Online Program

Legal requirements and policy development: Barriers and obstacles to health information exchange

Monday, November 4, 2013

David Kulick, MPH, Crescent City Beacon Initiative, Louisiana Public Health Institute, New Orleans, LA
Kristin Lyman, JD, MHA, Health Systems Division, Louisiana Public Health Institute, New Orleans, LA
Haley Sulser, Information Services, Louisiana Public Health Institute, New Orleans, LA
Liam Bouchier, Division of Information Services, Louisiana Public Health Institute, New Orleans, LA
background The Louisiana Public Health Institute (LPHI), as the administrator of the Greater New Orleans Health Information Exchange (GNOHIE), encountered complex legal requirements to consider both the state and national law pertaining to health information exchange. This iterative development process involved understanding and interpreting the ambiguous legal requirements and creating consent policies, sensitive data policies, and data suppression methods to ensure appropriate information sharing.

objective Barriers and associated solutions to clinical information sharing will be discussed. As health information moves from information silos towards system-wide coordinated care, it is important to disseminate such information to manage information so as to maximize the effectiveness of the infrastructure while protecting patients' confidentiality and privacy.

methods LPHI undertook a thorough legal review of the laws associated with electronic health information exchange. The GNOHIE governance body adopted an opt-in model requiring patients to sign a consent form to share information. The legal review also identified sensitive data categories requiring varying levels of data suppression.

results The opt-in consent model has resulted in relatively low numbers of consenting participants. This has in turn limited the exchange of clinically relevant data. Additionally, the sensitive data suppression has limited a large percentage of patient information from being uploaded into the GNOHIE. This is a result of the strategy selected and the capability to suppress data within the GNOHIE.

discussion The obstacles to information sharing are complex and limit the exchange of relevant clinical information that could be used to improve patient care. Increasing the accessible information must involve policy change by identifying the ambiguity in the current state and federal law and recognizing how such ambiguity practically affects information exchange and patient care. As health information exchange expands, it will be necessary to better define legal requirements to encourage effective and protective information sharing across health systems.

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Other professions or practice related to public health
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
describe the complex barriers to implementing a legal consent policy. list at least two solutions to understanding and developing consent and sensitive data policies and operational frameworks. differentiate between different data suppression methodologies and how they affect the availability of health information and care coordination strategies.

Keyword(s): Law, Accountability

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked to develop and define the legal requirements of health information sharing within a health information exchange in accordance with state and federal law.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.