HIT Health Information Exchange Could Be Hampered By State Lines
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SAN FRANCISCO – A key component of health information technology and the meaningful use of electronic health records is the exchange of health information, something that could be hampered if states have varying degrees of privacy and security standards that exceed current HIPAA regulations, HHS' David Blumenthal said at a recent EHR conference. "Congress has chosen not to pre-empt the states' ability to set privacy and security requirements that exceed federal ones," Blumenthal, head of the Office of the National Coordinator for Health Information Technology, said Oct. 5 at the National EHR Acquisition, Implementation and Operations Summit. Challenges with health information exchange, seen as a primary benefit of the adoption and use of EHRs in making informed treatment decisions, could arise when that information needs to travel across state lines, particularly in metropolitan areas that straddle borders (i.e. Boston or Kansas City). Blumenthal offered an optimistic prediction that this could get taken care of between states without having to go back to Congress for additional legislation to level the privacy and security playing field for HIE on a national level. "It may be that if we adopt by consensus a set of federal requirements that are more demanding than [Health Insurance Portability and Accountability Act] requirements – I am not talking legislatively, I am talking about building a consensus [where] the best practices become the standard – if that is sufficiently demanding and sufficiently protective, it may be that some of these state-to-state differences will melt away," Blumenthal said. A Focus On Intrastate HIE But for now, Blumenthal said the Office of the National Coordinator is focused on getting health information exchange right on an intrastate basis. "If we can get it right within states for now, not foreclosing the cross-state solutions and continuing to work on cross-state solutions where there is compelling patient-related rational in the short term, I think we will after a national dialogue get to the place where we have enough uniformity across states that we will get information flowing where it's needed and when it's needed that meets 99% of patients' needs," he said. That consensus could also be pivotal in gaining the public trust that will be needed to spur and maintain the use of electronic health records. And Blumenthal did not rule out the possibility of a legislative fix if needed. "HIPAA may not be sufficient in the world of electronic systems to assure public trust in the electronic health information exchange and storage," Blumenthal admitted during his keynote address. "We are going to be … carefully examining where we need to go forward with new provisions of either guidance, regulation or law that may be required to assure that the public stays with us in this endeavor.” In getting to that consensus on how to approach and implement suitable privacy and security measures, Blumenthal called for all stakeholders to get involved in crafting standards. "We need to engage in a broad, deep national dialogue about what the requirements should be for patient control and consent over exchanged health information," Blumenthal said. Local HIE Leadership Needed Health information exchange is one of the areas that will be developed as the Office of the National Coordinator works on the second stage of meaningful use criteria. HHS took some criticism when HIE requirements were loosened during the finalization of the first stage of meaningful use (Also see "House Republicans Challenge HHS Officials On Relaxed Meaningful Use Rules For Health IT" - Pink Sheet, 21 Jul, 2010.). Blumenthal said the office will be looking at the local level to drive HIE use. He noted that this will be among the top challenges of getting the use of EHRs to a point where it is simply routine for health care providers. "Creating a community of willing participants in health information exchange is a very tall order in our decentralized, fractionalized, competitive health care system," Blumenthal said. "We're doing what we can to get this going, of course. The standards we created with advice from our Health Information Technology Standards Committee were really a critical first step, only a first step, but a first step." He pointed to HIE grants that have been issued as a key component, noting that they were not only intended to be used to develop technical solutions to information exchange but to develop leaders in the local community. "We desperately need local leadership to build teams for health information exchange at the local level," Blumenthal said. "We can't do that at the federal level. We are too far from the local community. We don't have the trust. We don't have the knowledge. In some ways, we are asking you all to be our partners in governing, our partners in leading, our partners in catalyzing, our partners in problem solving." |