Videri Quam Esse

I was reading the pop HIStalk wellness information technology news/opinion site the other hateful solar daytime when I ran into a blurb stating that outset inwards 2014, a novel “North Carolina police describe requires hospitals with EHRs to connect to the state’s HIE together with submit information on services paid for with Medicaid funds”. For the uninitiated, HIE stands for Health Information Exchange, together with inwards this context it refers to a federally funded organisation whose mission is to facilitate clinical information central inwards the State. There are similar organizations inwards nigh every State, funded dorsum inwards 2009, amongst Meaningful Use together with other shovel cook economical stimulus activities, through the ARRA together with its HITECH Act.

The noble destination of HIE organizations everywhere is to improve assist for patients past times simplifying interoperability betwixt disparate EHR technologies, allowing clinicians timely access to relevant, up-to-date medical information at the signal of care. It makes perfect feel that North Carolina would similar to “nudge” hospitals into sharing information with community physicians to improve assist coordination together with hopefully outcomes for its citizens. What doesn’t build whatever feel at all though, is the narrow requirement for Medicaid information only. Wouldn’t North Carolina desire amend assist coordination for all people? And how does a infirmary submit information precisely for a subset of services (not necessarily a subset of patients)? And why is this express to submission, together with at that topographic point is no requirement that hospitals avail themselves of HIE information submitted past times others? Obviously, I needed a flake to a greater extent than information to satisfy my foolish curiosity….

The initiative off stride was to banking company lucifer out the North Carolina HIE. Like many other organizations of its kind, the NC HIE chose to create a clinical information repository to live on fed past times prospective customers with “prescriptions, vaccinations, allergies, lab together with exam results, icon reports, conditions, diagnoses or wellness problems together with medical see notes”, together with with infirmary ADT (admission-transfer-discharge) information equally well. So far, similar similar HIE organizations across the country, NC HIE is failing to garner active back upward from local hospitals. In an interview with the Carolina Journal before this summer, Mark Bell, CIO of the North Carolina Hospital Association (NCHA), suggested that “[t]ypically, a provider volition non live on thrilled with the thought of someone else making coin off of their data” which seems to live on a “hot push topic”. Indeed, the NC HIE client listing is remarkable for the absence of North Carolina’s famous academic centers of excellence together with their affiliates. 

Mr. Bell’s hardly novel implication that some HIE organizations are seeking “to aggregate all that information together with sell it to anyone who wants to purchase that data, or for research, or a release of other uses” does heighten the uncomfortable specter of patient privacy. According to its website, the NC HIE is an “opt out” exchange, which agency that patients are “automatically” enrolled inwards the central whenever they “visit a participating Dr. or hospital”, at no toll to the patient, of course. For inquiring minds, the NC HIE explains that it is precisely acting “as a “virtual medical tape department” to collect together with shop medical records, together with allow authorized providers to review together with upload records”, together with that “[h]aving a tertiary political party care medical records is mutual practice”. Right. People may nonetheless opt out past times calling a for certain telephone release or past times mailing a for certain form. As with nigh HIE organizations that engage inwards information accumulation, the “opt out” machinery does non forestall patient information from beingness sent to the HIE, beingness stored inwards the HIE database, beingness disclosed to world agencies, or beingness used for other purposes when required or equally permitted past times Applicable Law. It precisely prevents disclosure to doctors together with hospitals that are truly treating the opting out patient.

With that inwards mind, let’s become dorsum to the build novel Applicable Law. The original bill contained linguistic communication stating that effective Jan 1st 2014 “any hospital, equally defined inwards G.S. 131E-76(c), that has an electronic wellness tape scheme shall connect to the NC HIE together with submit private patient demographic together with clinical information on services paid for with Medicaid funds”. This is a pretty lucrative organisation for the NC HIE, which stands to gain to a greater extent than or less $5.5 meg per twelvemonth from subscription fees (at $250 per bed per year) alone, together with undetermined amounts from interface charges, which equally nosotros all know tin dismiss reckon tens of thousands of dollars for each facility. Forcing the rich together with famous North Carolina wellness systems to back upward the floundering world central may get got been proficient plenty argue to innovate this legislation, but that’s non the halt of the story. The final bill, which is at in 1 trial the police describe of the dry soil inwards North Carolina, was amended to include the following: “The NC HIE shall plough over the Department of Health together with Human Services real-time access to information together with information contained inwards the NC HIE”, together with goes on to specify that the “Department of Health together with Human Services together with the NC HIE shall execute an understanding regarding the utilization together with sharing of information together with information contained inwards the HIE Network”, inwards a mode that complies with HIPAA together with federal law. Note that the amendment linguistic communication is non specific to “services paid for with Medicaid funds”.

It looks similar the State of North Carolina came upward with a rather innovative method for participating inwards what Mr. Bell from the NCHA damage a “hot push topic”. I am non for certain how, or if, the State is planning to enforce this law, together with I am non for certain if hospitals volition accept the extra problem (and expense) needed to segregate together with submit to the State precisely those medical records that comprise a Medicaid charge, but 1 thing is certain: private patients inwards North Carolina get got absolutely no say inwards this matter.  And together with hence nosotros accept 1 to a greater extent than stride on the route to trusted exchange.