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
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
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
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
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. Blumenthal, David, and Aneesh Chopra. “EHR Data
Exchange Highlight of Direct Pilot Program Launch.”
February 2, 2011. http://healthit.hhs.gov/blog/onc/
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. ¢
1. Goldstein, Melissa M., and Alison L. Rein. “Consumer
Consent Options for Electronic Health Information Exchange: Policy Considerations and Analysis.” March 23,
AHIMA. “Health Information Exchange (HIE)—What Does It
Mean to Me and My Doctor?” www.ahima.org/resources/
Diana Warner ( email@example.com) is a practice manager at AHIMA.