HI499 Unit 8 Seminar Reflection Example

The Question I Asked About a 72-Hour Hold, and the Question That Came Back About Proxy Booking: A Unit 8 Seminar Reflection

[Student Name]

Purdue University Global

HI499: Bachelor's Capstone in Health Information Management

Unit 8 Seminar Reflection

[Instructor Name]

[Date]

The classmates' projects and Callowfield Health are composite; the federal rules and source cited are real.

The First Question: Mine, About Someone Else's Project

Dana's capstone addressed portal message volume at a composite clinic network. When lab results reach the patient portal before a physician has commented, patients send messages asking what the numbers mean, and nurses spend hours each day answering them. Dana proposed holding every result for 72 hours so the physician could add a note first. It was a thoughtful proposal, built on a real staffing problem, and the message counts were convincing. I asked whether a blanket 72-hour hold could count as information blocking. My reasoning was that under the federal definition, a practice that a provider knows is unreasonable and that tends to slow or stop a patient's access to electronic health information is information blocking, unless it fits an exception (45 C.F.R. § 171.103). Delaying every result by policy looked like interference to me. The exception most likely to fit is the one for preventing harm, but as I understood it, that exception does not cover a delay applied to everyone. It requires a determination about risk, either made for an individual patient by a licensed clinician or based on data known or suspected to be wrong, such as a result attached to the wrong person (45 C.F.R. § 171.201). Dana's answer was fair. Dana pointed out that patients can choose to wait for a physician's note, and asked whether offering that choice would satisfy the rule. The instructor suggested that a patient's own request to delay is treated differently from a policy imposed on everyone. Dana revised the proposal in the session: results would release immediately by default, patients could choose a delay in their portal settings, and physicians could hold a specific result for a specific patient with a documented reason. I had walked into the seminar ready to test other people's projects against the rules, and I had not tested my own as hard.

The Second Question: Someone Else's, About Mine

Later in the same session, I presented my progress: the staff review queue for uncertain matches from Callowfield Health's self-scheduling tool, the address standardization service and the two booking questions. Marcus asked one question: what happens when a parent books for a child? I did not have an answer. The tool allows a parent or guardian to book for a dependent, and when they do, the parent types the child's name and birth date but often their own phone number and email. The child's existing record may carry a different phone number, so the engine's score drops into the uncertain band and the booking goes to the queue. That much the design handles. But my two booking questions, about earlier visits and former surnames, are answered by the parent. The optional last four digits could easily be the parent's own. And the confirmation message goes to the parent's email.

The harder problem was privacy. My constraint review had tested what patients see, and it had blocked showing them possible matches. It had not considered that the person booking might not be the patient. If a confirmation message said "We found your existing record," a parent would learn that the child had been seen before, which may not be appropriate when the child is an adolescent who received confidential services. California allows minors to consent to some services on their own, and the records of those services are protected from parents in specific ways. My Unit 6 review had never asked who the person typing was.

What I Changed

I revised the queue procedure and the constraint review that week. Bookings made by a proxy are now flagged in the queue, and the reviewer checks the proxy relationship on file before attaching the booking to a record. If no proxy relationship exists, the booking is held and the patient access team contacts the family by phone. The confirmation message never says whether an existing record was found, for any booking, so it reveals nothing to whoever reads it. The optional last-four field now carries a label stating that it must be the patient's own number. The constraint review now has a sixth row, proxy and minor access, and the final paper will present it as a correction prompted by peer review.

What the Seminar Taught Me About Review

Looking back, both questions worked the same way. Each took a design built for a typical user and asked about a user the designer had not pictured: a patient who wants results right away, a parent typing a child's details. Critical reflection is partly the practice of looking for the assumptions built into one's own work (Rolfe et al., 2001), and the seminar showed me that the most useful reviewer is often someone who did not build the design. Dana and I both left with better projects, and I left with a habit: before calling any constraint review complete, I now ask who else might be on the other side of the screen.

References

45 C.F.R. § 171.103 (2024). https://www.ecfr.gov/current/title-45/section-171.103

45 C.F.R. § 171.201 (2024). https://www.ecfr.gov/current/title-45/section-171.201

Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection for nursing and the helping professions: A user's guide. Palgrave Macmillan.