HIMSS 2008: Privacy--The 'Thorniest' Issue in Data Exchange

Gary Baldwin, for HealthLeaders Media, February 25, 2008

Establishing rules around patient consent and privacy is one of the most difficult aspects of establishing a healthcare information exchange. That was the message delivered by Irene Koch, executive director of the budding Brooklyn Health Information Exchange, or BHIX, who spoke at HIMSS 2008.

Formed in 2006, BHIX is an effort to share data among several nursing homes and home care agencies with Maimonides Medical Center and Kingsbrook Jewish Medical Center. The presentation provided insight into why data exchanges often struggle. For example, BHIX initially had hoped for a "universal consent" process. In this model, having one provider in the exchange gain a patient's agreement to participate in the exchange would automatically enroll all other providers, and thus streamline sharing data among the multitude of potential participants.

However, after reviewing other exchanges, BHIX opted for a "provider-by-provider" consent process. In this method, the provider gaining patient consent would be able to view information generated by other providers.

There were other difficulties encountered beyond the logistics of gaining informed consent, however. For example, Koch pointed out how the lack of a standard clinical vocabulary makes interpreting shared records difficult. Pertaining to medications, "start date" and "effective date" mean different things at different organizations.

The Brooklyn project is among some nearly 400 similar ventures underway in the U.S., according to HIMSS Analytics. Maimonides won a New York state grant in 2006, which sparked the formation of the now-independent BHIX. It has a joint governing model, representing three home care agencies and four nursing homes. The data exchange will enable the sharing of both discrete electronic data and scanned images, such as advance directives. Data sharing is expected to begin later this year.

--Gary Baldwin