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  • Robert Rowley, MD | Markle | Advancing America's Future
    Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Robert Rowley MD Independent Health Care Consultant Member Markle Connecting for Health Steering Group Robert Rowley MD is an independent health care consultant He created and developed the early EMR system Medical ChartWizard based on his own need for a more efficient record system As the former Chief Medical Officer at Practice Fusion he guided the development of company s Electronic Health Record system connected with the physician community and ensured that the system progressed in the best interest of doctors Rowley has over 30 years of health care experience He has also accumulated extensive experience in managed care having

    Original URL path: http://www.markle.org/health/experts-impact/1671-robert-rowley-md (2016-02-10)
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  • Seth Cohen | Markle | Advancing America's Future
    Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Seth Cohen Senior Director of Sales Castlight Health Member Markle Connecting for Health Work Group on Consumer Engagement Our Mission Markle works to realize the potential of information technology to address previously intractable public

    Original URL path: http://www.markle.org/health/experts-impact/1670-seth-cohen (2016-02-10)
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  • Steve Lafferty | Markle | Advancing America's Future
    Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Steve Lafferty Director Health Benefits Target Corporation Member Markle Connecting for Health Work Group on Consumer Engagement Steve Lafferty is currently one of the directors of benefits at Target He is responsible for all health and wellness benefits for more than 300 000 Target team members in the U S In addition to overseeing the health and wellness benefit plan design and implementation he is also responsible for the development and implementation of Target s cross company well being strategy Prior to his current role Lafferty had over 16 years of merchandising experience in the retail industry He joined Target in January 2000 and held various positions throughout the organization As Senior Manager of Healthcare Strategy he led a cross company team in the development and implementation of Target s health

    Original URL path: http://www.markle.org/health/experts-impact/1669-steve-lafferty (2016-02-10)
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  • Charles Parker | Markle | Advancing America's Future
    Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Charles Parker Executive Director The Continua Health Alliance Member Markle Connecting for Health Work Group on Consumer Engagement Charles Chuck Parker is the Executive Director of the Continua Health Alliance a membership driven company focused on developing an eco system of interoperable personal health devices He leads the many workgroups and day to day operations of the Alliance Prior to Continua Parker was the Chief Technology Officer and Vice President of Business Development and Marketing at Masspro where his primary duties were developing and managing new business opportunities focused on increasing the adoption of health information technology as well as developing quality measurement and pay for performance systems He has led national programs for practice transformation and has served on national committees for assessing adoption requirements He has been instrumental in developing Quality Measurement programs for CMS the Commonwealth of Massachusetts

    Original URL path: http://www.markle.org/health/experts-impact/1668-charles-parker (2016-02-10)
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  • Resources | Markle | Advancing America's Future
    providers 10 Data accuracy is therefore one of the nine principles underpinning The Markle Connecting for Health Architecture for Privacy in a Networked Health Information Environment 11 Despite the severity of the problem the risks posed by dirty data often go unrecognized in many ways the problem of inaccurate data remains a low priority for companies and organizations 12 It is critical to understand the problem and to develop strategies for minimizing data inaccuracies and the potential harm they cause II Understanding Dirty Data Definitions Causes and Locations Data quality is broadly defined as the totality of features and characteristics of a data set that bear on its ability to satisfy the needs that result from the intended use of the data 13 Data accuracy is one of the foundational features that contribute to data quality14 along with other attributes such as timeliness relevancy representation and accessibility15 In addition data quality has two essential components content i e the information must be accurate and form i e the data must be stored and presented in a manner that makes it usable These definitions are important to keep in mind when considering ways to minimize data inaccuracies as they illustrate why the task of fixing dirty data requires more than merely providing right information Equally important when developing a strategy to increase data quality is identification of the underlying causes of dirty data Two broad categories of errors can be distinguished systematic and random Among the sources of systematic errors are programming mistakes bad definitions for data types or models violations of rules established for data collection poorly defined rules and poor training Random errors can be caused by keying errors data transcription problems illegible handwriting hardware failure e g breakdown or corruption and mistakes or deliberately misleading statements on the part of patients or others providing primary data This is obviously not an exhaustive list but a few examples of the types of errors that may occur It is worth noting that according to the Data Warehousing Institute 76 percent of all errors across sectors and setting result from data entry This suggests the critical role played by human error many of the strategies proposed below therefore focus on reducing the likelihood of human error III Strategies to Address Dirty Data Towards a Data Quality Culture To establish data quality within a health care setting and to prevent data quality errors in the system and limit their consequences health care organizations should develop comprehensive strategies to establish a data quality culture Ideally such strategies should be developed from the outset and be embedded in the design of any networked health information exchange system Organizations can use a variety of tools and techniques to increase the cleanliness of data both at the time of collection and during subsequent processing For the purposes of Markle Connecting for Health data cleanliness efforts should be concentrated on those data elements required by the RLS As the US moves towards widespread data standardization 16 data input quality control can improve the usability and quality of data outputs It should be noted that the documentation of a clinician cannot by law be changed retroactively as this constitutes a change to the documented medical record of an individual adding corrected information is allowed For cases in which data cleansing techniques17 are applicable in health care for example detection not resolution of a single patient with two records these techniques can be automated e g in the form of software packages or involve a human component e g monitoring and training Ultimately a well thought out and comprehensive data quality program should include both automated and human strategies such as Standardize data entry fields and processes for entering data18 Institute real time quality checking including the use of validation and feedback loops19 Design data element to avoid errors for example through the use of check digits and checking algorithms on numeric identifiers where human entry is involved and the use of well designed user interfaces 20 Develop and adhere to guidelines for documenting the care that was provided to the patient21 Review automated billing software Build human capacity including training awareness building and organizational change Each of these strategies will incur certain costs but they are likely to be less expensive than addressing errors resulting from a system designed without data quality features The US health care system has a unique window of opportunity to establish such an internal data quality culture when considering how to adopt health IT systems in the near future These organizational strategies should be complemented by external strategies especially redress mechanisms which encourage identification and correction of errors Redress mechanisms are frequently built into laws and regulations which among other things allow consumers to access and correct errors in personal information In the United States legal systems for redress date back at least to the Fair Credit Reporting Act of 1970 In addition redress is built into the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996 Common redress strategies include Notice of a possible adverse decision using inaccurate data and the procedure for challenging it Access to the information on which the decision is based which is premised on the ability to trace information to its source for verification Opportunity to correct erroneous information and an obligation to correct or delete information that is erroneous Procedures for ensuring that erroneous information does not re enter the system Obligations on data furnishers to respond to requests for reconsideration of data and to take corrective action when justified and Independent administrative or judicial review and enforcement IV Creating a Data Quality Culture Implementation Issues to Consider Implementing a data quality culture as suggested above poses various challenges Without specifying the operational procedures that may be unique to each network design and RLS implementation the following set of questions will need to be addressed Record Locator Service How do data quality concerns affect the RLS and clinical data exchange What are the particular data quality problems likely to afflict the RLS requiring RLS specific interventions How does the network deal with the integrity of data in the RLS itself Who is responsible for these cleaning functions in the network Network versus Participants What are the expectations or requirements for each Participant vis à vis the Network with regard to sustaining a data quality culture Are patients rights to access their records as they pertain to the RLS provided by the Network centrally or does each Network participant offer such a policy individually Should the Network provide universal data audits on RLS fields across all participants flag conflicts and resolve them Should Networks use common training modules and protocols across all participants to address human errors What are the roles of the Network and its participants with regard to cleaning clinical data that is exchanged among participants Patient Empowerment How do patients communicate corrections through the entire system rather than just to the first place they might identify dirty data Are patients or Network participants allowed to complete partial matches by using the RLS to search across the system on the patient s behalf in the interest of improving data quality What are reasonable procedures for rollover and rollback corrections across the system For a definition and description of a Record Locator Service RLS see http www markle org health markle common framework connecting professionals p4 Estimating the precise cost to business is difficult According to Gartner a consultancy at least 25 percent of critical data stored by Fortune 1000 companies is inaccurate and will continue to be so at least through 2007 In addition The Data Warehousing Institute calculates that poor data quality costs US businesses more than 600 billion a year See Leitheiser Robert Data Quality in Health Care Data Warehouse Environments Proceedings of the 34th Hawaii International Conference on System Sciences 2001 p 3 Available at http csdl2 computer org comp proceedings hicss 2001 0981 06 09816025 pdf These are but a few of the figures to suggest the scale of the problem See for instance Leitheiser Robert Data Quality in Health Care Data Warehouse Environments Proceedings of the 34th Hawaii International Conference on System Sciences 2001 p 3 Available at http csdl2 computer org comp proceedings hicss 2001 0981 06 09816025 pdf Aronsky Dominik and Petr Haug Assessing the Quality of Clinical Data in a Computer based Record for Calculating the Pneumonia Severity Index JAMIA 7 55 65 Seddon and Williams Data Quality in the Population Based Cancer Registration An Assessment of the Merseyside and Cheshire Cancer Registry Brit J Cancer 1997 76 5 667 74 Barrie and Marsh Quality of Data in the Manchester Orthopaedic Database Br Med J 1992 304 159 62 Horbar and Leahy An Assessment of Data Quality in the Vermont Oxford Trials Network Database Control Clin Trials 1995 16 1 51 61 See IOM To Err is Human Building a Safer Health System IOM Quality of Healthcare in America Committee 2000 See McDonald Darryl Data Quality Management Oft Overlooked Key to Affordable High Quality Patient Care Whitepaper 7 17 2004 at HCT Project Volume 2 p 1 Available at http www hctproject com documents asp grID 376 d ID 2711 Smith Peter et al Missing Clinical Information During Primary Care Visits JAMA Feb 2 2005 293 5 565 571 Dovey S M et al A Preliminary Taxonomy of Medical Errors in Family Practice Quality and Safety in Health Care 2002 11 233 238 It is important to note that most clinicians are trained to expect errors in the data and in the identity of the patient to whom the data belongs and sometimes demand new tests or order additional tests to confirm a conclusion that might affect a significant clinical decision The study also notes that clinicians saved 30 minutes a month immediately after a data quality improvement program was instituted with trends showing that more time could be saved as time went on See Nicholson R E and Penney D R Quality Data Critical to Healthcare Decision Making Presentation at the 2004 International Federation of Health Records Organizations IFHRO and Annual AHIMA Convention 2004 AHIMA Convention Proceedings Cottrell Carl Medicare Data Study Spotlights Coding Errors Journal of AHIMA 71 no 8 2000 58 59 See for instance Gibbs Martin et al Data Quality Database Fragmentation and Information Privacy Surveillance and Society 3 1 45 58 Available at http www surveillance and society org Articles3 1 data pdf Privacy concerns with regard to medical data often lead to privacy protective behavior that ranges from disclosing wrong or no information to not seeking health care altogether See Markle Connecting for Health The Markle Connecting for Health Architecture for Privacy in a Networked Health Information Environment See Markle Connecting for Health The Markle Connecting for Health Architecture for Privacy in a Networked Health Information Environment Multiple reasons why data quality problems are not addressed can be given These range from low awareness of the cost of data quality problems tolerance for errors to skepticism over ability to improve things and get returns See for instance Olsen Jack Data Quality the Accuracy Dimension Morgan Kaufman Publishers 2003 Page 13 Arts et al op cit p 602 A similar definition is provided by Juran who defines data to be of high quality if they are fit for their intended uses in operations decision making and planning Cited in Redman DM Review p 2 Olsen Jack Data Quality the Accuracy Dimension Morgan Kaufman Publishers 2003 Page 24 Cited in Gendron Michael et al Data Quality in the Healthcare Industry Data Quality September 2001 7 1 p 1 For an interesting analysis of some attempts towards clinical data standards and the challenges for adoption see Kim K Clinical Data Standards in Healthcare Five Case Studies Prepared for California HealthCare Foundation July 2005 Available at http www chcf org publications 2005 07 clinical data standards in health care five case studies For a discussion see Arts et al op cit and Leitheiser op cit See for example Teperi J Multi Method Approach to the Assessment of Data Quality in the Finnish Medical Birth Registry J Epidemiol Community Health 1993 47 3 p 242 7 Gissler M et al Data Quality After Restructuring a National Medical Registry Scand J Soc Med 1995 23 1 p 75 80 See for example de Lusignan Simon Does Feedback Improve the Quality of Computerized Medical Records in Primary Care JAMIA 2002 9 p 395 401 Porcheret Mark Data Quality of General Practice Electronic Health Records The Impact of a Program of Assessments Feedback and Training JAMIA 2004 11 p 78 86 For additional insights in the importance of data element design to prevent errors see Koppel R et al Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors JAMA 2005 293 1197 1203 AHIMA Coding Products and Services Team Managing and Improving Data Quality Updated AHIMA Practice Brief Journal of AHIMA 74 no 7 July August 2003 64A C Markle Connecting for Health thanks Stefaan Verhulst Chief of Research Markle Foundation for drafting this paper 2006 2012 Markle Foundation These works were originally published as part of the Markle Connecting for Health Common Framework Resources for Implementing Private and Secure Health Information Exchange They are made available free of charge but subject to the terms of a License You may make copies of these works however by copying or exercising any other rights to the works you accept and agree to be bound by the terms of the License All copies of these works must reproduce this copyright information and notice Download T5 Background Issues on Data Quality T4 One of two use cases we tested in the Markle Connecting for Health Common Framework prototype was the exchange of laboratory results In order to do so we adopted a format for representation in the network that had the best fit with broad adoption and potential standardization The Laboratory Results schema we used was derived from the ELINCS v2 0 draft specification created by the California Healthcare Foundation 1 The specification can be found at http elincs chcf org specifications aspx There is considerable work on laboratory results standards and we anticipate that there will be future changes to this standard in the near term Because the Common Framework maintains a separation between data description and transport updates to the lab results standard will not require re engineering the network to accommodate the new standard The ELINCS 2 0 version we used is still in draft form The messages as we formatted them had several deviations from the ELINCS implementation guide in its draft form ELINCS prohibits populating many of the PID fields NHIN permits any or all to be populated in query messages and returns most of those values when responding to a query Our own implementation will return most of the contents of the PID segment in the query response with the exception of SSN which we will blank out The ELINCS draft requires a time zone accompanying all date time values while we do not We believe that that requirement will be relaxed in the balloted standard Only the first component of the OBR 15 SPECIMEN SOURCE is allowed to be valued in the ELINCS draft We routinely get very useful specimen source information in all five components of this HL7 field and have allowed them to be populated The draft ELINCS spec requires all units be expressed as UCUM codes We do not expect to see all units expressed in that coding system HL7 permits OBX 14 DATE TIME OF OBSERVATION when test results for some members of a test battery were preformed at a time different from the other members of the test battery ELINCS forbids this value We support it The ELINCS draft limits the value type in OBX results segments to be of type CE code SN structured numeric ST string TX text or FT formatted text HL7 defines a much longer list of allowed value types Our messages also support the longer list for those value types such as DT date etc The ELINCS draft ignores OBX 4 SUB ID for all but microbiology tests Our messages include that value It is useful for formatted reports and for other less common types of data OBR fields for Principal Results Interpreter Assistant Results Interpreter Reason For Study Technician Diagnostic Service Sect ID Danger Code Relevant Clinical Info and Priority are prohibited from being valued in the ELINCS draft Our messages support those values http www chcf org Markle Connecting for Health thanks the Indiana prototype team J Marc Overhage MD PhD Clement McDonald MD and Lonnie Blevins for their implementation efforts on this standard 2006 2012 Markle Foundation These works were originally published as part of the Markle Connecting for Health Common Framework Resources for Implementing Private and Secure Health Information Exchange They are made available free of charge but subject to the terms of a License You may make copies of these works however by copying or exercising any other rights to the works you accept and agree to be bound by the terms of the License All copies of these works must reproduce this copyright information and notice Download T4 Laboratory Results Standards T3 One of two use cases we tested in the Markle Connecting for Health Common Framework prototype was the exchange of medication history In order to do so we adopted a format for representation in the network that had the best fit with broad adoption and potential standardization The Medication History schema we used was derived from the National Council for Prescription Drug Programs NCPDP1 SCRIPT specification version 8 1 as described by RxHub 2 We generated a schema for use in the prototype using the ZixCorp3 XML implementation These Medication History schemae as developed by CSC can be located at https ehr consult csc com cfh There is considerable work on medication history standards and we anticipate that there will be future changes to this standard in the near term Because the Common Framework maintains a separation between data description and transport updates to the medication history standard will not require re engineering the network to accommodate the new standard www ncpdp org http www surescripts com www zixcorp com Markle Connecting for Health thanks the Massachusetts prototype team John Halamka MD Vinod Muralidhar John Calladine and Gail Fournier for their implementation efforts on this standard 2006 2012 Markle Foundation These works were originally published as part of the Markle Connecting for Health Common Framework Resources for Implementing Private and Secure Health Information Exchange They are made available free of charge but subject to the terms of a License You may make copies of these works however by copying or exercising any other rights to the works you accept and agree to be bound by the terms of the License All copies of these works must reproduce this copyright information and notice Download T3 Medication History Standards P8 This document outlines a proposed policy for sub network organizations SNOs regarding breaches of confidentiality of patient data Definitions When used in this policy the following words shall have the definitions indicated A Sub Network Organization SNO shall operate as a health information data exchange organization whether regionally or affinity based that operates as a part of the National Health Information Network NHIN a nationwide environment for the electronic exchange of health information made up of a network of networks Confidentiality shall have the same meaning as in the HIPAA Security Rule which is the property that data or information is not made available or disclosed to unauthorized persons or processes 1 Breach of Confidentiality shall mean that confidential data or information has been made available or disclosed to unauthorized persons or processes Under the HITECH Act there is now a federal definition of Breach Participant shall have the same meaning as in the Markle Connecting for Health Model Contract for Health Information Exchange which is a party that is registered with the SNO to act as a Data Provider and or as a Data Recipient 2 Security incident shall have the same meaning as in the HIPAA Security Rule which is defined broadly and includes attempted or successful unauthorized access use disclosure modification or destruction of information or interference with system operations in an information system 3 Treatment shall have the same meaning as in the HIPAA Privacy Rule which is the provision coordination or management of health care and related services by one or more health care providers including the coordination or management of health care by a health care provider with a third party consultation between health care providers relating to a patient or the referral of a patient for health care from one health care provider to another 4 Executive Summary This proposed SNO policy includes the following A Compliance with HIPAA Security Rule The SNO will comply with the HIPAA Security Rule The SNO Participants will be required to comply with all applicable federal state and local laws B Responsibility of Participants to Train Personnel and Enforce Policy A SNO Participant that may have access to patient data via the SNO network must appropriately train its personnel and inform them that any breach of confidentiality is actionable Each Participant should follow and enforce its own institution s confidentiality policies and disciplinary procedures C Notification of Breach The SNO itself must report any breaches and or security incidents to the particular data provider whose data was improperly used as in most cases the SNO is a business associate of some or all of its Participants Each SNO Participant must agree to inform the SNO of any serious breach of confidentiality but is not required to notify the SNO of minor breaches Note As mentioned earlier any SNO policy should require that the Participants comply with all applicable federal state and local laws which may include laws relating to notification of patients Participants and SNOs should also work towards implementing a system that ensures affected patients are notified in the event of a breach D Withdrawal from the SNO Provisions could be included in SNO agreements relating to withdrawal from the SNO The Markle Connecting for Health Model Contract for Health Information Exchange provides a variety of model provisions that could allow Participants to terminate their participation freely at any time require that termination be preceded by a substantial period of advance notice or require that Participants maintain their participation for a certain period of time The Markle Connecting for Health Model Contract for Health Information Exchange also provides a model provision allowing for a Participant to withdraw from a SNO if a serious breach of its patient data has occurred 5 SNOs and Participants are encouraged to consider the particular circumstances of small provider practices in developing relevant terms for withdrawal from SNO provisions in their SNO agreements E Indemnification for Breaches of Confidentiality The Markle Connecting for Health Model Contract for Health Information Exchange provides a variety of model provisions concerning indemnification A SNO may also choose to adopt special rules governing indemnification for particular situations such as a breach of confidentiality of protected health information For example the SNO s agreement could provide for mutual indemnification between all Participants for breaches of confidentiality of patient data with the scope of the indemnification to be determined by the SNO Detailed Discussion and Sample Contract Language Compliance with HIPAA Security Rule The SNO should comply with the HIPAA Security Rule and thus do the following 1 ensure the confidentiality integrity and availability of all electronic protected health information the SNO creates receives maintains or transmits 2 protect against any reasonably anticipated threats or hazards to the security and integrity of such information 3 protect against any reasonably anticipated uses or disclosures of such information that are not permitted or required under HIPAA and 4 ensure compliance with this regulation by its workforce 6 Of course the SNO must also comply with other applicable federal state and local laws 7 Any SNO participation or vendor agreement should also require that the other parties comply with all applicable federal state and local laws 8 Responsibility of Participants to Train Personnel and Enforce Policy The SNO policy should mandate that the SNO Participant appropriately train its personnel9 and inform its personnel that any breach of confidentiality is actionable See relevant sample contract excerpt below 10 Section 4 04 Access to Information By Participants Personnel Each Participant shall determine the personnel under its control including any personnel of physician practice groups allowed to access Information pursuant to Section 4 01 b who may have access to patient data via the Network For Participants who are technically able to do so each Participant shall provide daily electronic files to the SNO of the individuals it designates under this Section If such electronic notice is not feasible each Participant shall provide lists of such individuals through e mail hard copy or facsimile to the SNO no less frequently than biweekly Each Participant shall certify a That such designated personnel have received training regarding the confidentiality of PHI under the Privacy Rule and all other applicable State and local laws and agree to protect the Information in compliance with the Privacy Rule such laws and this Agreement b That such designated personnel shall only access the Network for allowable purposes c That such designated personnel have agreed to hold any passwords or other means for accessing the Network in a confidential manner and to release them to no other individual d and e That such designated personnel agree and understand that their failure to comply with the terms of this Agreement may result in their exclusion from the Network and may constitute cause for disciplinary action by the Participant Further the SNO may also want to require that the SNO Participant enforce these confidentiality provisions by appropriately disciplining its personnel No specific policy is set at the SNO level for Participants 11 because each Participant should already have its own confidentiality policies and disciplinary procedures within its organization See relevant sample contract excerpt below Section 5 02 Enforcement of Confidentiality by Participants Each Participant agrees to enforce the confidentiality provisions of this Agreement by appropriately disciplining individuals within each Participant s organization who violate the confidentiality of the Information pursuant to each Participant s respective confidentiality and disciplinary policies Such discipline may include but not be limited to warnings suspensions termination or modification suspension or revocation of medical staff privileges Notification of Breach Notification of breach of confidentiality of patient data is impacted not only by HIPAA laws but also by state breach notification laws that are becoming more common Thus any SNO policy should require that the Participants and the SNO itself comply with all applicable federal state and local laws In addition the SNO must report any breaches to the particular data provider whose data12 was improperly used This would not be limited to serious breaches but would include all breaches Most SNOs will be a business associate of the Participants who provide patient data to the SNO in which case the SNO is required under HIPAA to report all Security Incidents to the covered entity 13 See relevant sample contract excerpts below 14 Section 8 03 Report of Improper Use or Disclosure The SNO agrees promptly to report to a Participant any use or disclosure of the Participant s PHI not provided for by this Agreement of which the SNO becomes aware and Section 8 14 HIPAA Security Rule Provisions a b The SNO agrees promptly to report to a Participant any Security Incident related to the Participant s ePHI of which the SNO becomes aware Similarly each Participant must agree to inform the SNO of any serious breach of confidentiality It is not necessary for a Participant to inform the SNO of minor breaches of confidentiality unless there is otherwise a legal duty to disclose such breaches to the SNO While it is difficult to define what would rise to the level of a serious breach SNOs and Participants might decide that the breaches of concern would be ones that impact 1 the viability of the network 2 the trust that other Participants have in each other or 3 the legal liability of the SNO In addition SNOs and Participants might decide that repeated minor breaches that demonstrate a pattern of lax internal operations or enforcement may also rise to the level of a serious breach See relevant sample contract excerpt below Section 5 01 Confidentiality The Participants agree that any Information obtained from the Network will be kept confidential pursuant to the Privacy Rule and all other applicable federal state and local laws statutes and regulations as well as each Participant s own rules and regulations governing the confidentiality of patient records and information Participants agree to report promptly to the Management Committee any serious breach of the confidentiality of the Information of which it becomes aware As mentioned above some states have enacted laws that require the notification of individuals whose personal data is compromised 15 Several federal bills have also been introduced that include breach notification which could pre empt state law if and when enacted 16 SNOs must analyze any relevant state laws in this regard and what impact such laws may have on the SNO s operations For example a state law may require that a SNO notify a covered entity Participant of a breach but the burden to notify patients may fall on the covered entity Participant rather than the SNO In any event procedures need to be in place that will address this scenario in advance of an event Communities should be prepared to comply with evolving national norms regarding breach notification and Participants and SNOs should work towards implementing a system that ensures affected patients are notified in the event of a breach Withdrawal from the SNO SNOs may wish to consider including a provision in their Participant agreements allowing for withdrawal from the SNO As noted above the Markle Connecting for Health Model Contract for Health Information Exchange provides a variety of model provisions that could allow Participants to terminate their participation freely at any time require that termination be preceded by a substantial period of advance notice or require that Participants maintain their participation for a certain period of time 17 In general SNOs and Participants are encouraged to consider the particular circumstances of small provider practices in developing relevant terms for withdrawal from SNO provisions in their SNO agreements The Markle Connecting for Health Model Contract for Health Information Exchange also provides a model provision allowing for a Participant to withdraw from a SNO if a serious breach of its patient data has occurred as described here See relevant sample contract excerpt below Section 12 03 Withdrawal of a Participant The following shall constitute adequate cause for the withdrawal from this Agreement a A significant breach of another Participant s duties of confidentiality under ARTICLE V of this Agreement with regard to Information stored on or transmitted over the Network by the withdrawing Participant or a significant breach of the SNO s duties under ARTICLE VII or ARTICLE VIII with regard to Information stored on or transmitted over the Network by the withdrawing Participant provided that the Participant has allowed a reasonable time for the SNO to cure any such significant breach Any claim of a significant breach by a Party shall be submitted to the Management Committee which will determine pursuant to Section 10 02 of this Agreement whether a claimed breach is significant enough to constitute cause under this Agreement This determination shall be an advisory opinion and shall not be binding on any party to this Agreement and shall not act as a waiver or determination of any Party s rights under federal state or local laws In a vote to determine whether a breach is significant the complaining party ies and the alleged breaching party ies shall not participate Whether the SNO should have a mechanism for termination of a Participant for significant breaches of confidentiality could be an item for further discussion among Participants and SNOs This typically would not be a problem in a model where individual users are not Participants but rather are part of a Participant s workforce Thus the Participant s own internal policies would be invoked in the event of a breach of patient data by the individual user The Markle Connecting for Health Model Contract for Health Information Exchange includes several model provisions that could allow for a SNO to terminate a Participant s Registration Agreement including a model provision allowing for termination for cause Indemnification for Breaches of Confidentiality Indemnification provisions may or may not be included in a SNO agreement As noted above the Markle Connecting for Health Model Contract for Health Information Exchange provides a variety of model provisions concerning indemnification 18 A SNO may also choose to adopt special rules governing indemnification for particular situations such as a breach of confidentiality of protected health information For example the SNO s agreement could provide for mutual indemnification between all Participants for breaches of confidentiality of patient data with the scope of the indemnification to be determined by the SNO See relevant sample contract excerpt below 19 Section 12 03 Indemnification by Participants A Participant that breaches the confidentiality of the Information or submits inaccurate incomplete or defamatory data to the Network Breaching Participant agrees to indemnify and hold harmless any other Party against whom any claim or cause of action is brought Sued Party by any individual arising out of or resulting from such breach of confidentiality or submission of inaccurate incomplete or defamatory data by the Breaching Participant or any individual for whom such Participant is responsible Such indemnification shall include the payment of all costs associated with defending such claims or causes of action whether such claims or causes of action are meritorious including reasonable attorney fees and any settlement by or judgment against the Sued Party arising out of or resulting from any breach of confidentiality of the Information or the submission of inaccurate incomplete or defamatory data to the Network by the Breaching Participant or any individual for whom such Participant is responsible In the event a suit is brought against the Sued Party under circumstances where this Section applies the Breaching Participant at its sole cost and expense shall defend the Sued Party in such suit if written notice thereof is promptly given to the Breaching Participant within a period wherein the Breaching Participant is not prejudiced by lack of such notice If the Breaching Participant is required to indemnify and defend it will thereafter have control of such litigation but the Breaching Participant may not settle such litigation without the consent of the Sued Party which consent shall not be unreasonably withheld This Section is not as to third parties a waiver of any defense or immunity otherwise available to the Sued Party and the Breaching Participant in defending any action on behalf of the Sued Party shall be entitled to assert in any action every defense or immunity that the Sued Party could assert in its own behalf SNO Participants might also require that the SNO have an obligation of indemnification in its role as Business Associate and or as administrator of the network See relevant sample contract excerpt below Section 12 04 Indemnification by the SNO The SNO agrees to indemnify and hold harmless any other Party against whom any claim or cause of action is brought Sued Party by any individual arising out of or resulting from any breach of confidentiality of the Information whether through disclosure or through acts or omissions in the design and or maintenance of the Network by the SNO or any individual for whom the SNO is responsible Such indemnification shall include the payment of all costs associated with defending such claims

    Original URL path: http://www.markle.org/resources/rework-america/video/about-markle/event/general-markle-financial-information/health/rework-america/video/economic/commentary-rework-america-members?term_node_tid_depth=All&tid_1=All&date_filter[value]=&page=20&tid=All (2016-02-10)
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  • A New Main Street | Markle | Advancing America's Future
    Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos A New Main Street Publication Date Tuesday January 1 1991 In this essay former Markle president Lloyd N Morrisett reflected on the Main Street of his childhood and the potential of using television to build a sense of community by recreating Main Street on a national level and improving voter education during presidential election

    Original URL path: http://www.markle.org/publications/962-new-main-street (2016-02-10)
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  • Is Overreliance on Technical Standards Undermining Efforts to Use IT to Transform the U.S. Health System? | Markle | Advancing America's Future
    Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Is Overreliance on Technical Standards Undermining Efforts to Use IT to Transform the U S Health System Publication Date Friday August 1 2008 Publication Source Health Affairs Considers whether efforts on technology standards absent alignment of policy objectives and financial incentives is magical thinking and reports that the nation s health IT coordinator and colleagues say the current policy strikes the right balance Is Overreliance

    Original URL path: http://www.markle.org/health-it-and-recovery-act-health/overreliance-technical-standards-undermining-efforts-use-it (2016-02-10)
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  • Health Information Exchange: ‘Lex Parsimoniae’ | Markle | Advancing America's Future
    Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos About Markle Page Sections About Markle A Message from Zoë Baird Our Principles Our Impact Board of Directors Senior Team Our History Quick Links Conference Space Events Markle in the News Media Releases Past Initiatives President s Letters Rework America Page Sections About Rework America A Message from Rework America Opportunity for All Our Impact Initiative Members Expert Advisors Quick Links Rework America Connected Our Book America s Moment Initiative Overview Latest News Letters to Members Member Commentary Personal Stories Rework America Library Health Page Sections About Health Our Impact Steering Group Consumer Work Group HIE Committee Quick Links Blue Button Common Framework Health IT Health Library National Security Page Sections About National Security Post 9 11 Legacy Our Impact Task Force Quick Links National Security Library Reports and Recommendations Sharing and Collaboration The Lawfare Blog Library Quick Links Our Book America s Moment Archive Media Releases Member Commentary President s Letters Videos Health Information Exchange Lex Parsimoniae Publication Date Wednesday August 1 2007 Publication Source Health Affairs Article covers the health information exchange HIE it s details and how it will change America should it be fully integrated by creating a consistent network of networks across the country Health Information Exchange Lex Parsimoniae

    Original URL path: http://www.markle.org/common-framework-health/health-information-exchange-lex-parsimoniae (2016-02-10)
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