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▷ COVER STORY CONTINUEDappointments to their own personalcalendar, including any attachmentsthat may contain protected healthinformation? It’s very complicated. Youconstantly have to be aware of all thethreats out there.”Health Information ExchangesThe impact on the privacy and securityof protected health information byhealth information exchange (HIE) istremendous. Healthcare organizationsthat create and maintain the recordessentially may lose some control asrecords are integrated across a healthcaresystem or regional HIE. It’s criticalfor HIM professionals to contributeto the process, according to AHIMAPrivacy and Security Practice Councilmember Rose T. Dunn, MBA, RHIA,CPA, FACHE, chief operating officer ofFirst Class Solutions, Inc. in St. Louis,MO. “Careful planning needs to occurwhen an HIE is being created, andHIM representation needs to be frontand center balancing clinical needs andpatient protections,” says Dunn.e-ConsentOne of the goals of federal policy is toinspire consumer trust and confidencein HIEs. To this end, the Office ofthe National Coordinator for HealthInformation Technology has awarded acontract to software firm APP Design,Inc. for a trial project. They will designa model for securing electronic patientconsent for sharing information and tofind an innovative way to help patientsunderstand their choices related tothe electronic sharing of their healthinformation by their healthcare providers.The stakes are even greater whendealing with sensitive information suchas HIV, mental health, or substanceabuse records. Some states requirepatients to sign consent forms allowingthat information to be shared with aprimary care physician; this is a stricterformulation of consent than is containedin HIPAA. Regional HIEs must addressthese inconsistencies across state lines.Use of Meta-data TagsAnother goal of federal policy is to inspireprovider trust in HIE, so clinicians willreadily trust that the health informationthey receive is correct. Metadata is onetool for building confidence in the HIEsystem. The term “metadata” is oftenused to mean “data about data”—datathat provides more information ordetail about a piece of data. The federalgovernment is evaluating a minimal setof standards for metadata that couldbe attached to a summary care record.Say a patient wants to download theirhealth information from their healthcareprovider’s patient portal to their personalhealth record (PHR). When a patientshares a PHR with a new clinician,attached metadata could help ensure thatthe data belongs to this patient.Three main categories of metadata arebeing considered. Patient identitymetadata is the necessary data requiredto uniquely select a patient from apopulation with a guaranteed degree ofaccuracy. Provenance metadata is datathat provides information on a dataset’shistory, origin, and modifications.Privacy metadata is the data that couldbe used to convey and communicatepatient preferences (permissions orlimits) associated with the sharing of hisor her health information.Unique Patient IdentifierAHIMA recommends the use of a uniquepatient identifier to be included in thecore data elements of the master patientindex. The unique patient identifiersupports the privacy, security, andconfidentiality of protected patient healthinformation because it can help protectconfidentiality of patient informationand identify those who violate patientconfidentiality. A recent ANSI reportaddresses this privacy safeguard. Amongthe report’s findings: at least 12 stategovernments have begun investigatinguse of unique patient identifiers.AHIMA ResourcesWant to learn more about these and otherprivacy and security issues? Visit ahima.org/advocacy/arraprivacy.aspx and ahima.org/resources/psc.aspx to find informationthat can help you be more effective atyour job. If you’re interested in becominga credentialed privacy and securityexpert, look for the upcoming Certifiedin Healthcare Privacy and Securitycredential (CHPS) Exam Prep workshopOctober 4–5 in Chicago (the April 19–20workshop is sold out). v4 ▷ PAGEAHIMA ADVANTAGE