Health Information Exchanges
What is a Health Information Exchange?
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.
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:
- CHOP HIE — This exchange is managed by CHOP. It gives authorized healthcare providers and hospitals (and their staff) not affiliated with CHOP access, with the patient's permission, to information from the patient's CHOP medical record. Some authorized healthcare providers have direct electronic access to the CHOP medical record of a patient while other healthcare providers depending upon the electronic medical record system they have may only obtain a care summary document describing a patient’s care.
- Virtua HIE — This exchange is managed by the Virtua healthcare system. It gives authorized healthcare providers (and their staff) who participate in the exchange electronic access to a patient’s medical information. CHOP and other authorized healthcare providers supply information to the exchange and are able to access information that is in the exchange. This is a list of healthcare providers participating in the Virtua HIE.
- Direct access by CHOP to a patient’s electronic medical record at other hospitals — This type of HIE gives CHOP direct electronic access to information about the care our patients received from other healthcare providers participating in the exchange (with the patient's permission where appropriate).
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:
- CHOP HIE — Generally, all information in the patient's CHOP electronic medical record is available to authorized healthcare providers (and their staff) who certify to CHOP that they are involved in that patient’s care. For some healthcare providers, such as hospitals, only care summary documents are available. These documents include basic information like the patient’s diagnoses, medications, allergies, lab tests and visit summaries.
- To sign up
- Special, written authorization is required to participate in this HIE because the patient's medical record (including sensitive information) is electronically available to participating healthcare providers.
- Signing this special authorization form also allows CHOP to share care summary documents with certain healthcare providers caring for the patient (such as some hospitals) in place of the patient's medical record.
- Patients can visit any CHOP registration area or speak with any CHOP healthcare provider to sign up for this HIE.
- To opt out
- Patients who sign a special authorization can revoke it at any time to stop their information from being shared electronically in the future. The patient can still receive care at CHOP, but healthcare providers not affiliated with CHOP won't be able to access medical information electronically. Non-electronic means of sharing information are still available.
- To sign up
- Virtua HIE — For patients who receive radiological services at Virtua, the information CHOP shares with this exchange is limited to your demographic information (such as name and medical record number) and radiological images from a patient's CHOP electronic medical record (such as X-rays) when a patient is seen at both CHOP and Virtua. CHOP is working with Virtua to expand the scope of the Virtua HIE to allow CHOP and Virtua to electronically request and obtain information about most care delivered to our patients. We’ll share more information about this expanded service when it becomes available. Written permission will be required before the CHOP medical record is shared in the expanded Virtua HIE.
- To sign up
- No action is required to sign up for this HIE; because the type of information currently shared by CHOP with this HIE is limited, it is automatically shared unless a patient chooses to opt out.
- To opt out
- A patient may choose to opt out of this HIE. To opt out of the Virtua HIE a patient may complete, sign and submit this HIE opt-out form to Virtua or call 1-800-VIRTUA-3.
- To sign up
- Direct access by CHOP to a patient's electronic medical record at other hospitals — This type of exchange allows CHOP healthcare providers (and our support staff) to have direct electronic access to a patient's electronic medical record that is maintained by another healthcare provider who has cared for that patient. At some participating hospitals CHOP can access the patient's medical record. At other hospitals CHOP can only download a care summary document with basic information about the patient’s care such as diagnoses, medications, allergies, lab tests and visit summaries.
- To sign up
- The patient may need to provide authorization to the hospital or healthcare provider that maintains the patient's record before CHOP will be permitted to access the patient's medical information electronically.
- To opt out
- The patient will need to contact the hospital or healthcare provider that maintains the patient's medical record to request that electronic access to medical information be discontinued to outside healthcare providers (like CHOP).
- To sign up
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 healthcare 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.
- 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.