Legal Considerations in Joining an
By Chris Dimick
THE LEGAL ISSUES healthcare organizations must consider when joining a health information exchange (HIE) go far be- yond the standard HIPAA-related concerns. HIEs are rapidly gaining prominence in healthcare, bolstered by federal initiatives like the meaningful use program, which re- quires participants engage in HIE activities. The prospect of im- proved healthcare delivery through improved access to health information is also driving organizations to sign up with HIEs. Legal issues should be addressed from the start of any partner- ship between an HIE and a healthcare organization, according to Claudia Egan, JD, and John Orth, CDIA+. Egan is an attorney with von Briesen & Roper based in Milwaukee, WI, and Orth is
principal consultant for EHRs at IMERGE Consulting. They discussed the legal and compliance issues that affect interoperable
electronic record exchange during a presentation at AHIMA’s
Legal EHR Summit in August in Chicago. They have firsthand
HIE experience—both volunteer with Wisconsin’s state HIE, the
The legal issues one must address with an HIE are many and
can differ from typical legal issues within a healthcare organization, Orth says.
Healthcare facilities must ensure the contract they enter into
with an HIE addresses both how to exchange information as
well as what to do when things go wrong, Egan says.
Local and regional HIEs have been developing across the
country without using a standard participant contract, or trust
agreement. Legal problems have come up when one state HIE
tries to exchange information with a different state HIE and
their contract agreements do not align.
Some HIEs also find problems in their cooperative when their
exchange contract with participants is weak and does not explicitly list how to handle the various operational and legal issues that can arise during health data exchange.
Healthcare organizations looking to sign up with an HIE
should ensure the following points are addressed in their ex-
change contracts, Orth and Egan say:
“People haven’t worked out what to do or how to fix it when
things go wrong,” Egan says. “That is why it is important to have
a contract in place, which would be a DURSA or some other
agreement about how you are going to fix everything. The con-
tract should have a process, not just a remedy.