AZ 'Health-e Connection' aims to be national model
Task force develops 'road map'
A person is far from home, driving on an interstate highway, passing through a rural area and, because of an accident or a sudden illness, is taken for treatment to the emergency department (ED) of a nearby hospital. Even if the individual is conscious and able to communicate, those providing care are limited by their inability to access the person's health care records.
"Wouldn't it be great if there were standard procedures for getting that information?" says Julie Johnson, CHAM, director of revenue cycle management and HIPAA privacy officer at Mt. Graham Medical Center in Safford, AZ.
"If the person is able to communicate, you can get a list of the medications they're on, but if not, the physicians have to use their best judgment," she adds. "What if the person needed blood, and the blood type was right there?"
Being able to have that information available quickly and efficiently when such occasions arise is the goal of a program called Health-e Connection, established by Arizona Gov. Janet Napolitano, who has said she wants her state to be the national model for electronic connectivity of health care records.
The plan is to create the infrastructure necessary to achieve 100% electronic health data interchange between payers, health care providers, consumers of health care, researchers, and government agencies, Johnson says. "It's all about standardization."
Going electronic
"We've all been directed to have electronic health records by 2010," she points out. "It will take every part of the hospital, including access."
Even the insurance company knowing right away that a covered person is in for services would help treatment be given more efficiently, Johnson notes. "Who's to say the trigger [for the data exchange] is not through access notifying the payer? Perhaps that will be how it's generated. Or maybe it will be through accessing a clinical database."
While there are a few other regions in the country with well-developed systems for electronic connectivity of health care information, Arizona's project is one of the first statewide efforts, says Kristen Rosati, JD, chairperson of the Privacy and Security Task Group.
"I think Arizona is a real model — No. 1 because we have created a collaborative atmosphere," adds Rosati, an attorney with the Phoenix-based firm Coppersmith Gordon Schermer Owens & Nelson, PLC. "That is one of the reasons we have been able to do this so quickly."
Napolitano launched the project in October 2005 with a "call to action" meeting that drew some 200 people, including physicians, hospital CEOs and chief financial officers, health care lawyers and vendors, among others.
As a result of their efforts, the Arizona Health-e Connection Roadmap — a document which focuses on the "what, when, why, and who" necessary to create the desired infrastructure — was delivered to the governor this April.
"Everyone really felt like they had a place at the table, including consumers," Rosati says. "The governor convened a steering committee, which was the decision-making body, and then the steering committee convened the work groups."
In addition to the privacy and security group, there are work groups covering financial and technical concerns.
"The road map sets forth the sort of projects we want to do," Rosati adds. "Over the next year, we will look in more detail at how to make sure privacy and security of health information is protected as we decide which of these options will be implemented."
Johnson, who learned of the initiative through a call for participation from several state health care organizations, was present at the initial meeting, she says, and ultimately became part of one of the privacy and security task group.
What's private in an e-health info exchange?
As part of that group, she brainstormed with other members on potential legal barriers to the development of the proposed e-health information exchange, and how best to safeguard the confidentiality of the data, Johnson says.
Some of the challenges addressed, she adds, included the following.
• How will the e-health information exchange address consumers' control over their own health information?
On one hand, consumers legitimately want control over their health information and want the right to choose whether to participate in a health information exchange. On the other hand, seeking consumer consent could mean that a person might need the benefits of the system — as in the car accident mentioned above — before he or she has the opportunity to opt in or out of the system.
Additionally, seeking consent would not only be an expensive and administratively difficult task, but also would diminish the effectiveness of the information exchange in addressing public concerns, such as using the information for bioterrorism surveillance.
• How will the e-health information exchange handle "special" health information that has greater confidentiality protection?
This might include records related to a patient's HIV status, for example, or the notes of a session with a psychotherapist, Johnson points out.
Other types of health information that have greater confidentiality protection than that provided by the Health Insurance Portability and Accountability Act (HIPAA), which forms the federal "floor" of protection, are such areas as genetic testing, mental health, and alcohol and substance abuse treatment.
Some of the options identified for handling such information in the exchange are: excluding all data that require this special protection; including some sensitive information but excluding that which has the greatest restrictions on use and disclosure; including the information, but restricting the use of all information in the exchange to comply with the most restrictive laws; determining a way to flag information that requires more confidentiality protection; or asking the state legislature to amend laws to facilitate the e-health information exchange.
"Across the country, states have more restrictive laws," Rosati notes. "HIPAA forms the floor, but we have to make sure we are complying with state law. It's tricky, because as we're doing the exchange, we need to have a way to protect more sensitive health information. A person may go into a clinic for genetic testing, but not want that in the medical record.
"There is a lot of concern that if such information lands in the wrong lap, there might be discrimination against [those to whom it relates]," she says. "There is some tricky technology [that will] shield that information from the data exchange. We are working closely with people, identifying the technology we are going to use."
• How will the e-health information exchange handle minors' health information?
Minors have the right to consent to certain types of health care in Arizona, such as treatment for sexually transmitted diseases, HIV testing, and alcohol and drug abuse treatment, as well as prenatal and other reproductive care. If they are emancipated, have been married, are homeless, or are in the military, minors have the right to consent to all health care.
However, the roadmap points out, they also have the right to control the information related to that care and must authorize disclosure of that information to their parents or guardians. The challenge for the electronic information exchange then becomes determining how to meet the participants' legal obligations to protect minors' rights in that area.
To meet that challenge, the task force will consider such options as implementing a mechanism for providers to flag information related to health care for which a minor has given consent but which also requires authorization for release of that information to parents. Another option would be excluding minors' health information from the system if it relates to health care for which the minor has the right to consent.
The latter may have negative consequences if the excluded information is significant to other treatment provided to the minor, the roadmap states.
Another option is that the e-health information exchange could request the Arizona legislature to pass a law granting parents and guardians the right to see their children's health information, perhaps with exceptions to protect minors in cases of abuse or other circumstances.
The concern with that route is that it could discourage minors from obtaining prenatal or reproductive care or treatment for sexually transmitted diseases.
• Who will have access to the e-health information in the exchange and for what purpose?
It must be determined, for example, whether health plans and employer group health plans will have access to information in a patient health summary.
The most important message for access professionals and other health care providers, says Rosati, is to participate in the development of electronic health care exchanges in their own regions and states.
"The more that hospitals and their representatives are involved in the creation of these systems," she adds, "the more they will reflect the needs of the hospital."
Arizona Gov. Janet Napolitano developed a program called Health-e Connection and wants her state to be the national model for electronic connectivity of health care records.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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