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Your Medical Information and Health Information Exchanges (HIEs)

It’s not uncommon that the patients we treat receive medical care from many different healthcare providers, not all of whom are affiliated with CHOP. Allowing our patients’ healthcare providers electronic access to medical information can reduce the risk of unnecessary or duplicate services, prevent delays in treatment, and improve the overall quality of the care for our patients.

What is a Health Information Exchange?

A Health Information Exchange (HIE) is a way to share our patients' medical information electronically between all healthcare providers participating in the exchange. Authorized healthcare providers participating in the exchange may supply a patient’s medical information, or receive information about a specific patient.

Which HIEs does CHOP participate in and who has access to these exchanges?

CHOP is just beginning to participate in HIEs, but this participation is expanding. Currently, healthcare providers not affiliated with CHOP can get electronic access to the CHOP medical record of their patients (with the patient’s permission where appropriate). Authorized healthcare providers are being added regularly to HIEs in which CHOP participates to better serve our patients.

Today CHOP participates in the following HIE arrangements:

As CHOP’s participation in other exchanges expands, we’ll update this information. Check back for updates.

What information is available in HIEs and how can patients sign up or opt out ?

The following information from a patient's CHOP medical record is available in each of the HIEs in which the Hospital participates. Also included below are details about how a patient can sign or opt out of each HIE:

Authorized healthcare providers who have access to a patient’s medical information in an exchange will be able to view, print and retain documents from that patient’s medical record.

What about sensitive and adolescent-controlled information?

Certain information is designated as "sensitive" information including information about mental health, drug and alcohol abuse, HIV/AIDS and genetic information. This "sensitive" information is given special additional protection under law. In addition state law allows adolescent patients to obtain certain services on their own without their parent's consent. Such services include pregnancy prevention/contraception, pregnancy testing, pregnancy care and testing/treatment for sexually transmitted infections, with respect to which the adolescent patient controls the release of the information.

If a patient agrees to allow his or her medical information to be shared in an HIE, information in the CHOP electronic medical record, including sensitive information and information adolescent patient's control, will be accessible to authorized healthcare providers who participate in the exchange. For example, a diagnosis of bi-polar would be included and a list of current medications may indicate that the patient is taking birth control pills. (There are limited exceptions of certain information that will not be shared in an HIE related to mental health provider notes stored in confidential sections of CHOP’s medical record and provider notes from a CHOP family planning clinic visit.)

Written permission is required to allow CHOP to share a patient's medical record in an HIE since the record may contain sensitive information. It is important to know that since state law allows patients between the ages of 13 and 17 to obtain certain services listed above without their parent's consent the permission of both the patient and parent is usually required for a patient's CHOP medical record to be shared in an HIE.

Who can give permission to share a patient's medical information in an HIE?

Generally, for patients under the age of 13, parents or legal guardians make health care decisions for the patient and control release of the patient’s medical information. In these situations, the patient/legal guardian signs any authorization required to allow the patient’s CHOP medical record to be shared in an HIE. Competent patients who are 18 years of age and older are considered adults who are able to make their own healthcare decisions and would provide authorization to allow their CHOP medical record to be shared in an HIE. For patients between the ages of 13 and 17, the signature of both the patient and parent/legal guardian is usually needed for the patient’s medical record to be shared in an HIE. This is the case because there may be information in the patient’s medical record that state law considers to be controlled by the patient and other information in the record may be controlled by the patient’s parent or legal guardian. Patients 13 years of age and older are legally presumed competent unless a medical professional determines evidence of incapacity. Here’s a chart for reference:

Age of patient
Age 12 and younger Parent / legal guardian
13-17 years of age Patient and Parent/legal guardian
18 years of age or older or otherwise legally emancipated Patient

For HIEs in which a patient’s medical record is shared, these same rules apply for opting out of an HIE.

How will my information be used by HIE healthcare providers?

Medical information obtained by authorized healthcare providers through an HIE may only be used for purposes of providing treatment, obtaining payment, or to perform business operations and other activities allowed or required by law. The CHOP Notice of Privacy Practices explains in detail the purposes for which a patient's medical information can be used and shared by CHOP and the patient's rights regarding this information. Each healthcare provider participating in the exchange is required to have their own Notice of Privacy Practices.

How secure are HIEs?

All healthcare providers are required by law to protect the privacy of medical information. Special security features seek to keep patients’ information secure and prevent medical information from being seen by anyone who should not have access. For example, data transfers between healthcare providers are encrypted so your that patients’ medical information cannot be accessed by anyone without the de-encryption key. If improper access does occur through an HIE, the law requires that the patient be notified.

Who do I contact for more information?

If you have additional questions about CHOP’s HIE activities please contact us online.

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