Journal of AHIMA - May 2012

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 HIV/AIDS 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 x Redisclosure

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 states.

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-
clude:
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
identity authentication
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.

Note

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.