20 Feb Healthcare execs, state employees testify on behalf of patient data exchange bill
Madison, Wis. – If you believe patient health information should be electronically exchanged between different health systems and facilities, Wednesday was a pretty good day in the state Capitol.
The Senate Committee on Health, Human Services, Insurance and Job Creation heard testimony on a bill to remove barriers to electronic patient data exchange in Wisconsin. The testimony favored the bill, and came from state employees and healthcare professionals during a public hearing in which there were no fireworks on a measure that generated some concern at a recent Assembly Committee on Public Health.
The measure is Assembly Bill 793 and its Senate companion, SB 487.
Peter Strombom, president of Strombom Associates and former vice president and chief information officer at Meriter Hospital, said the bill would pave the way for the interoperability of computer systems, which will be necessary for electronic patient data exchange.
“If the legislation is passed, it will facilitate the move to interoperability,” said Strombom, a fellow with the College of Health Information Management Executives. “It does not create interoperability, but it removes some of the barriers to interoperability and it will improve clinical outcomes.”
Strombom, who said the Madison patient data exchange project was put on hold due to these barriers, noted that moving electronic records between healthcare providers is more secure than using paper records. He also said interoperability does not mean access to a patient’s complete medical record, just those aspects that will assist physicians who are providing care a particular time.
Consent decree
According to the state Department of Health and Family Services, which helped craft the bill, language in existing state statutes makes the exchange of healthcare information of mentally ill patients difficult because of the requirement for patients to provide informed written consent, which is not always easy to obtain.
Physicians need better access to clinical information to better care for patients, according to Katie Plona, a legislative liaison for the DHFS. She said the bill seeks to strike a balance between patients’ privacy rights and their treatment needs.
“While SB 487 is not only thing we need to do to foster health information exchange, it is a necessary first step,” she said.
The bill is the result of work with key stakeholder groups, including mental health advocates and private-sector partners, to reduce restrictions on the electronic sharing of certain health information without written consent of patients, and to modernize privacy laws governing confidentiality in a way that is aligned with federal policies. Among other things, the bill would eliminate the requirement to document all disclosures except for those covered under the Health Insurance Portability and Accountability Act (HIPAA), such as cases involving child or elder abuse case.
Jay Gold, senior vice president and chief medical officer for MetaStar, spoke in favor of bill from a personal standpoint. Gold said it’s essential for the quality of healthcare that patient information to be exchanged quickly; otherwise, a diagnosis can be faulty to the detriment of a patient’s health.
Gold said he would go even further regarding the information that could be transmitted as long as there are reasonable protections for breach or misuse, but said the current bill is far superior to existing law. The benefits of having that information, he said, far outweigh the risks of exchanging the information electronically.
Barrier removal
In particular, the state mental health statute, 51.30, which pertains to mental health, developmental disability, and AODA treatment records, has resulted in delays to the implementation of the Madison area patient data exchange.
Statute 51.30 creates barriers to health information exchange because in most circumstances the patient’s written consent is required to disclose information to another healthcare provider. Under current law, only certain elements of a patient’s treatment records may be released without informed written consent. These elements include name, date of service, diagnosis, and medications. In addition, these details may only be released to healthcare providers in a “related healthcare entity,” which generally means a clinically integrated care setting or a given health insurance plan.
For example, current law would not allow a physician from Dean Clinic in Madison to share a patient’s health information with a University of Wisconsin physician without the written informed consent of the patient.
The bill proposes to amend statute 51.30 to allow the exchange of “crucial” information that physicians have identified a need for, and it would allow for the exchange of information with any healthcare provider with a need to know. It would do so by adding diagnostic test results and symptoms to the list of elements that may be exchanged without patient written consent and by removing a requirement that data only be exchanged within a “related healthcare entity.”
Written consent still would be needed to disclose information on an entire consultation note or discharge summary and other elements not contained in the bill.
Fuller disclosure
Additional barriers to patient data exchange are contained in other areas of state law, and SB 487 also is designed to remove them. They include a prohibition of re-disclosure of information received by one healthcare entity to another entity, and a requirement for documentation of all disclosure of health information. The federal HIPAA law requires documentation of some but not all disclosures.
The bill would allow re-disclosure of health information in a way that benefits electronic patient data exchange while retaining limitations on re-disclosure to protect confidentiality. It also eliminates the requirement to document all disclosure and aligns state law with HIPAA document disclosure requirements for child or elder abuse cases or public health reporting and disclosures to law enforcement and coroners.
Existing law also makes it hard to share health information with a patient’s family member, friend, or other person involved in the patient’s care. Doing so requires the written consent of the patients when the patient may not be available or capable of providing written consent.
The bill would allow healthcare providers to disclose health information to a patient’s family, friend, or someone else the patient identifies – as long as the patient provides informal permission. If the patient is not available or physically or cognitively unable to grant informal permission, the dissemination of information would be up to the caregiver’s professional judgment.
State Sen. Kathlelen Vinehout, D-Alma, asked whether the provision enabling healthcare professionals to use their professional judgment is consistent with HIPAA.
Beth DeLair, DHFS legal consultant on the state’s eHealth project and a former compliance director at UW Hospital and Clinics, said it’s a bit different than HIPAA. Under HIPAA, she said, there are three ways a healthcare provider can disclose information – if a patient agrees, if they don’t object, or if they use their professional judgment.
In Wisconsin, “stakeholders wanted a two-step process,” DeLair said. “If patient is there, ask them. If they are not physically or cognitively able, then it would default to professional judgment.”
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