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The HIPAA Privacy Rule and Electronic Health Information Exchange in a Networked Environment

Its going to be a busy year a really busy year. In 2022, much of the promise of the 21st Century Cures Act comes to certified health IT near you. ONC dutifully monitors industry progress towards certification to the 2015 Edition Cures Update (Cures Update), which introduces new standards and functionalities that will benefit our health care system in a variety of ways. This includes improved interoperability through secure, standards-based application programming interfaces (APIs) and the United States Core Data for Interoperability Version 1 (USCDI v1);

Gaps in health IT use illustrate the inequities that unfortunately exist in our health care system, which in turn can lead to inadequate patient care, experience, and outcomes. During ONCs 2021 Tech Forum, Dr. Linda Rae Murray, the former chief medical officer at the Cook County Health & Hospital System, highlighted some of the health disparities she had seen firsthand while serving medically underserved patients in Chicago for more than 20 years. When her organization launched a new electronic health record system almost 15 years ago,

Patients who identify mistakes in their records could also help prevent medical errors. In a survey of 29656 patients (22% response rate) of whom 18301 had read at least 1 ambulatory note and answered questions on errors, 1 in 5 found an error and 42.3% of the patients perceived the identified errors to be serious.5 The most common errors were related to diagnoses, medical histories, medications, test results, notes on the wrong patient, and notes pertaining to the wrong side of the patients body (left vs right). Under the law, a finding of malpractice liability requires a finding of patient injury. Patients who report errors in their health information could therefore prevent physicians from relying on erroneous data that may lead to poor diagnostic or treatment decisions and legal liability. An analysis of 20 randomized clinical trials related to sharing clinical notes (involved 17387 patients) supports the conclusion that sharing electronic health records could improve patient safety.6

As a repository of sensitive patient information, the companys databases churn silently behind the scenes of their medical care, scooping up their most guarded secrets: the diseases they have, the drugs theyre taking, the places their bodies are broken that they havent told anyone but their doctor. The family of databases that make up MarketScan now include the records of a stunning 270 million Americans, or 82% of the population.The vast reach of MarketScan, and its immense value, is unmistakable. Last month, a private equity firm announced that it would pay $1 billion to buy the databases from IBM. It was by far the most valuable asset left for IBM as the technology behemoth cast off its foundering Watson Health business.

ONCs information blocking regulations apply to interferences with the access, exchange, or use of electronic health information (EHI) (45 CFR Part 171) and define certain exceptions to the definition of information blocking. Thus, its important that those subject to the information blocking regulations health care providers, developers of certified health IT, and health information networks/exchanges (cumulatively, actors) understand what health information the regulations cover.

Global Edition2022 Look AheadSo TEFCA is live. Now what?Former National Coordinator for Health IT Dr. Don Rucker discusses what’s next for interoperability and why he sees TEFCA as a ‘solid first step.‘By Kat JercichJanuary 24, 202202:58 PMPhoto: HIMSS MediaThis past week, the U.S. Office of the National Coordinator for Health IT announced that the Trusted Exchange Framework and Common Agreement is now live. The announcement marks a major step forward toward nationwide interoperability, aimed at simplifying inter-organizational connectivity and ultimately giving individuals access to their healthcare information. TEFCA has been in progress over multiple administrations following the passage of the 21st Century Cures Act in 2016 and few have a better sense of its ins and outs than Dr. Donald Rucker, who served as national coordinator for health IT from 2017 through 2021. Rucker, now chief strategy officer with 1upHealth, sat down with Healthcare IT News to chat about what’s next for interoperability in the United States, the advantages of FHIR-enabled tools and the importance of being able to analyze population-wide health data. Q. What interoperability challenges do you see TEFCA addressing? A. It’s a hard space. And it’s worth understanding why it’s hard. You can look at connectivity: Are we getting information on one patient? Or on a population? And then, the other dimension is: Is this connectivity the patient controlsor that gets data into patients’ hands, or is this connectivity between providers? Sothose are probably three somewhat separate buckets. TEFCA is really about the incumbent providers sitting on electronic medical records and getting the various medical record vendor networks first and foremost and then the health information exchanges to talk to each other. This is important in a lot of healthcarebecause patients may be too sick, or too young, or too oldto remember medical details. If you come into the trauma bay, you may not be able to remember what your password is or your provider site.I see TEFCA, as it is, as sort of a placeholder for some of the richer computing that needs to follow if we’re going to have a rational healthcare system. If we’re going to do the things that are measures of value, measures of public health support for social determinants of health, we need sort of a different system than the connectivity pathways that we have today.

Patients are being encouraged to take charge of their health and self-manage medical conditions. More people are, and will increasingly be, making their own decisions about their health, including what tests to undergo

The Trusted Exchange Framework and Common Agreement is now available. Within the health information technology (health IT) world, few things have been as elusive as a governance framework for nationwide health information exchange. When ONC was formed in 2004, the concept of a nationwide health information networkwhere your information could be located across the country in a clickwas a big picture vision that drove the federal governments early health IT infrastructure, standards, policy actions, and investments.Whats followed as a result of two laws (HITECH Act and 21st Century Cures Act) and remarkable continuity across four administrations has been steady growth, maturity, and investment from both the public and private sectors. Most health care providers use electronic health records.1,2,3 Many are connected to and engage in at least one form of electronic health information exchange.4,5,6 And health information networks are now dotted across the US map supporting communities with a wide range of services.7Todays milestone marks the beginning of a new era of electronic health information exchange in the US. That world we wanted to see back in 2004its hereand now its time to put what weve built to use.Our goals for the Trusted Exchange Framework and Common Agreement (TEFCA) are:Goal 1: Establish a universal policy and technical floor for nationwide interoperability.Goal 2: Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value.Goal 3: Enable individuals to gather their health care information.

In the last few days, I have reached out to 4 different clinical trial study information support lines and individual study sites for patients to potentially enroll. Not one reply or call back. No auto-response messages. No chatbot. Nothing. For all the efforts and hype on the latest digital he