Comments by Dominick Bizzarro Posted on January 31, 2008

These comments were developed collaboratively by the diverse membership of healthcare organizations at the Healthcare Information Xchange of NY.

Page #	Line #	Comments/Criticisms	Suggested Alternatives
19	28-38	Please comment on the applicability of the "one-to-one exchange" exception to a secure, encrypted e-mail system that allows providers engaged in the treatment of a common patient to exchange patient specific data in a protected, HIPAA compliant environment, either through a portal or secure email system. This may involve more than two exchanging providers.	Please reconsider the scope limit of two exchanging providers. It is our understanding that this type of electronic exchange is not considered community-wide (or statewide) and is adequately regulated, even though more than one provider may be involved. These systems have great utility as a HIPAA compliant alternative to unencrypted e-mails, and have a lower barrier to implementation.
20	33-41	To enable the highest standards of quality and patient safety, a provider affiliated with a facility that has received patient consent to access the patient's information, should have access to that patient's information at any facility at which the patient receives care. There are clear and compelling patient-centric, clinical quality reasons for ensuring that the consent "travels" with a specific physician across care settings. Examined in the context of a primary care physician receiving the consent, the patient's intent is to offer their primary physician a comprehensive picture to enable better decision making for the direct benefit of the patient. For example, if a physician is affiliated with a primary care group (the facility) where the patient has granted consent, that same physician should have access to the patient's information at a hospital, regardless of the consent status of any hospital organization. The intent of the patient in granting the physician access through the original facility	Once a physician in one organization has received patient consent to access a patient's information, allow that physician access to that patient's information regardless of the facility at which the patient is receiving care.
28	34-40	We offer affirmative support for payer access as defined in the report. Payers are best treated as another critical component to the successful, secure and appropriate sharing of medical information. Payers provide care management and quality improvement opportunities that can provide direct, enduring value to the patient, as well as create a strong foundation for achieving efficiencies important to NYS. Removal of payer access would be detrimental to progress of RHIOs and the SHIN-NY, and decrease the benefits of these efforts to the patients we all serve.