Information Technology Reference
In-Depth Information
Exactly how the technology architecture of health information exchange will
ultimately play out isn't clear at this point and it will be very interesting to watch it
evolve over the coming years.
Privacy, Security and Trust
No health information technology is useful in the real world unless it can provide
sufficient protections for who has access to what elements of each patient's data
(Privacy) - assurance that only authorized persons or entities can access that data
(Security), and that everyone involved can be certain that the data they are sharing
is going to the person or entity they want it to go to (Trust).
Congress addressed this issue in HIPAA, reasoning that, for the health industry
to adopt digital technology, there had to be a clear definition of the necessary data
protections. Interestingly, the primary original motivator for the act was not improved
patient care. It was helping employees keep their insurance when they changed jobs
and administrative reform, the desire to introduce and have widespread adoption of
new electronic formats mostly for the exchange of financial datasets such as the
ANSI 837 format for claims and the ANSI 835 electronic remittance advice.
Today, with the focus now more on the automation of clinical data, HIPAA regu-
lations are of great importance to all health providers considering electronic records.
The rather complex details of HIPAA aren't important here but I can recommend
one clearly written and not overly long practitioners' guide to those who are inter-
ested in them. [
8
] What we will focus on his
how
privacy, security and trust are
supported by health informatics systems.
Privacy:
Patients, by law, own their clinical records. Their provider may own the
paper on which they are recorded or the disk on which they are stored but the data
itself is owned by the patient. Only the patient or their personal representative can
authorize exactly who can view that data and for what purposes. There are excep-
tions, of course. These include direct treatment (T) situations, transmitting informa-
tion to get paid (P), and certain specific administrative functions necessary in the
operations (O) of healthcare entities, such as accreditation, quality management,
reporting to healthcare agencies for comparative analysis and internal training activ-
ities. Together these are often referred to as TPO.
Beyond these, it is generally the case that access to PHI must be limited based on
the patient's preferences. This can be relatively simple in an office practice but con-
sider what might happen with electronic records, particularly if they are connected
to an HIE. A cancer patient, for example, might want to disclose certain aspects of
their care to support a research effort for their particular condition or to see if they
qualify for a clinical trial. They might not want to release other aspects of their care,
such as a sexually transmitted disease or a mental health problem. The general prin-
ciple here is referred to as “granular control” of health records (or “data segmenta-
tion” in the report that we'll quote in the following paragraphs). It has to do with
how clinical data can be logically grouped for the purposes of patient consent to its
