This summer, the Department of Human and Human Resources (HHS) Office for Civil Rights (OCR) released its third in a series of frequently asked questions (FAQs) related to sharing disclose protected health information (PHI) among providers. It’s the latest action by HHS in untangling the Gordian Knot of data sharing in support of data interoperability key to advancing whole-person care.
HHS is working to assuage HIPAA (privacy laws) fears around patient information. The agency’s first two FAQ series addressed third-party health app use and liability between business associates and liability for data breaches.
According to the latest OCR FAQs:
1: The HIPAA Privacy Rule permits a covered entity to disclose protected health information (PHI) to another covered entity for its own healthcare operations purposes, or for the healthcare operations of the entity receiving the information. If the disclosure of PHI is for the healthcare operations of the recipient covered entity, the Privacy Rule requires that each entity either has or had a relationship with the individual who is the subject of the PHI being requested, the PHI pertains to that relationship, and the disclosure is for a healthcare operation or for healthcare fraud and abuse detection or compliance.
2: If a covered entity possesses or receives PHI about an individual, it can use or disclose such PHI where, and in the manner, permitted by the Privacy Rule. Covered entities are prohibited from using or disclosing PHI for marketing purposes without the individual’s authorization, unless the communications are subject to an exception. One such exclusion from the definition of marketing is for communications to individuals regarding replacements to, or enhancements of, existing health plans, so long as the covered entity is not receiving financial remuneration for the communications.
Whole-Person Care Requires Advanced Data Sharing
Healthcare providers – and by default, social providers – have long struggled to deliver the whole-person care model of delivery. The benefits of community coordinated care are well known. Advantages include avoiding readmissions, medication errors, and expensive imaging and lab testing. Sharing such information also aids housing, and other human-services agencies provide services, especially in addressing Social Determinants of Health (SDoH). SDoH such as food and housing scarcity as well as economic instability and low education can account for 80 percent of poor health.
According to the New England Journal of Medicine, SDoH:
“As our health system moves toward value-based models which incentivize positive results rather than individual procedures and treatments, healthcare industry leaders increasingly are regarding the social determinants of health (SDOH) as critical components of these efforts. By concentrating on these facets of well-being in tandem with medical care, providers are taking a holistic view of patients and overall population health to enhance patient care, promote superior outcomes, and drive value in healthcare organizations.”
Effective data sharing, including PHI, is necessary to advance community care coordination. Early research in 2012 suggested that even when the data is available for sharing, there are confounding barriers. These include a lack of ownership of the shared care plan, lack of consistent communications between providers, and lack of clarity in workforce roles and responsibilities, according to Shell Culp, a senior fellow at the Center for Digital Government.
“But the health systems have made much progress since those early days. Payers have realized that coordinated care translates into cheaper costs of care and better outcomes for patients/clients,” said Culp.
Case Management Software a Key Component of Community Care Coordination
As an example, The California Whole Person Care Pilot Program (WPC) jut received a $100 million in the 2019 governor’s budget. WPC is designed for the “coordination of health, behavioral health, and social services, as applicable, in a patient-centered manner with the goals of improved beneficiary health and well being through more efficient and effective use of resources. The program lays out specific data sharing and access to its 25 pilot sites. Data sharing platforms must enable a beneficiary’s medical provider, care coordinators, and social service providers to share data and “communicate effectively.” Among the supported data projects are:
– Health Information Exchanges (HIE)
– Patient population software
– Case management software
– Data warehouses
– Real-time data collection
Data security, especially given high profile hacks, is of the utmost concern for medical and social providers. Existing HIPPA laws to protect patient data do not cover all circumstances. Data protections around wearables such as fitness trackers and other technologies, for example, require additional protections. There are many barriers to PHI interoperability, ranging from technical to financial to cultural. But HHS is on a mission to advocate for and advance whole-person care through data sharing.