tal health commitment process and mental health inpatient
care. The same laws often prohibit the redisclosure of health
information from these types of facilities.
In addition, there are a variety of healthcare laws that may affect how HIEs are able to connect and share health information.
These laws may address the following:
x Mental health and substance abuse
x Developmental disability
x Genetic testing
x Medical record content and format requirements
x Authentication requirements
x Record retention requirements
x Licensure issues for access and updating across state lines
Agreements That Lower the Barriers
The lack of standards has created challenges for connecting
HIEs. In addition to laws imposed on HIE systems, industry
and vendor standards may vary, making it nearly impossible for
HIEs to connect within the same local area—much less across
Though it is not yet a law, building stronger standards into
the federal Standards and Interoperability Framework may be
just around the corner. Currently, having optional standards
for HIEs greatly reduces the ability to share patient information when needed. Having a single standard not only improves
interoperability, but it also benefits vendors and providers by
lowering overall costs. The building blocks for sharing patient
information need to be unambiguous.
Varying laws addressing identity verification and authority to
access health information pose another obstacle. State laws may
require documentation, statements, or representations from individuals requesting disclosure. A business associate agreement
can cover entities sharing patient health information within the
scope of the agreement, helping overcome this barrier. A data
use and reciprocal support agreement, a contract that contains
most of the essential legal and compliance specifications needed for a successful HIE, is also beneficial.
Building the Next Building Blocks
To address the patchwork of laws, the Office of the National
Coordinator for Health IT is focusing on the next set of build-
ing blocks to accelerate health information exchange. These in-
x Directory services that allow lookup of providers by data
such as name, phone number, and email address, or by a
particular hospital or hospital department
x Digital certificate management and discovery to support
x Governance, or a common set of rules of the road, to build
a trusted exchange and to make the nationwide health in-
formation network more scalable1
Most recently, Maine and five other states received grants for
sharing information between behavioral healthcare organiza-
tions within the state. Patients who sign consent allow their be-
havioral healthcare providers to share their behavioral health
information with general medical care providers.
1. Mosquera, Mary. “HIE as a Verb: ONC Wants to Move
Quickly on Data Exchange.” Healthcare IT News, March
9, 2012. www.healthcareitnews.com/news/hie-verb-onc-wants-move-quickly-data-exchange.
Diana Warner ( email@example.com) is a professional practice resource manager at AHIMA.