Preparedness before the storm: Legal and policy barriers to effective use of health information exchanges in a public health emergency

Background: Immunization Information Systems (IIS) are a valuable public health tool during public health emergencies, as evidenced by the efficient use of the Louisiana Immunization Network for Kids Statewide (LINKS) by almost every state in the country during Hurricane Katrina. Use of LINKS saved millions of public health dollars in vaccine and administration costs. However, there are several legal and policy barriers to the effective use of any type of regional health information exchanges during public health emergencies, which hamper their utility. Target Audience: Policy makers on the Federal, State, Local levels. Project description: During the Katrina relief efforts, a state of public health emergency was declared in Texas, which suspended the procedural laws and rules “if strict compliance with the provisions, orders or rules would in any way prevent hinder or delay necessary action in coping with a disaster”. Although such a provision exists in most states, there are certain planning activities that must take place prior to an emergency to enable an IIS or other health information exchange system to be used to its fullest potential. Results/Lessons Learned: Laws and policies on the state and federal level need to support the development of Regional Health Information Exchanges in the following categories: (1) the age range of participants in a registry, (2) data sharing between states (3) consent issues (4) safeguarding privacy while supporting data exchange and (5) mandatory provider participation in health information exchanges.