John Halamka has posted a few thoughts from a meeting on dispute resolution in healthcare:

Life as a Healthcare CIO: Followup on Dispute Resolution

The key insight, which followed from the “ePatient Dave” data kerfuffle, is that we need to find a way to web-enable dispute resolution in healthcare. There’s not too much to add to that, except to reinforce that he’s absolutely right, and perhaps to suggest that it’s a broader issue than just PHR data disputes. In general, civilization benefits when we have more APIs to mediate our interactions with large, impersonal agencies. Two principles:

1. Personal Health Record platforms, like Google Health and HealthVault, need to incorporate a dispute resolution workflow into their core APIs. This makes implementation a little harder, but it also removes one of the major objects institutions may have to sharing data with consumers by way of a PHR. The institution can implement the back-end portion of the dispute any way they want.
2. Some percentage – unknown but likely high – of institution to PHR data exchanges will be flawed. Some percentage of those flawed transactions – unknown but likely low – will be caught by savvy patients. The rest will flow through and be discovered later, if at all. At the minimum, this means dispute resolution will have to be implemented for any data held in the PHR – allowing disputation at the time of data acquisition is insufficient. And as patient data is relied upon more widely, we’ll likely need more ways to validate its integrity.

If we can’t rely on the consumer to spot all the errors (and we can’t), automated tools may be able to fill a small part of the gap by looking for logical inconsistencies. This needs to be approached with care – too many unnecessary queries to hospitals will impose too much of a burden, and “Are you sure  you have this? Because if you did you’d probably be dead.” is probably not a question that the average patient wants to be asked.