Journal of AHIMA - May 2011

that may be shared. There may be times when patients want to restrict specific information from certain providers or even restrict it from the HIE in its entirety.

Patients may want to determine the time frame for when their PHI is available in the HIE and expect their information to be taken out after that point in time. They may also want to define the purpose for which their information is shared.

As noted above, some HIE models allow this type of granularity. However, there may be times where state laws supersede the patient’s restrictions for purposes such as health surveillance activities. State and federal laws will also drive the need to separate data based on the nature of the information. For example, the federal Confidentiality of Alcohol and Drug Abuse Patient Records (Part 2) regulation prohibits redisclosure of substance abuse records.

State and federal laws will define sensitive data, though patients may want more information restricted than what the laws require. HIEs must identify what individual pieces of data are eligible for the exchange and ensure only those pieces flow into the HIE.

In order for patients to make informed consent choices, they must be educated on the benefits of HIEs and how PHI is transmitted.

The HIE’s consent model and software functionality will determine its ability to specify exactly what information may be sent, to whom, under what circumstances, and for what period of time, or the granularity allowed.

HIEs must also identify unstructured data, especially information from legacy data. This information will not be able to be managed through the application of consent management systems.

Educating Patients

Patients who do not understand or trust HIEs may choose to opt out but still have their information shared in the traditional manner of faxing or mailing. Whether patients opt in to the HIE or stay with the traditional means of exchanging information, they need to be educated on the benefits of HIEs and how PHI is transmitted.

Privacy and security will continue to be a patient concern and must be addressed in the patient education. In addition, it will be up to organizations and providers to ensure patients understand the benefits and risks of not sharing their information. For example, patients who opt in to the HIE ensure their physician has the most up-to-date information, including current medi-

HIE Progress at the State and Federal Level

THE FEDERAL GOVERNMENT continues to achieve new milestones in helping HIEs take root across the US. In February, the Office of the National Coordinator for Health IT launched Direct Project pilots in Minnesota and Rhode Island. These states will soon be joined by New York, Connecticut, Tennessee, Oklahoma, Texas, and California.

The Direct Project is a streamlined version of the Nationwide Health Information Network that sends data through secure messaging over the Internet. The project will enable healthcare providers to replace mail and fax for simple and secure transmittal of PHI. This is a significant step toward meeting ONC’s commitment to make HIE accessible and practical for the nation’s clinicians. 1

Note

1. Blumenthal, David, and Aneesh Chopra. “EHR Data Exchange Highlight of Direct Pilot Program Launch.” February 2, 2011. http://healthit.hhs.gov/blog/onc/ index.php/2011/02/02/ direct-project-pilot-programs-launched.

cations and health concerns, available in emergency situations.

Ideally, HIEs will be able to offer patients the granularity they desire. However, engaging patients and determining their preferences for sharing their PHI can be both technically and operationally challenging.

Providers are considered key players in identifying and honoring patient preferences. But some providers may see educating patients and identifying patient preferences at the point of care as a stumbling block. They may be overwhelmed with the process of identifying the patient preference, recording that information, and administering the preferences upon release.

To help facilitate the process of educating patients, AHIMA has developed a brochure with fundamental information about HIEs and how PHI will be used. The brochure outlines what an HIE is and the benefits of participating in one. It is available for download at www.ahima.org/resources/hie.aspx. ¢

Note

1. Goldstein, Melissa M., and Alison L. Rein. “Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis.” March 23, 2010. http://healthit.hhs.gov/portal/server.pt/commu- nity/healthit_hhs_gov__privacy_and_security/1147.