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  • Consumer Policy Brief | Markle | Advancing America's Future
    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 Consumer Policy Brief Markle Common Framework for Networked Personal Health Information Publication Date Wednesday June 25 2008 Publication Source Markle This policy brief explores how Millie a 21st Century consumer would benefit under a Common Framework to help her obtain and control electronic copies of her personal health information and connect to health information services Her character illustrates the needs of millions of U S adults who could benefit from greater connectivity in health and health care The brief provides an

    Original URL path: http://www.markle.org/publications/855-consumer-policy-brief (2016-02-10)
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  • Consumer Technical Brief | Markle | Advancing America's Future
    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 Consumer Technical Brief Markle Common Framework for Networked Personal Health Information Publication Date Wednesday June 25 2008 Publication Source Markle This policy brief explores how Millie a 21st Century consumer would benefit under a Common Framework to help her obtain and control electronic copies of her personal health information and connect to health information services Her character illustrates the needs of millions of U S adults who could benefit from greater connectivity in health and health care The brief provides

    Original URL path: http://www.markle.org/publications/856-consumer-technical-brief (2016-02-10)
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  • Common Framework for Networked Personal Health Information: Statement of Support | Markle | Advancing America's Future
    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 Common Framework for Networked Personal Health Information Statement of Support Publication Date Wednesday June 25 2008 Publication Source Markle Consumers need to be full participants in modern health information tools and services to help them prevent illness communicate better with clinicians understand costs and treatment options make better health decisions and take better care of loved ones The Markle Connecting for Health Common Framework for Networked Personal Health Information defines a set of practices that when taken together can enhance consumer participation and protect personal information AARP Aetna Allscripts American Academy of Family Physicians American College of Cardiology American College of Emergency Physicians American College of Physicians American Medical Association America s Health Insurance Plans Association of Cancer Online Resources ACOR org BlueCross BlueShield Association CareGroup Healthcare System Carestream Health Inc Center for Democracy and Technology Center on Medical Record Rights and Privacy Cisco Systems Inc Computer Sciences Corp Consumers Union Dossia DrFirst FollowMe Geisinger Health System

    Original URL path: http://www.markle.org/publications/869-common-framework-networked-personal-health-information-statement-support (2016-02-10)
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  • Visioning Scenarios | Markle | Advancing America's Future
    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 Visioning Scenarios Health Decision Making Circa 2015 Publication Date Friday September 21 2007 A description of an ideal state circa 2015 in which health professionals consumers and others are connected across a secure network that supports decision making based on timely access to meaningful health information Read the Visioning Scenarios

    Original URL path: http://www.markle.org/publications/880-visioning-scenarios (2016-02-10)
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  • Policies in Practice Overview | Markle | Advancing America's Future
    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 Policies in Practice Overview Providing individuals access to their own information is well rooted in Fair Information Practice Principles FIPPs and a basic expectation for health IT Convenient access to one s own personal health information serves as a building block to helping people lead healthier lives and get higher quality more cost effective care The Markle Connecting for Health Common Framework for Networked Personal Health Information released in 2008 recommends practices that encourage appropriate handling of personal health information as it flows to and from electronic personal health records PHRs and similar applications or supporting services It is built upon a set of FIPPs based core principles that provide the foundation for managing personal health information within consumer accessible data streams The Markle Common Framework approach has been applied to create two bodies of work related to the following specific health information technology IT contexts The Markle Common Framework for Private and Secure Health Information Exchange released in 2006 The Markle Common Framework for Networked Personal Health Information released in 2008 Purpose Helps health information networks to share information among their members and nationwide while protecting privacy and allowing for local autonomy and innovation Purpose Recommends practices that encourage appropriate handling of personal health information as it flows to and from electronic PHRs and similar applications or supporting services Focus Specific to the context of the electronic exchange of patient information among health professionals and health care entities Focus Specific to the context of connecting individuals online to their own information such as via electronic PHRs or to other health related services and applications that use the individual s personal health information The Markle Connecting for Health Common Framework Policies in Practice for Networked Personal Health Information Policies in Practice is an addendum to the Markle Common Framework for Networked Personal Health Information The Policies in Practice were developed through a collaborative process by a diverse group of health care leaders with hands on experience implementing or using consumer access services including technology experts consumer representatives and health care providers The Policies in Practice address the following areas Policies in Practice The Download Capability Outlines the basic requirements for giving patients access to personal health information through a download capability Consumer Policy Brief Explores how Millie a fictitious 21st Century consumer would benefit under a Common Framework to help her obtain and control electronic copies of her personal

    Original URL path: http://www.markle.org/health/markle-common-framework/connecting-consumers/policies-practice-overview (2016-02-10)
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  • Individual Access | Markle | Advancing America's Future
    providers payers pharmacies self insured employers to new entrants to the health sector e g technology companies employer coalitions or state or regional health information sharing efforts The Markle Common Framework for Networked Personal Health Information is intended for any organization providing consumer access services regardless of whether it is covered by the Health Insurance Portability and Accountability Act HIPAA a business associate of a HIPAA covered entity or outside of the HIPAA regulatory purview The Markle Common Framework approach has been applied to create two bodies of work related to the following specific health information technology IT contexts The Markle Common Framework for Private and Secure Health Information Exchange released in 2006 The Markle Common Framework for Networked Personal Health Information released in 2008 Purpose Helps health information networks to share information among their members and nationwide while protecting privacy and allowing for local autonomy and innovation Purpose Recommends practices that encourage appropriate handling of personal health information as it flows to and from electronic PHRs and similar applications or supporting services Focus Specific to the context of the electronic exchange of patient information among health professionals and health care entities Focus Specific to the context of connecting individuals online to their own information such as via electronic PHRs or to other health related services and applications that use the individual s personal health information Health information sharing efforts should implement all the elements of the Markle Connecting for Health Common Framework for Private and Secure Health Information Exchange for electronic exchange of patient information among health professionals and health care entities If a health information sharing effort is also going to play a role in helping providers give patients access to their own information then the policies and practices of the Markle Common Framework for Networked Personal Health Information should also be applied to address the specific function of connecting individuals online to their own information As we outline in Questions 2 and 4 below many health information sharing efforts are contemplating access for individuals through a variety of models including service models for participating doctors and hospitals to attain the patient engagement requirements of the Meaningful Use MU financial incentives Back to top II Why is consumer access important and how are health information sharing efforts considering a role in helping to provide access for individuals Providing individuals with access to information captured about them is well rooted in Fair Information Practice Principles FIPPs and is a basic expectation for health IT Convenient access to one s own personal health information is a building block to helping people live healthier lives and get higher quality and more cost effective care Roughly two thirds of the American public and doctors support an individual s ability to view and download his her personal health information online according to a recent Markle Survey on Health in a Networked Life 2 By giving individuals convenient access to copies of their own information organizations can help patients communicate better with health care providers and take an active role in transforming health care Network enabled efficiencies and safety improvements are more likely to occur if individuals and health care professionals act as partners who share access to and responsibility for updating personal health information We describe this potential in the Markle Common Framework Consumers as Network Participants Juan Alaniz Washington State Just as the goal for providers is not just acquisition of health IT it s about them using health IT to transform how they deliver health care For consumers the goal is not just that they access their health information electronically The goal is that by putting consumers in the driver s seat they can become direct participants in their care in collaboration with their physicians and they can help direct how their health care will be delivered In the last few years several factors have accelerated the effort to connect consumers to their health care providers and their own information As in other sectors many health entities such as integrated delivery networks and health insurers recognize the value of and are emphasizing online connections with consumers to improve service lower administrative costs and remain competitive The Health Information Technology for Economic and Clinical Health HITECH Act established that individuals have the right to obtain electronic copies of their information held in electronic health records EHRs The MU requirements under HITECH also have placed priority on patient access and engagement for providers and hospitals to qualify for federal financial incentives Section 13405 e of HITECH established an individual s right to request information in electronic format from EHRs and have it sent to a service of the individual s choosing Although there may be varying interpretations as to whether this provision applies specifically to state or regional health information sharing efforts it clearly establishes the basic expectation that health IT will help foster individual access to personal health information The MU requirements of the EHR Incentives Program include the delivery of electronic copies of personal health information to patients For Stage 2 of this program it has been proposed that patients should be able to view and download their information from participating providers and hospitals Similarly patient engagement is likely to be a focus for emerging requirements for Accountable Care Organizations ACOs within the Medicare Shared Savings Program Individual access is also addressed in a March 2012 Program Information Notice titled Privacy and Security Framework Requirements and Guidance for the State Health Information Exchange Cooperative Agreement Program released by the Office of the National Coordinator for Health Information Technology ONC As a result of all of these factors several health information sharing efforts are seeking ways to help participating providers and hospitals fulfill these MU and health care reform requirements These health information sharing efforts are contemplating how to enable providers achievement of these requirements in a variety of ways For example some will seek to provide secure access directly to individuals to retrieve information such as medication lists or past lab results from doctors and hospitals Alternatively some may supply such information to the providers EHRs which in turn offer online access to individuals through secure online patient portals or electronic PHRs Yet another opportunity to provide individuals with access to their own health information is via secure e mail In all cases the provider would have a primary role in engaging patient participation which could help satisfy some of the requirements of these programs Notably a health information sharing effort does not have to aggregate an individual s information in order to provide a useful service Simply providing basic information such as record location services can be useful to both participating providers as well as patients The information a health information sharing effort is able to make available to patients will reflect its larger structure and organization and should respect the meaningful decisions individuals have made with the providers or entities with whom they have a relationship about whether and how to share their health share their information Regardless of the ways in which consumers may be ultimately given access to their personal health information such access must be implemented with careful policies and practices in place to protect personal health information and earn the trust of the public and providers Back to top III What are the components of the Framework and how can they be incorporated in the procurement process for personal health information services The Markle Common Framework for Networked Personal Health Information is built upon a set of core principles that provide the foundation for managing personal health information within consumer accessible data streams These principles are based on accepted FIPPs Each principle must be contextualized into a set of policy and technology practices that together protect privacy and enhance trust All such policy and technology practice areas must be addressed in a sound and public way to provide adequate protections to consumers and to encourage trust across a network See Appendix A for the principles and Appendix B for the practice areas A useful resource to implement the Markle Common Framework for Networked Personal Health Information is the detailed due diligence Policy and Technology Checklists for Procurers and Implementers These tools were derived by analyzing the recommendations of each practice area then developing a set of detailed questions that can be used as a checklist of recommended policy practices which may be used in requests for information RFI requests for proposals RFP procurement requirements or policy development discussion guides Back to top IV What is a good starting point for individual access The ability for individuals to log in securely online to view and download pertinent health information such as what is required for patient engagement under Meaningful Use is a good starting place for enabling individual access The Markle Connecting for Health public private collaboration has emphasized the download capability as a critical building block for patient engagement and market innovation 3 Implementing the online view and download capability for patients is not the same as developing and implementing a fully functional PHR The basic requirements begin with secure online access meaning that the identity of each individual given credentials to access his or her own data must be proofed to an acceptable level of accuracy and the individual must present an acceptable token e g unique username and password combination upon login to get access to the data for view and or to download Establishing an individual s identity and issuing authentication tokens for network access can be a significant barrier for health information sharing efforts or any entity that does not have a direct relationship with the patient The solutions will depend on the relationship that the entity has with patients or whether it can bootstrap identity proofing performed at participating provider organizations or other organizations that may have a relationship with the consumers The CT2 guide of the Markle Common Framework for Networked Personal Health Information has a detailed set of recommendations regarding identity proofing and monitoring authentication tokens and reliance on third parties for such services The second basic requirement is that logged in individuals be able to view and download key information about themselves in human readable formats The MU patient engagement data sets are a good place to start such as problem and medication lists allergies laboratory results and clinical visit summaries from eligible providers and hospital discharge instructions from eligible hospitals Any entity offering the download capability should obtain independent confirmation from the individual i e such as a yes response to a question that the individual wants to download a copy of personal health information Such independent confirmation should be obtained after presenting the individual with at a minimum the following clearly stated information Health records can contain sensitive information If you download sensitive information to a shared or unsecured computer or device others might see it You are responsible for protecting the information that you download and for deciding with whom to share it Are you sure you want to download a copy of your personal health information to the computer or device you are using With respect to download formats human readability is the minimum requirement Additionally if the data are available in the standardized clinical summary formats endorsed as MU standards i e CCD or CCR the patient should have an option to download that data in those formats The bottom line requirement for human readability ensures that people will not need to use a specific application or service to see their own health information They should have the option of viewing and downloading their information in human readable form through ubiquitous Internet browsers and common software formats e g text spreadsheet or PDF By human readable we mean information viewable and downloadable online should be in English or other language common to a provider s majority population of patients It is ideal for the terminology to be as patient friendly and free of medical jargon as possible as well as translated into languages common to a provider s patient population However we do not recommend strict requirements for how understandable the information must be to patients at this time It is more important to make the information available securely and conveniently online The important distinction of a basic view and download capability is that the entity providing it does not also necessarily have to do the hard work of developing applications that allow consumers to use or manipulate their own health information Once individuals download their information they have the opportunity to choose from a variety of different services or offerings to manage and use the information further The experience at the U S Department of Veterans Affairs VA and with the Medicare and TRICARE programs demonstrate that the basic capability has value to patients and can spur private sector innovation When the VA enabled patients to download their information the private sector responded by demonstrating a wide range of applications that made that information useful to patients making it easier to know when to take medications storing medical images and connecting with peers who have similar health conditions As the download capability becomes a common feature individuals may have a need for proxy services to organize and regularly update their personal health information The Markle Common Framework Policies in Practice The Download Capability provides specific recommendations for health information sharing efforts and other data holders to enable patients to download their information as well as policy considerations for enabling secure automated downloads through a variety of services Back to top Appendix A The Markle Common Framework for Networked Personal Health Information consists of Consumer Policy CP and Consumer Technology CT guides it is a hallmark of the approach that policy and technology work together interdependently Here are the nine principles and their corresponding guides CORE POLICY PRINCIPLES MARKLE COMMON FRAMEWORK FOR NETWORKED PERSONAL HEALTH INFORMATION PRACTICE AREAS 1 Openness and transparency Consumers should be able to know what information has been collected about them the purpose of its use who can access and use it and where it resides They should also be informed about how they may obtain access to information collected about them and how they may control who has access to it CP2 Policy Notice to Consumers 2 Purpose specification The purposes for which personal data are collected should be specified at the time of collection and the subsequent use should be limited to those purposes or others that are specified on each occasion of change of purpose CP2 Policy Notice to Consumers CP3 Consumer Consent to Collections Uses and Disclosures of Information CT4 Limitations on Identifying Information 3 Collection limitation and data minimization Personal health information should only be collected for specified purposes and should be obtained by lawful and fair means The collection and storage of personal health data should be limited to that information necessary to carry out the specified purpose Where possible consumers should have the knowledge of or provide consent for collection of their personal health information CP2 Policy Notice to Consumers CP3 Consumer Consent to Collections Uses and Disclosures of Information CT4 Limitations on Identifying Information 4 Use limitation Personal data should not be disclosed made available or otherwise used for purposes other than those specified CP2 Policy Notice to Consumers CP3 Consumer Consent to Collections Uses and Disclosures of Information CP7 Discrimination and Compelled Disclosures CT3 Immutable Audit Trails CT4 Limitations on Identifying Information 5 Individual participation and control Consumers should be able to control access to their personal information They should know who is storing what information on them and how that information is being used They should also be able to review the way their information is being used or stored CP3 Consumer Consent to Collections Uses and Disclosures of Information CP5 Notification of Misuse or Breach CP7 Discrimination and Compelled Disclosures CP8 Consumer Obtainment and Control of Information CT3 Immutable Audit Trails CT5 Portablility of Information 6 Data quality and integrity All personal data collected should be relevant to the purposes for which they are to be used and should be accurate complete and up to date CP6 Dispute Resolution CP8 Consumer Obtainment and Control of Information CT2 Authentication of Consumers CT3 Immutable Audit Trails 7 Security safeguards and controls Reasonable safeguards should protect personal data against such risks as loss or unauthorized access use destruction modification or disclosure CP5 Notification of Misuse or Breach CT2 Authentication of Consumers CT4 Limitations on Identifying Information CT6 Security and Systems Requirements CT7 An Architecture for Consumer Participation 8 Accountability and oversight Entities in control of personal health information must be held accountable for implementing these principles CP4 Chain of Trust Agreements CP5 Notification of Misuse or Breach CP6 Dispute Resolution CP9 Enforcement of Policies CT3 Immutable Audit Trails 9 Remedies Remedies must exist to address security breaches or privacy violations CP5 Notification of Misuse or Breach CP6 Dispute Resolution CP9 Enforcement of Policies Back to top Appendix B Consumers as Network Participants Explains why consumer participation can be transformative in health care as it has been in other sectors why networked personal health records PHRs are a vital tool to empowering consumers and how policies can help guide an emerging industry CP1 Policy Overview Describes the policy landscape including how the Health Information Portability and Accountability Act HIPAA as well as state and contract laws apply to emerging consumer data streams Explains unregulated and regulated areas of the current environment and argues for a voluntary common framework of policies CP2 Policy Notice to Consumers Recommends preferred practices for giving consumers access to the policies for collection use and disclosures of personal health information including privacy and security practices terms and conditions of use and other relevant policies CP3 Consumer Consent to Collections Uses and Disclosures of Information Describes mechanisms to capture the consumer s agreement prior to any collection use or disclosure of personal data explains why notice and consent are not sufficient by themselves in providing adequate protection for

    Original URL path: http://www.markle.org/health/markle-common-framework/connecting-professionals/individual-access (2016-02-10)
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  • FAQs | Markle | Advancing America's Future
    and deployment of technology and in an ongoing manner Both policy and technology evolve with new information sharing needs and objectives and therefore will remain important objectives Back to top How has the landscape changed since release of the Markle Common Framework The health information sharing landscape has changed dramatically since release of the Markle Common Framework in 2006 Over recent years the level of federal leadership new regulation and public investment around health information sharing have increased substantially In addition use of health IT has grown among providers and individuals alike Early efforts to establish an infrastructure for health information sharing were bolstered in 2004 through an Executive Order which established the Department of Health and Human Services HHS Office of the National Coordinator for Health Information Technology ONC and made possible efforts for standards harmonization use case development and the certification of electronic health record EHR products By 2006 the health care sector was struggling to overcome challenges of policy technology and capital investment to advance health information sharing Adoption of health IT in clinical settings was weak In 2006 only 29 2 percent of physicians reported any electronic medical record EMR or EHR in their office based practice 10 An EMR EHR is a medical or health record system that is either all or partially electronic excluding systems solely for billing That same year 26 health information exchanges HIEs reported being operational and transmitting data for use by their health care stakeholders 11 Enactment of the HITECH Act in February 2009 marked a new level of federal leadership regulation and investment for health information sharing Aiming to address many of the challenges facing the health care sector the HITECH Act codified into law the U S Department of Health and Human Services HHS Office of the National Coordinator for Health Information Technology ONC established federal advisory committees to advise ONC on policy and standards decisions invested in state HIE set forth an EHR incentives program for Medicare and Medicaid providers established new initiatives to support the education and training of the health IT workforce modified particular aspects of the Health Insurance Portability and Accountability Act of 1996 HIPAA and established new programs to foster individual engagement with health IT On the heels of the HITECH Act broad scale health care reform legislation the Patient Protection and Affordable Care Act of 2009 ACA was enacted Aspects of ACA aim to further leverage health IT in efforts to transform health care For example it calls for the creation of a Shared Savings Program to deliver seamless high quality care for Medicare beneficiaries through Accountable Care Organizations ACOs which must apply health IT in order to meet care coordination requirements Recent investments have recognized health IT and health information sharing as critical to improving the quality and efficiency of health care in the U S as reflected by rising adoption rates Preliminary data indicate that 43 9 percent of physicians reported any EMR EHR in their office based practice in 2009 12 By 2011 85 HIEs were reported to be operational 13 A recent Markle Survey on Health in a Networked Life uniquely compares the core values of physicians and patients on deployment of IT in health care Seventy four percent of doctors surveyed said that they would prefer computer based means electronic networks secure email or portable storage devices to paper and fax when sharing patient information with each other Up to 74 percent of doctors agreed that patients should be able to share information with their doctors electronically At least 59 percent of the public agreed with this statement The survey results also indicate that personal health record PHR adoption is on the rise with 10 percent of the surveyed public reporting having a PHR in 2010 compared to 3 percent in 2008 14 Back to top How does the Markle Common Framework align with state and federal efforts Since its release in 2006 health information sharing efforts have used the Markle Common Framework to develop architecture specifications and policies for the private and secure sharing of health information Many states cite the Markle Common Framework in their operational and strategic plans to ONC as part of the State HIE Cooperative Agreement Program States also refer to the Markle Common Framework in their online policy and technology materials 15 The Markle Common Framework is also closely aligned with federal policy efforts For example the EHR incentive program reflects many elements of the Markle Common Framework setting forth minimum necessary standards to allow for flexibility and innovation within the marketplace as well as requiring the submission of aggregate quality data to minimize risk of exposing patient data 16 17 In the area of population health ONC recently announced new efforts to explore and further the application of distributed networks 18 The important role of foundational principles policies and practices like those of the Markle Common Framework in supporting the trusted sharing of health information is recognized by the federal government For example in March 2012 ONC released a Program Information Notice titled Privacy and Security Framework Requirements and Guidance for the State Health Information Exchange Cooperative Agreement Program that builds upon the Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information and sets forth guidance centered on FIPPs based principles for states to apply in developing their privacy and security policies and practices In addition the Health IT Task Force a joint initiative of the ONC and Office of Management and Budget called for select federal agencies to coordinate health IT investments around a shared set of policy and technology principles to maximize the benefits of health IT In September 2010 Vivek Kundra the Federal Chief Information Officer and David Blumenthal the National Coordinator for Health IT articulated a set of policy and technology principles for agencies to use as a guide in planning for and using health IT investments that emphasized five principles Improve health and health care Promote open government and provide patients with a secure timely electronic copy of their own information Share health information between providers Protect privacy and security aligning with FIPPs and Use a distributed data architecture versus centralized data warehouses 19 Back to top How does the Markle Common Framework for Private and Secure Health Information Exchange relate to the Markle Common Framework for Networked Personal Health Information The Markle Common Framework approach based on Fair Information Practice Principles FIPPs has been applied to create two bodies of work These two frameworks share the same foundational attributes and principles The variation in the frameworks is how these principles are specifically applied in two different information sharing contexts as outlined below The Markle Common Framework for Private and Secure Health Information Exchange released in 2006 The Markle Common Framework for Networked Personal Health Information released in 2008 Purpose Helps health information networks to share information among their members and nationwide while protecting privacy and allowing for local autonomy and innovation Purpose Recommends practices that encourage appropriate handling of personal health information as it flows to and from electronic PHRs and similar applications or supporting services Focus Specific to the context of the electronic exchange of patient information among health professionals and health care entities Focus Specific to the context of connecting individuals online to their own information such as via electronic PHRs or to other health related services and applications that use the individual s personal health information Back to top Appendix A Each of the Policies in Practice and the Policy and Technology Guides of the Markle Common Framework for Private and Secure Health Information Exchange Markle Common Framework addresses a subset of relevant core policy and technology principles The tables in this Appendix identify each resource and its corresponding core policy and technology principles Markle Connecting for Health Core Policy Principles Markle Connecting for Health has published a set of policy principles that provide the foundation for privacy and health information technology IT in a networked environment The Markle Connecting for Health approach dictates that these nine principles be balanced together and considered as part of one package Elevating certain principles over others would weaken any overall architectural solution to privacy protection in a networked health information environment In brief the principles and the corresponding resources are as follows CORE TECHNOLOGY PRINCIPLES MARKLE COMMON FRAMEWORK PRACTICE AREAS POLICIES IN PRACTICE 1 Openness and transparency There should be a general policy of openness about developments practices and policies with respect to personal data Individuals should be able to know what information exists about them the purpose of its use who can access and use it and where it resides P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P4 Correctly Matching Patients with Their Records P6 Patients Access to Their Own Health Information P7 Auditing Access to and Use of a Health Information Exchange P8 Breaches of Confidential Health Information P9 A Common Framework for Networked Personal Health Information Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation Individual Access Connecting Patients with Their Health Information 2 Purpose specification The purposes for which personal data are collected should be specified at the time of collection and the subsequent use should be limited to those purposes or others that are specified on each occasion of change of purpose P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P4 Correctly Matching Patients with Their Records Consent Implementing the Individual Participation and Control Principle in Health Information Sharing 3 Collection limitation Personal health information should only be collected for specified purposes should be obtained by lawful and fair means and where possible with the knowledge or consent of the data subject P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More 4 Use limitation Personal data should not be disclosed made available or otherwise used for purposes other than those specified P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P4 Correctly Matching Patients with Their Records P7 Auditing Access to and Use of a Health Information Exchange T1 The Common Framework Technical Issues and Requirements for Implementation T6 Record Locator Service Technical Background from the Massachusetts Prototype Community Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More 5 Individual participation and control Individuals should control access to their personal information Individuals should be able to obtain from each entity that controls personal health data information about whether or not the entity has data relating to them Individuals should have the right to Have personal data relating to them communicated within a reasonable time at an affordable charge if any and in a form that is readily understandable Be given reasons if a request as described above is denied and to be able to challenge such denial and Challenge data relating to them and have it rectified completed or amended P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P3 Notification and Consent When Using a Record Locator Service P6 Patients Access to Their Own Health Information P8 Breaches of Confidential Health Information P9 A Common Framework for Networked Personal Health Information T5 Background Issues on Data Quality T6 Record Locator Service Technical Background from the Massachusetts Prototype Community Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation Individual Access Connecting Patients with Their Health Information 6 Data integrity and quality All personal data collected should be relevant to the purposes for which they are to be used and should be accurate complete and current P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P5 Authentication of System Users P6 Patients Access to Their Own Health Information T5 Background Issues on Data Quality T6 Record Locator Service Technical Background from the Massachusetts Prototype Community T7 Consumer Authentication for Networked Personal Health Information Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation 7 Security safeguards and controls Personal data should be protected by reasonable security safeguards against such risks as loss or unauthorized access destruction use modification or disclosure P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P4 Correctly Matching Patients with Their Records P5 Authentication of System Users P7 Auditing Access to and Use of a Health Information Exchange P8 Breaches of Confidential Health Information P9 A Common Framework for Networked Personal Health Information T1 The Common Framework Technical Issues and Requirements for Implementation T2 Health Information Exchange Architecture Implementation Guide T6 Record Locator Service Technical Background from the Massachusetts Prototype Community T7 Consumer Authentication for Networked Personal Health Information Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation Individual Access Connecting Patients with Their Health Information 8 Accountability and oversight Entities in control of personal health data must be held accountable for implementing these information practices P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P5 Authentication of System Users P7 Auditing Access to and Use of a Health Information Exchange P8 Breaches of Confidential Health Information T1 The Common Framework Technical Issues and Requirements for Implementation T7 Consumer Authentication for Networked Personal Health Information Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation 9 Remedies Legal and financial remedies must exist to address any security breaches or privacy violations P1 The Architecture for Privacy in a Networked Health Information Environment P2 Model Privacy Policies and Procedures for Health Information Exchange P4 Correctly Matching Patients with Their Records P8 Breaches of Confidential Health Information Consent Implementing the Individual Participation and Control Principle in Health Information Sharing Policy Aware Procurement Strategies and Practices Asking the Right Questions Reaching the Right Answers Mechanisms for Oversight Accountability and Enforcement The Model Contract Update and More Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation Markle Connecting for Health Core Technology Principles In addition to the set of policy principles Markle Connecting for Health has published a set of technology principles Together these principles have guided the specific practical decisions about the architecture specifications and policies that support private and secure sharing of health information across the nation In brief the technology principles and corresponding resources are as follows CORE TECHNOLOGY PRINCIPLES MARKLE COMMON FRAMEWORK PRACTICE AREAS POLICIES IN PRACTICE 1 Make it Thin Only the minimum number of rules and protocols essential to widespread sharing of health information should be specified as part of a common framework It is desirable to leave to the local systems those things best handled locally while specifying at a national level those things required as universal to allow for information sharing among subordinate networks T1 The Common Framework Technical Issues and Requirements for Implementation T6 Record Locator Service Technical Background from the Massachusetts Prototype Community Governance of Health Information Sharing Efforts Achieving Trust and Interoperability with Meaningful Consumer Participation 2 Avoid Rip and Replace Any proposed model for health information sharing must take into account the current structure of the health care system While some infrastructure may need to evolve the system should take advantage of what has been deployed today Similarly it should build on existing Internet capabilities using appropriate standards for ensuring secure transfer of information T1 The Common Framework Technical Issues and Requirements for Implementation T6 Record Locator Service Technical Background from the Massachusetts Prototype Community 3 Separate Applications from the Network The purpose of the network is to allow authorized persons to access data as needed The purpose of applications is to display or otherwise use that data once received The network should be designed to support any and all useful types of applications and applications should be designed to take data in from the network in standard formats This allows new applications to be created and existing ones upgraded without re designing the network itself T1 The Common Framework Technical Issues and Requirements for Implementation T2 Health Information Exchange Architecture Implementation Guide T3 Medication History Standards T4

    Original URL path: http://www.markle.org/health/markle-common-framework/connecting-professionals/faqs (2016-02-10)
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  • CT1 | Markle | Advancing America's Future
    will be handled according to fair information practices Appendix A Data Flow Scenarios The following scenarios are designed to illustrate electronic data streams for the most common transaction in health care a drug prescription The first scenario describes a common and simplified set of transactions stemming from a small clinical practice The second scenario adds sophistication and complexity depicting transactions that are less common today although they may become more common in the emerging electronic environment The additional transactions increase potential value for many stakeholders including the consumer but also heighten the risk to privacy and security due to multiple round trips across data sources and copies being held by an increasing array of parties Note The numeric sequence of copies below is designed to help the reader understand the parties that create and receive information related to a prescription transaction A real world chronology would be different than the sequence reflected here as some transactions are batched with longer lag times than others Scenario 1 SIMPLE Radhika Parekjhi MD works for a small practice that does not have an electronic health record EHR or e prescribing application The practice does however utilize practice management software for electronic claims submittal Steve Jones a pharmacist with ACME Pharmacy Chain performs his work using a pharmacy information system that includes e prescribing functionality In follow up to receiving abnormal blood test results at a health fair Millie Robin makes an appointment to see Dr Radhika Parekjhi At the appointment Dr Parekjhi reviews Millie s current health status and health history including her abnormal lab results performs an exam and orders additional tests Based on this information Dr Parekjhi diagnoses a medical condition and decides to prescribe a new medication Millie s doctor s office stores this information copy I 1 in the paper chart for Millie at the practice The I designates a copy that includes identifiable data Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Millie patient Demographic Contact Insurance Employment Provider seen referred Biometric data e g blood pressure Diagnoses Problem list Procedures Medications Allergies Immunizations Hospitalization history Laboratory results Other health history e g family history of heart disease Lifestyle history e g smoker Social history e g married Information provided by Millie in the context of her appt w Dr Parekjhi Millie Patient Registration Paper chart Millie Dr Parekjhi and staff Paper chart I 1 paper Visit history Doctor progress notes Other information specific to care received at this practice After reviewing Millie s current medications problem list and medication allergies Dr Parekjhi finds no contraindications or interactions and decides to prescribe medication X to treat Millie s newly diagnosed medical condition Dr Parekjhi writes a paper prescription for medication X and hands it to Millie Dr Parekjhi completes documentation for Millie s encounter and the following day a coder employed by the practice electronically submits a claim to Millie s Health Plan Payer for payment This information includes Millie s diagnosis procedural and other personal health information 1 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Doctor office paper chart Demographic Contact Insurance Health claim type e g Workman s Comp Prescriber ID e g DEA Employment Diagnoses Procedures including the CPT code that contains the prescribed medication Health claim submitted to Payer Doctor s office Claims Clearninghouse I 2 Other claims submitted to same Clearinghouse A Claims Clearinghouse entity receives the claim processes it and sends it to Millie s Payer in the Payer s required format Clearinghouse stores copy I 2 The Clearinghouse sells aggregated de identified data to research companies as part of its revenue model A Health Care Market Research Company stores de identified copy DI 1 DI stands for data that has been de identified Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Clearinghouse De identified data Generate revenue Claims Clearninghouse Health Care Market Research Company DI 1 n a Millie s Payer receives the claim from the Clearinghouse and adjudicates the claim Payer stores copy I 3 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Clearinghouse Demographic Contact Insurance Health claim type e g Workman s Comp Prescriber ID e g DEA Employment Diagnoses Procedures Claim processing completed ready for adjudication Claims Clearinghouse Payer I 3 Other claims for Millie submitted to this same Payer Millie s Payer sends a de identified copy of Millie s data to a third party organization for data analysis This third party stores copy DI 2 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Payer De identified data Analysis on quality and effectiveness Payer Data Analytics Company DI 2 n a Millie arrives at her Pharmacy and hands the paper prescription to a pharmacist assistant As required by protocol the assistant confirms Millie s information and collects additional information required to process fulfill the prescription Millie s Pharmacy stores the information in its system copy I 4 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Millie s prescription Demographic Contact Insurance Prescriber ID Medication prescribed medication x Millie presents in person to fill her new prescription Millie s paper prescription Millie s Pharmacy I 4 Other prescriptions filled at this Pharmacy and chain if applicable The pharmacist assistant who receives Millie s prescription makes a Formulary and Benefits and Drug Utilization Review request via the Pharmacy s information system to Millie s Pharmacy Benefits Manager PBM via a pharmacy claims processing network or via a direct connection between the Pharmacy and the PBM Millie s PBM stores copy I 5 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Pharmacy Demographic Contact Medication prescribed medication x Formulary and Benefit and Drug Utilization Review REQUEST Pharmacy Millie s PBM via claims processing network I 5 Claims based Rx history data specific to the PBM Millie s PBM sends the requesting Pharmacy a response message which includes a confirmation of Millie s medication benefits eligibility i e whether the PBM accepts or rejects the claim Millie s co pay for medication X and a message indicating that no medication interactions were found based on Millie s medication history as known by this PBM Millie s Pharmacy stores copy I 6 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Millie s PBM Demographic Contact Insurance Interaction alert s Formulary and Benefit and Drug Utilization Review RESPONSE Millie s PBM via claims processing network Pharmacy I 6 Other prescriptions filled at this Pharmacy and chain if applicable Pharmacist Steve Jones fills the prescription and Millie pays the co pay Because the Pharmacy is part of a larger chain a copy of Millie s prescription transaction is sent to the Pharmacy s Central Data Warehouse The Pharmacy s central data warehouse stores copy I 7 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Pharmacy Demographic Contact Insurance Prescriber ID e g NPI Medication s prescribed and or dispensed Transfer of information to Pharmacy s data warehouse Pharmacy Pharmacy s Central Data Warehouse I 7 Other prescriptions previously filled by this Pharmacy chain The Pharmacy submits a claim to Millie s PBM for payment Millie s PBM stores copy I 8 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Pharmacy Demographic Contact Insurance Prescriber ID e g NPI Medication s prescribed and or dispensed Claim information Pharmacy requests payment for Millie s medication Pharmacy Millie s PBM I 8 Other claims for Millie submitted to this PBM for adjudication Millie s PBM adjudicates the claim and sends it to Millie s Payer for payment Millie s Payer stores copy I 9 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Pharmacy Demographic Contact Adjudicated claim Payment of medication claim Millie s PBM Millie s Payer I 9 Other claims for Millie submitted to this Payer Millie s Payer sends Millie s adjudicated claims data ready for payment to a Third Party Administrator TPA that pays each claim the doctor s visit and Pharmacy claim and sends Millie an Explanation of Benefits EOB detailing financial components of her visit with Dr Parekjhi including the amount billed amount eligible for payment insurance benefit paid or applied to deductible and Millie s expected remaining balance due The TPA stores copy I 10 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Payer Demographic Contact Millie s adjudicated claims data To enable the TPA to pay Millie s claim and send Millie an EOB Health Plan Payer Third Party Administrator Millie I 10 Other adjudicated data about Millie received by this TPA Millie s PBM may be allowed to de identify the transaction and send this de identified data to a Pharmaceutical Manufacturer and or sell it to a Pharmaceutical Market Intelligence Company The Pharmaceutical Manufacturer and Pharmaceutical Market Research Company each store a copy of Millie s de identified data copies DI 3 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have PBM De identified data Generate revenue or fulfill contractual obligations PBM Pharmaceutical Market Research Company DI 3 n a Scenario 2 COMPLEX Jennifer Smith MD works for a hospital medical group that uses practice management software and an electronic health record EHR that includes e prescribing and electronic claims submittal functionality Steve Jones a pharmacist with ACME Pharmacy Chain performs his work using a pharmacy information system that includes e prescribing functionality In follow up to receiving abnormal blood test results at a health fair Millie Robin makes an appointment to see Dr Smith At the appointment Dr Smith reviews Millie s current health status and health history including her abnormal test results performs an exam and orders additional tests Based on this information Dr Smith diagnoses a medical condition and decides to prescribe a new medication The Hospital s EHR stores a copy of this information copy I 1 The I designates identifiable data Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Millie patient Demographic Contact Insurance Employment Provider seen referred Biometric data e g blood pressure Diagnoses Problem list Procedures Medications Allergies Immunizations Hospitalization history Laboratory results Other health history e g family history of heart disease Lifestyle history e g smoker Social history e g married Millie s appt w Dr Smith Millie Patient Registration Scheduling Hospital PMS EHR Millie Dr Smith and staff Hospital EHR I 1 Doctor progress notes Visit history Other information specific to care received at Hospital Before proceeding Dr Smith uses her e prescribing tool to make an Rx History Request 2 This request is for the past 120 days of Millie s retail prescription history and includes Millie s Name DOB and Gender This information is submitted electronically and routed through SureScripts Pharmacy Health Information Exchange PHIE SureScripts and Hospital s EHR store copies I 2 and I 3 respectively Note that alternatively Dr Smith s e prescribing tool may allow her to request a Claims Medication History from Millie s PBM to receive prescription history from all pharmacies including mail order for which Millie used her medication benefits However the specifics of this alternative scenario are not covered here Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Hospital EHR Demographic Contact Prescriber ID e g NPI Retrieve last 120 days of Rx history REQUEST Hospital EHR SureScripts Pharmacy networks SureScripts I 2 Retail based Rx history data older than 120 days SureScripts Demographic Contact Medication history Retrieve last 120 days of Rx history RESPONSE SureScripts Hospital EHR I 3 n a After reviewing confirming Millie s updated retail medication history problem list and medication allergies and finding no potential contraindications or interactions Dr Smith informs Mille that she would like to prescribe medication X to treat her medical condition Because Millie expresses concern about the possibility of high out of pocket costs Dr Smith uses her e prescribing tool to make a Formulary and Benefits Information 3 request to determine whether medication X is on Millie s pharmacy benefits formulary Note that more commonly in offices with e prescribing and scheduling software this type of transaction is handled automatically via an interface between the two systems Millie s First Last Name DOB Gender Zip Code and medication X are electronically transmitted to RxHub a switch of switches for major pharmacy benefit managers or PBMs to uniquely identify Millie in RxHub s Master Patient Index prior to RxHub routing the request to Millie s current Pharmacy Benefits Payer PBM RxHub does not store a copy of data received sent Millie s PBM receives the request and stores copy I 4 and routes a response back through RxHub to Dr Smith s EHR via the e prescribing application The response message indicates that Millie is eligible for prescription drug coverage and that the medication is on formulary but requires prior authorization Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Hospital EHR Demographic Contact Medication prescribed medication x Benefits Eligibility and Formulary Request REQUEST Hospital EHR Millie s PBM I 4 Claims based Rx history data specific to the PBM Millie s PBM Demographic Contact Insurance Prior authorization status Benefits Eligibility and Formulary Request RESPONSE Millie s PBM Hospital EHR Not stored Millie is satisfied with the formulary information and expected out of pocket costs and asks Dr Smith to have the prescription sent to her local Pharmacy Because Millie s medication requires prior authorization a medical necessity review of clinical data submitted by the prescribing physician and available prescription drug history against pre established clinical criteria Dr Smith must fill out additional diagnosis and medication history for Millie and fax a completed prior authorization request to Millie s PBM with an expected one business day turnaround time to receive request approval 4 Millie s PBM stores copy I 5 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Hospital EMR Demographic Contact Insurance Prescriber ID e g NPI Diagnoses Problem list Medication s prescribed Prior Authorization for medication is required Hospital Millie s PBM I 5 paper fax Claims based Rx history data specific to the PBM Additional health data see I 13 Confident that Millie s PBM will approve the new medication Dr Smith uses the e prescribing application s pharmacy directory to find Millie s Pharmacy and send the prescription electronically This request response is sent via SureScripts PHIE 5 SureScripts stores copy I 6 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Hospital EHR Demographic Contact Pharmacy Prescriber ID e g NPI Medication s prescribed e Prescription step 1 of 2 Hospital EMR SureScripts I 6 Retail based Rx history data Dr Smith completes documentation for Millie s encounter and a claim is sent to Millie s plan sponsor Payer for payment This information includes diagnosis procedural and other personal health information 6 about Millie A Claims Clearinghouse receives the claim processes it and sends it along to Millie s Payer in the required format Clearinghouse stores copy I 7 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Hospital EMR Demographic Contact Insurance Health claim type e g Workman s Comp Prescriber ID e g DEA Employment Social history e g married Diagnoses Procedures Health insurance claim submitted to Payer Hospital EMR Claims Clearinghouse I 7 Other claims submitted to same Clearinghouse The Clearinghouse sells aggregated de identified data to health care market research companies for profit Health Care Market Research Company stores de identified copy DI 1 DI indicates de identified information Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Clearinghouse De identified data Generate revenue Claims Clearinghouse Health Care Market Research Company DI 1 n a If the Hospital that employs Dr Smith has rights to Millie s Rx data the Hospital may de identify it and sell it to a health care market intelligence company The Health Care Market Research Company stores de identified copy DI 2 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Hospital EHR De identified data Generate revenue Hospital Health Care Market Research Company DI 2 n a The Payer receives the claim from the Clearinghouse adjudicates it and pays the Hospital Payer stores copy I 8 Source of Data Personal Data Transferred Transfer Reason Transaction Detail Source Recipient Recipient Copy What Other Personal Data May the Recipient Have Clearinghouse Demographic Contact Insurance Health claim type e g Workman s Comp Prescriber ID e g DEA Employment Social history e g married Diagnoses Procedures Clearinghouse requests reimbursement from Payer Claims Clearinghouse Payer I 8 Other

    Original URL path: http://www.markle.org/health/markle-common-framework/connecting-consumers/ct1 (2016-02-10)
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