Requirements regarding the electronic transfer of personal health information differs from state to state. Some have suggested that the Federal government needs to establish guidelines for health information exchanges.
Health information exchanges (HIEs) are technology solutions that address healthcare issues by aggregating massive amounts of data and allowing multiple entities have access to the data for research and quality purposes. HIEs can be thought of as technology systems that permit the transfer of electronic personal health information (PHI) between organizations within a region or a system. For example, an HIE may be set up between hospitals and public health departments to transmit data regarding diseases. This information can be used to determine if a certain substance such as contaminated water or poor air quality is harming specific populations. Because patient information is protected by HIPAA, HIEs are necessary to securely transfer electronic PHI.
HIEs are an important part of establishing partnerships throughout a community. They empower public health departments and hospital networks by providing a method for each to manage health-related programs and provide the necessary related services. According to the latest eHealth Initiative report, HIEs improve the quality of care and reduce healthcare costs by securely transmitting PHI (AHIMA 2011).
To date there are two types of HIEs; “Opt-out” and “Opt-in”. An opt-out HIE network allows a patient’s PHI to be exchanged through the network unless the patient formally requests their PHI not be part of the HIE. The opt-out approach dominates HIEs because it is easy to set up, has lower administrative burdens, and historically there are higher levels of participation – making an opt-out version better poised to serve communities by providing a more robust set of data.
Despite the noted advantages, opt-out HIEs are threatened by state legislation regarding how health information data is transferred. PHI such as genetic information, HIV status, abortion history, mental and behavioral health issue data is considered highly personal and therefore more heavily protected in some states. Therefore, this type of information poises an issue for HIEs that span across state lines. Some have suggested that this information should be automatically excluded from the exchange. However, in doing so the value of the HIE is substantially depleted.
An opt-in HIE network requires affirmative authorization from a patient before their PHI can be exchanged. An opt-in network has received less favor amongst organizations implementing HIEs because of the increased effort required to achieve patient participation. Gayle Harrell, a former Florida state legislator claimed, “We have a very distinct right to privacy that’s not only guaranteed in our Constitution, but has been upheld in our courts. And there’s nothing more private than your healthcare information.” If we agree with Ms. Harrell, then the debate about which type of HIE is best is clearly opt-out models.
An opt-in model offers a way to overcome the legal shortcomings of opt-out models by allowing patients to select which PHI will be available for exchange and to what extent. However, participation levels are historically lower and physicians are required to contact each patient before their information can be included in the HIE – a feat which may take years.
Each HIE model comes with its own unique advantages and limitations. However, since the electronic transfer of PHI is determined at the state level, each member of an HIE operating across state lines must determine how the laws of each state impact the type of HIE established – and, eventually we must determine if the healthcare industry would be better served with federal legislation outlining how and what PHI should be transferred.
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