Electronic patient data exchange: eHealth Board recommends changes to mental health law

Madison, Wis. - The Governor's eHealth Board has recommended changes to the state's mental health statute that could pave the way for legislation to accommodate electronic patient data exchange.

Wisconsin's mental health laws have been a barrier to the electronic exchange of patient data, especially among healthcare facilities in Madison. Health care providers here have been working with Epic Systems to develop a data exchange structure that originally was expected to “go live” over the summer, but was sidetracked by the objections of mental health advocates.

The proposed changes to state statute 51.30, which mirrored the recommendations of a working group, now move to the Legislature.

Healthcare providers are hoping that enabling legislation can be crafted and adopted in the first quarter of 2008.

Existing law

The eHealth Board adopted the recommendations of a 51.30 work group consisting of people from medical device providers, hospitals, mental health professionals, those who serve the developmentally disabled, and others. The group included Shel Gross, director of public policy for Mental Health America of Wisconsin.

Amendments to 51.30 are designed to eliminate barriers to patient data exchange, improve the ability of healthcare providers to make sound patient care decisions, and reduce variations between Wisconsin law and the federal Health Information Portability and Accountability Act, also known as HIPAA.

Except in limited circumstances, 51.30 now prohibits the disclosure of mental health, alcohol and other drug abuse information, and developmental disability healthcare information to providers for treatment purposes unless consent is obtained from patients or their legally authorized representative.

This consent requirement is considered more stringent than HIPAA and Wisconsin laws governing other types of healthcare information that permit disclosure of patient information for treatment purposes without patient consent.

Modifications cover an agreed-upon set of information that could be exchanged among providers for treatment purposes without patient consent.

The working group recommended disclosure to all treating providers, without patient consent, of the following information: name, address, date of birth, name of mental health provider, date of service(s), diagnosis, medications, allergies, and other relevant demographic information.

Their recommendations also would enable health providers to electronically share diagnostic information such as lab results, imaging, and EKGs. The recommendations also cover symptoms pending confirmation that they are recorded as discrete elements in many electronic medical record systems.

The recommendation does not allow health providers to exchange psychiatric information.

Still up in the air

The 51.30 work group also identified a number of areas where additional action would pave the way for the implementation of proposed changes. The group did not reach a consensus on whether to place statutory limits on which providers receive 51.30 records for treatment purposes without patient consent.

Some members wanted to limit the types of healthcare providers that could receive 51.30 records without patient consent to those that directly interact with a given patient, while others were concerned that such a limitation would not be feasible for electronic data exchange.

The work group also indicated that additional discussion is needed regarding the appropriate sanctions for unauthorized access and disclosure, regular access audits that are not complaint driven, and relevant requirements under HIPAA.

The group felt that Wisconsin statutes related to liabilities and penalties for unauthorized disclosure should be reconsidered in conjunction with the proposed changes to 51.30, perhaps including penalties for inappropriate access or disclosure linked to professional and institutional licensure.

It also asserted that training on all privacy and security standards should be mandated, and that treating providers should be encouraged to participate in anti-stigma training with relevant stakeholders.

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