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#1: Scope of Governed Activities MSSNY recognizes that organizations such as RHIOs, Exchanges or CHITAs may have many uses for patient data many of which are unrelated to patient care as determined by the RHIO or Exchange. We support statewide standards and protocols which will govern each RHIO and Exchange and the health information service providers with whom they contract. At page 19, line 28, a paragraph outlines an exception which relates to 'one-to-one' electronic health information exchange as follows: "one-to one health information exchange taking place through a RHIO or Community Exchange or CHITA is not subject to new consent policies; one-to-one exchange is best described as a request by a treating clinician to receive information from or send information to an identified source (i.e. presumably either another collaborating clinician or an ancillary service provider); common examples include physician referrals, a discharge summary being sent by a treating hospital to the referring physician, or the delivery of lab results to the clinician who ordered the test." |
MSSNY agrees with the Committee's definition of a 'one-to-one' exchange but feels strongly that the following should be the standard which would support a 'one-to-one' exchange whereby technology is used to transfer the patient information in an interoperable and secure platform to mirror the current paper- based exchange. This type of exchange should not burden the treating physician(s) or the patient. This data exchange should not require patient consent and would optimize the quality of patient care. MSSNY also believes that patient data access without consent should also be extended in emergency room treatment scenarios whereby a physician uses a temporary security access code, commonly referred to as "break the glass" security to gain access to patient information that will allow for proper treatment (i.e. medications, conditions, recent tests, primary care physician information). This is absolutely necessary if the patient is incapacitated or unconscious. It is MSSNY's firm belief that in order to build a "connected" network as originally envisioned by the Federal government with its National Health Information Network and each State network such as SHIN-NY, the RHIOs and Exchanges must allow for a directory of EMR practices. This would allow physicians who treat new patients or seasonal patients to be able to direct a request for retrieval of that patient's data held by the previous physician (at least at the primary care physician level) or co- seasonal physician. This data must be allowed to move across the networks from the physician who has the data to the requesting physician and the data must not be copied or retained by any entity serving as a connection point. The standards which support 'one-to-one' exchange services in a RHIO, Exchange or CHITA must differentiate those exchanges from non-treatment related exchanges. So long as the RHIO, Exchange or CHITA has the capacity to separate this exchange – including policies and tools that enable the types of exchanges within the organization to be readily distinguishable – these organizations need not apply the new consent policies to 'one-to-one' components of the exchange. We believe that 'one-to-one' exchanges between collaborating physicians whether in a RHIO or Community Exchange or CHITA must be allowed without consent just as it is performed currently in the paper environment. |
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#2 Affirmative Consent The affirmative consent requirement of this document imposes upon the clinician the burden to educate the patient regarding the RHIO or Exchange or CHITA, its stakeholders and the uses of data permitted by the RHIO or Exchange or CHITA. In addition, the patient would need to provide an affirmative consent to each clinician and/or stakeholder within the RHIO or Exchange or CHITA to enable the use of the patient's data. |
MSSNY believes, however, that it should be the responsibility of the RHIOs, Exchanges or CHITAs to provide education to the patients by posting which stakeholders are included within the organization and the ways in which a patient's data might be used. The patient should be allowed to log on to a patient portal provided by the organization and indicate for which purposes the patient's data can or can not be used. MSSNY supports this approach and assumes this to be the standardized consent process as mentioned on page 10, line 6: NY HISPC Phase II. This would alleviate the burden on the physician and the patient of obtaining various patient consents for the use of the data. |
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#5 Sensitive Health Information |
MSSNY supports the patient's option to allow/disallow inclusion of sensitive data at the RHIO, Exchange or CHITA level for all uses as permitted or prohibited by current state and federal law. We recognize that this will frustrate the efforts of collaborating physicians who are treating the patient. If a treating physician does not have access to conditions, medications and test results, then he/she can not take advantage of the clinical decision support tools (eRx drug interactions, allergies, etc.) inherent within the EMR software. This would put the physician at risk of possible medical error and an ensuing adverse event occurrence. We believe the sharing of this information would not put the patient at risk, on the contrary, it would allow the patient to receive the best possible treatment and care. Again, if the patient can dictate at the organization level that certain data can not be included in non-treatment related uses, then the patient should have the right to disallow its use. |
