Unity Health Information Exchange February 24th, 2016

Key Definitions: What does it all mean? HIE: Health information exchange; mobilization of healthcare information electronically across organizations within a region. Opt-in: Patient consent model in which patients must specifically agree to share their record. Opt-out: Patient consent model in which patients must specifically request that their record not be shared. Current Legacy Health standard. Care Everywhere: Encounter- or patient-level data sharing (e.g.: Transitions of Care, Continuity of Care documents).

Local / National Trends General trend is towards Opt-Out Epic recommendation is Opt-Out Jefferson HIE is Opt-Out VA chose Opt-In for veterans Several HIEs have recently discarded Opt-In due to serious consequences for patients Source: July 2014, Market Economics http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/health-information-exchange/health-information-exchanges-introduce-pa?page=full

Trends in Behavioral Health Information Exchange Traditionally seen as fundamentally different from other clinical information, that needs to be shielded to protect patient privacy “Many organizations grant psychiatric health information a higher level of confidentiality than the rest of the patient's medical record. Though Epic recommends not suppressing clinical information, there are tools in Epic to do so, as needed.” “During a transition from a private mental health record to a shared electronic medical record, mental health patients were generally comfortable with the idea of and transition to a shared electronic medical record.” Confusion over legal issues around the sharing of this data, in part due to different legal framework for community organization and health systems

One Patient; Different Results Opt-In: - Patient Privacy (staff/clinicians) - Reduced care coordination -Perpetuates stigma -Increased duration of stay -Increased cost of care Opt-Out: - Patient Privacy (caregivers/family) - Increase care coordination -Decrease duration of stay -Decrease med rec errors -Decreased cost of care

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