“If the burden to access the information is too high, then the [portal] will not be used by enough physicians to make a significant difference in the care provided to Medicaid enrollees.”
user-friendly as possible for providers,” Ms. Kauffman said. HIPAA, for example, allows the state
to display patients’ general health infor- mation through the web portal without patient authorization for treatment and payment purposes. But Ms. Kauffman says sharing more sensitive facts may re- quire “extra review” and written patient consent. Specifically, that could include data related to:
• Sexual assault, • Genetics, • Family planning, • Mental health, • Communicable disease, • Psychotherapy notes, • Domestic violence, • Substance abuse, • HIV/AIDS, • Treatment of a minor, and • Intellectual disability.
complete. And from an office productiv- ity standpoint, the mechanics of how the portal will actually work are important. Like all new things, it’s easy to criticize, and we can’t let the perfect be the en- emy of the good. We need to carefully pilot this.”
Privacy a priority In an effort to improve quality, safety, and efficiency in Medicaid, the 2009 Texas Legislature, under House Bill 1218, told HHSC to develop a Medicaid HIE system. Part of that mandate included creating a web-based portal for Medicaid patients, which, in addition to the cur- rent immunization records and checkup reminders, would include new infor- mation on:
Jason V. Terk, MD
• Health events: a record of each patient visit to a health care pro- vider, including the provider’s name and address, dates
40 TEXAS MEDICINE January 2014
of service, standard diagnosis codes and descriptions, and procedure codes and descriptions;
• Prescription history: the medication name, quantity, last fill date, and number of refills for the prescription; and
• Lab tests: the date of service, a de- scription of the test, and test results.
Medicaid & CHIP Health IT Policy Ad-
visor Sylvia Kauffman says the new por- tal will provide three years of patients’ health history in those categories using Medicaid claims data. If a patient visits several different providers, Medicaid would merge those claims into a diag- nosis and treatment summary physicians can access in one place. One of Medicaid’s main tasks now
is figuring out how to include and yet protect what is considered “ultrasensi- tive” personal health information with- out running afoul of state and federal privacy laws. “That’s the challenge: We have to
make sure patients’ health information is protected and make [the portal] as
“We need to make sure the [portal] system knows how to treat this data based on what the law says: Each claim has to be reviewed to find out if any of this type of data is in it; how we display it; does it require patient consent; and do we need to provide a disclosure to the provider that we have revealed cer- tain information,” Ms. Kauffman said. To find that balance, HHSC formed
a workgroup that, at least in the initial phases of the new portal implementa- tion, recommended allowing patients to opt out of electronically sharing their Medicaid health information at any time. If patients opt out, the system would not display any of their health data. If they don’t opt out and by default agree to share their history, physicians would have to get written patient consent at the point of care and attest electronical- ly that they received it in order to view both the general and sensitive health data through the portal. There are ex- ceptions for emergencies. Physicians also would have to keep the consent form on file for seven years, according to a draft version of the portal’s Terms of Use Agreement. Ms. Kauffman called the proposed
up-front patient consent a “short-term strategy to get this data out as quickly
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