained. The documents that were flagged as containing sensitive data were reviewed in two different time periods to verify that the decision support system was not missing documents or withholding more documents than necessary.
The rule-based screening system has been in regular production use for the past 18 months. During the first evaluation period, 3% of 5,841 documents were identified as containing sensitive data (true-positive rate of 44%). After additional enhancements to the rules, the system was evaluated a second time and 4.5% of 6,935 documents were identified as containing sensitive data (true-positive rate of 98.4%).
The analysis of the system demonstrates that production rules can be used to automatically screen the content of transition of care documents for sensitive data. The utilization of the rule-based decision support system enabled our hospitals to achieve meaningful use and, at the same time, remain compliant with state and federal laws.
医疗保险和医疗补助服务中心的第二阶段最终规定要求，符合条件的医院在医疗转接时以电子方式提供就诊总结，以便有资格获得“有意义使用”激励付款。然而，马萨诸塞州法律和联邦法律禁止传输包含“敏感”数据的文件，除非每次传输都有新的患者同意。
描述用于筛查医疗转接文件中敏感数据的基于规则的决策支持系统的实施和评估。
我们实施了一个基于规则的文件筛查系统，以识别可能包含敏感数据的医疗转接文件。在获得新的患者同意之前，扣留检测到的文件的传输。在两个不同时间段对被标记为包含敏感数据的文件进行审查，以验证决策支持系统没有遗漏文件或扣留不必要的过多文件。
基于规则的筛查系统在过去18个月中一直在正常生产使用。在第一个评估期内，5841份文件中有3%被确定包含敏感数据（真阳性率为44%）。在对规则进行额外增强后，对系统进行了第二次评估，6935份文件中有4.5%被确定包含敏感数据（真阳性率为98.4%）。
系统分析表明，生产规则可用于自动筛查医疗转接文件内容中的敏感数据。基于规则的决策支持系统的使用使我们的医院能够实现有意义使用，同时保持符合州和联邦法律。
