Data tag­ging helps keep se­lected data pri­vate in EHRs

Data tag­ging al­lows se­lec­tive shar­ing with EHRs

Modern Healthcare - - NEWS - Joseph Conn

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Us­ing off-the-shelf con­tent stan­dards and mes­sag­ing pro­to­cols, the Vet­er­ans Af­fairs Depart­ment and the Sub­stance Abuse and Men­tal Health Ser­vices Ad­min­is­tra­tion of HHS have suc­cess­fully demon­strated how to elec­tron­i­cally tag men­tal health and other highly sen­si­tive clin­i­cal records to help providers com­ply with strin­gent state and fed­eral pri­vacy laws lim­it­ing the shar­ing of those records with­out pa­tient con­sent.

De­vel­op­ment of the elec­tronic pa­tient-con­sent man­age­ment sys­tem came in re­sponse to the VA’s and SAMHSA’s own needs to pro­tect the pri­vacy of pa­tients un­der two fed­eral med­i­cal record pri­vacy laws that are more ro­bust than the pri­vacy rule un­der the Health In­sur­ance Porta­bil­ity and Ac­count­abil­ity Act.

The demo was part of a Data Seg­men­ta­tion

“We’re try­ing to pro­vide pa­tients some abil­ity to con­trol what in­for­ma­tion is shared and make it easy on them.” —Mike Davis, VA project lead

for Pri­vacy Ini­tia­tive by the Of­fice of the Na­tional Co­or­di­na­tor for Health In­for­ma­tion Tech­nol­ogy at HHS. It also an­swers a 2010 call by the Pres­i­dent’s Coun­cil of Ad­vi­sors on Sci­ence and Tech­nol­ogy to use meta­data tag­ging to en­hance pri­vacy while mak­ing med­i­cal data more read­ily avail­able for re­search. A meta­data tag pro­vides in­for­ma­tion about the un­der­ly­ing data.

Tag­ging a pa­tient’s record at the “gran­u­lar” or data-el­e­ment level en­ables pa­tients to give con­sent to the ex­change of some parts of their med­i­cal record—such as a di­ag­no­sis code for di­a­betes and a drug pre­scrip­tion for its treat­ment—but not other parts, such as the di­ag­no­sis of a sex­u­ally trans­mit­ted dis­ease or a men­tal health coun­sel­ing ses­sion.

“The bot­tom line is we’re try­ing to pro­vide pa­tients some abil­ity to con­trol what in­for­ma­tion is shared and make it easy on them,” said Mike Davis, VA project lead and Vet­er­ans Health Ad­min­is­tra­tion se­cu­rity ar­chi­tect.

Fed­eral law ap­ply­ing specif­i­cally to the VA re­quires that, un­der typ­i­cal cir­cum­stances, the VA must ob­tain a vet­eran’s con­sent be­fore his or her med­i­cal records can be shared out­side the or­ga­ni­za­tion. The VA also abides by an­other fed­eral law that bars fed­er­ally funded al­co­hol and drug treat­ment providers from shar­ing in­for­ma­tion about such treat­ment with­out pa­tient con­sent. The lat­ter law cre­ates a con­sent re­quire­ment that sticks to and flows with the data, so that each sub­se­quent provider to re­ceive it also must ob­tain pa­tient con­sent to dis­close it else­where.

Pri­vacy laws in sev­eral states also con­tain these sticky pro­vi­sions, said Joy Pritts, chief pri­vacy of­fi­cer at ONC, who at­tended the demo in Bal­ti­more this month dur­ing a con­fer­ence spon­sored by Health Level 7. The health­care stan­dards de­vel­op­ment or­ga­ni­za­tion has pro­duced a clas­si­fi­ca­tion and cod­ing sys­tem to iden­tify and con­strain par­tic­u­larly sen­si­tive in­for­ma­tion; the sys­tem was used by the VA and SAMHSA in the demo, as were the ONC’s Di­rect mes­sag­ing pro­to­cols.

In the demon­stra­tion, a care sum­mary was ex­changed be­tween providers for a pa­tient en­rolled in an al­co­hol and drug abuse treat­ment pro­gram. The VA/SAMHSA sys­tem tagged dis­crete el­e­ments of the record “do not re-dis­close.”

One miss­ing piece in the au­to­mated pri­vacy pro­tec­tion scheme, how­ever, is how to deal with dic­tated notes con­tain­ing sen­si­tive pa­tient data. A text doc­u­ment could be con­strained by tag­ging the en­tire doc­u­ment, Davis said, but that would need to be done by hand, whereas tag­ging of dis­crete data can be done by the sys­tem, which can sit as a layer be­tween one provider’s EHR and an­other’s.

Pa­tients can spec­ify their wishes with com­put­er­ized con­sent di­rec­tives cre­ated on­line at home or on a provider’s com­puter sys­tem, he said.

Davis said there is no time­line for rolling out these func­tions across the VA, but the VA has sev­eral pi­lot sites run­ning where the sys­tem is in daily use record­ing a vet­eran’s sim­ple “yes/no” elec­tronic con­sent di­rec­tives for ex­change of their records with out­side providers.

Pritts said ONC has two ad­di­tional pi­lots planned, one with the VA and one with pri­vate-sec­tor providers.

“I think this can work for what’s called struc­ture data—med­i­ca­tions in the med­i­ca­tion list, al­ler­gies in the al­ler­gies list, di­ag­nos­tic codes in the prob­lem list, lab test re­sults, vi­tal signs—that type of in­for­ma­tion,” said Daniel Gottlieb, a part­ner in the Chicago of­fice of Mc­Der­mott Will & Emery who heads the firm’s health in­for­ma­tion tech­nol­ogy and data pro­tec­tion prac­tice.

With the EHR sys­tems used by providers to­day, “typ­i­cally the tech­nol­ogy doesn’t have the ca­pa­bil­ity” to seg­re­gate those drugs on a med­i­ca­tion list for a com­mon ail­ment from those drugs to treat an­other, more sen­si­tive one, such as a psy­chi­atric con­di­tion, Gottlieb said.

“That leaves you with two op­tions in the real world,” he said. “One is not to make that med­i­ca­tion list avail­able” out­side the or­ga­ni­za­tion. “Or, you can take the po­si­tion that pro­vid­ing high-qual­ity care” is the greater good, “and just de­cide that you’re go­ing to ac­cept that le­gal risk.”

Gottlieb said many providers lean to­ward the lat­ter, for in­stance if a pa­tient is tak­ing med­i­ca­tion for a psy­chi­atric dis­or­der but also for a chronic con­di­tion such as di­a­betes. “There could be the po­ten­tial for the ad­verse re­ac­tion be­tween the psy­chi­atric drug and some other drug,” pre­scribed ei­ther in the same hospi­tal or by an­other provider. “I think most peo­ple think avoid­ing that re­ac­tion takes prece­dent over the pri­vacy con­cern.”

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