Legal Barriers to the Growth of Health Information Exchange—Boulders or Pebbles?
Context: Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health...
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| Veröffentlicht in: | The Milbank quarterly Jg. 96; H. 1; S. 110 - 143 |
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| Hauptverfasser: | , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Wiley Subscription Services, Inc
01.03.2018
Blackwell Publishing Ltd John Wiley and Sons Inc |
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| ISSN: | 0887-378X, 1468-0009, 1468-0009 |
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| Abstract | Context: Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments. Methods: Analysis of federal and state health information privacy statutes and regulations and secondary materials. Findings: Although some legal barriers to HIE persist, many have been ameliorated—in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat "information blocking." Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate. Conclusions: Although patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. |
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| AbstractList | Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant obstacle to expanding electronic health information exchange (HIE) in the United States. Our review finds that over the past decade, several helpful developments have ameliorated the legal barriers to HIE, although variation in states' patient consent requirements remains a challenge. Today, health care providers' complaints about legal obstacles to HIE may be better understood as reflecting concerns about the economic and competitive risks of information sharing.
Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments.
Analysis of federal and state health information privacy statutes and regulations and secondary materials.
Although some legal barriers to HIE persist, many have been ameliorated-in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat "information blocking." Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate.
Although patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant obstacle to expanding electronic health information exchange (HIE) in the United States. Our review finds that over the past decade, several helpful developments have ameliorated the legal barriers to HIE, although variation in states’ patient consent requirements remains a challenge. Today, health care providers’ complaints about legal obstacles to HIE may be better understood as reflecting concerns about the economic and competitive risks of information sharing. Context Although the clinical benefits of exchanging patients’ health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments. Methods Analysis of federal and state health information privacy statutes and regulations and secondary materials. Findings Although some legal barriers to HIE persist, many have been ameliorated—in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat “information blocking.” Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance‐abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state‐law requirements for patient consent remain daunting to navigate. Conclusions Although patient consent requirements make HIE challenging, providers’ expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. Context: Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments. Methods: Analysis of federal and state health information privacy statutes and regulations and secondary materials. Findings: Although some legal barriers to HIE persist, many have been ameliorated—in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat "information blocking." Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate. Conclusions: Although patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. Policy Points:Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant obstacle to expanding electronic health information exchange (HIE) in the United States.Our review finds that over the past decade, several helpful developments have ameliorated the legal barriers to HIE, although variation in states’ patient consent requirements remains a challenge.Today, health care providers’ complaints about legal obstacles to HIE may be better understood as reflecting concerns about the economic and competitive risks of information sharing.ContextAlthough the clinical benefits of exchanging patients’ health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments.MethodsAnalysis of federal and state health information privacy statutes and regulations and secondary materials.FindingsAlthough some legal barriers to HIE persist, many have been ameliorated—in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat “information blocking.” Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance‐abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state‐law requirements for patient consent remain daunting to navigate.ConclusionsAlthough patient consent requirements make HIE challenging, providers’ expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant obstacle to expanding electronic health information exchange (HIE) in the United States. Our review finds that over the past decade, several helpful developments have ameliorated the legal barriers to HIE, although variation in states' patient consent requirements remains a challenge. Today, health care providers' complaints about legal obstacles to HIE may be better understood as reflecting concerns about the economic and competitive risks of information sharing.Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant obstacle to expanding electronic health information exchange (HIE) in the United States. Our review finds that over the past decade, several helpful developments have ameliorated the legal barriers to HIE, although variation in states' patient consent requirements remains a challenge. Today, health care providers' complaints about legal obstacles to HIE may be better understood as reflecting concerns about the economic and competitive risks of information sharing.Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments.CONTEXTAlthough the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments.Analysis of federal and state health information privacy statutes and regulations and secondary materials.METHODSAnalysis of federal and state health information privacy statutes and regulations and secondary materials.Although some legal barriers to HIE persist, many have been ameliorated-in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat "information blocking." Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate.FINDINGSAlthough some legal barriers to HIE persist, many have been ameliorated-in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat "information blocking." Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate.Although patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers.CONCLUSIONSAlthough patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. |
| Author | SAVAGE, LUCIA MELLO, MICHELLE M. DING, KAREN L. ADLER-MILSTEIN, JULIA |
| AuthorAffiliation | 2 Stanford University School of Medicine 3 University of California, San Francisco 4 Omada Health 1 Stanford Law School |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29504197$$D View this record in MEDLINE/PubMed |
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| References | 2017; 1 2012 2010; 19 2010 2010; 17 2002; 13 2017; 24 2008; 16 2009 2008 2007 1996 1974 2012; 19 2006 2002 2008; 4 2008; 1 2017; 377 2016; 35 2011; 154 2009; 28 2010; 23 2017; 95 2009; 55 2013; 32 2006; 21 2008; 27 2017; 12 2016; 43 1999; 34 2018 2017 2016; 62 2016 2015 2014 2011; 48 2013 2007; 26 2016; 22 e_1_2_9_75_1 e_1_2_9_31_1 e_1_2_9_52_1 e_1_2_9_50_1 e_1_2_9_73_1 e_1_2_9_10_1 e_1_2_9_35_1 e_1_2_9_56_1 Weiser SJ (e_1_2_9_8_1) 2010; 19 e_1_2_9_54_1 McCarthy DB (e_1_2_9_61_1) 1999; 34 Dimitropoulos LL (e_1_2_9_12_1) 2007 Dimitropoulos L (e_1_2_9_11_1) 2009; 28 Schmit CD (e_1_2_9_46_1) 2017 e_1_2_9_71_1 Holmgren AJ (e_1_2_9_29_1) 2016; 22 Downing NL (e_1_2_9_41_1) 2017; 24 Christiansen J. (e_1_2_9_7_1) 2008; 1 e_1_2_9_14_1 e_1_2_9_39_1 e_1_2_9_16_1 e_1_2_9_18_1 Adjerid I (e_1_2_9_79_1) 2018 e_1_2_9_64_1 e_1_2_9_20_1 e_1_2_9_62_1 e_1_2_9_22_1 e_1_2_9_68_1 e_1_2_9_24_1 e_1_2_9_66_1 Hoyt RE (e_1_2_9_60_1) 2014 Office of the National Coordinator for Health Information Technology (e_1_2_9_48_1) 2017 Thaler RH (e_1_2_9_57_1) 2008 e_1_2_9_6_1 e_1_2_9_4_1 e_1_2_9_2_1 Office of the National Coordinator for Health Information Technology (e_1_2_9_27_1) 2015 Markle Foundation (e_1_2_9_34_1) 2006 Bipartisan Policy Center (e_1_2_9_69_1) 2012 Office of the National Coordinator for Health Information Technology and Office for Civil Rights (e_1_2_9_43_1) 2016 Office of the National Coordinator for Health Information Technology (e_1_2_9_30_1) 2014 Mathematica Policy Research and Harvard School of Public Health (e_1_2_9_37_1) 2015 e_1_2_9_53_1 e_1_2_9_74_1 e_1_2_9_72_1 Adler‐Milstein J. (e_1_2_9_76_1) 2017 e_1_2_9_55_1 Greenberg MD (e_1_2_9_70_1) 2008; 4 e_1_2_9_15_1 e_1_2_9_38_1 e_1_2_9_17_1 e_1_2_9_36_1 e_1_2_9_59_1 e_1_2_9_19_1 e_1_2_9_63_1 e_1_2_9_40_1 Office of the National Coordinator for Health Information Technology (e_1_2_9_45_1) 2015 Lewis MT (e_1_2_9_58_1) 2015 e_1_2_9_21_1 e_1_2_9_23_1 e_1_2_9_44_1 President's Commission on Combating Drug Addiction and the Opioid Crisis (e_1_2_9_67_1) 2017 e_1_2_9_5_1 e_1_2_9_3_1 Office of the National Coordinator for Health Information Technology (e_1_2_9_26_1) 2013 Office of the National Coordinator for Health Information Technology (e_1_2_9_33_1) 2013 Simon SR (e_1_2_9_78_1) 2008; 16 Office of the National Coordinator for Health Information Technology and Office for Civil Rights (e_1_2_9_42_1) 2016 Doebbeling BN (e_1_2_9_77_1) 2006; 21 Office of the National Coordinator for Health Information Technology (e_1_2_9_28_1) 2016 Rothenberg LS (e_1_2_9_51_1) 2016; 43 e_1_2_9_9_1 Pritts J (e_1_2_9_47_1) 2009 e_1_2_9_25_1 Greenberg MD (e_1_2_9_13_1) 2009; 28 Wattenberg SA (e_1_2_9_65_1) 2010 Dullabh P (e_1_2_9_32_1) 2016 Johnson KB (e_1_2_9_49_1) 2016 |
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| Snippet | Context: Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in... Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant... Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant... Policy Points:Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant... |
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| SubjectTerms | 21st century Accountability Adoption of innovations Archives & records Barriers Blocking Breaches Complaints Computerized medical records Confidentiality - legislation & jurisprudence Consent Constraints Data exchange Disclosure Drug abuse Economics electronic health record Electronic health records Electronic Health Records - legislation & jurisprudence Electronic medical records Federal Government Financial incentives Government Regulation Health care industry Health care policy Health information health information exchange Health Information Exchange - legislation & jurisprudence Health Information Interoperability - legislation & jurisprudence health information technology Health insurance Health Insurance Portability & Accountability Act 1996-US Health records Health services Humans Incentives Information dissemination Information sharing Informed consent Law legal Matching Medical personnel Medical records Medical treatment Original Scholarship Participation Patient Identification Systems Patients Privacy Privacy - legislation & jurisprudence Regulation Risk assessment Segmentation State Government Statutes Substance abuse Substance abuse treatment United States |
| Title | Legal Barriers to the Growth of Health Information Exchange—Boulders or Pebbles? |
| URI | https://www.jstor.org/stable/26567685 https://onlinelibrary.wiley.com/doi/abs/10.1111%2F1468-0009.12313 https://www.ncbi.nlm.nih.gov/pubmed/29504197 https://www.proquest.com/docview/2010273961 https://www.proquest.com/docview/2010840007 https://pubmed.ncbi.nlm.nih.gov/PMC5835678 |
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