AMA House of Delegates

AMA to draft model legislation on information exchanges

The Association plans to delve into patient data privacy and ownership, especially as it pertains to payer involvement.

By Pamela Lewis Dolan — Posted July 4, 2011

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There is a need for more research on how to protect patient and physician interests regarding the ownership and use of clinical data sent to and from health information exchanges, according to the AMA House of Delegates.

During the Association's Annual Meeting, the house adopted policy calling on the AMA to study the issue and draft model legislation. The policy says model legislation is needed that calls attention to who owns the clinical data and who can access it, and when.

Nephrologist Steven Kanig, MD, a delegate for the New Mexico Medical Society and author of the policy, said in committee testimony June 19 that his introduction of the resolution came from his experience working with a health information exchange in New Mexico.

He said some plans in recent months have acquired HIE technology vendors, underscoring the need for better oversight.

UnitedHealth Group's health IT consulting subsidiary Ingenix bought Axolotl, an HIE technology provider, in 2010. United changed the Ingenix name to OptumInsight in April.

Aetna also entered the HIE market in 2010 with the purchase of Medicity.


Dr. Kanig

One issue the AMA policy says model legislation should address is "no payer would be allowed to obtain identifiable clinical data on individuals who are not currently insured members of a health plan belonging to that payer."

Informed consent would be the possible exception.

Joseph Heyman, MD, an obstetrician-gynecologist in Amesbury, Mass., who chairs OptumInsight's physician advisory board, said he and others on the board welcome the AMA's policy.

"It's really consistent with our thinking, and I believe it's consistent with the thinking of OptumInsight as well," said Dr. Heyman, who served as chair of the AMA Board of Trustees in 2008-09. He said the separation of OptumInsight from UnitedHealth Group creates a firewall that prevents the sharing of data between the two.

Dr. Heyman said physicians contracting with HIEs always should look for contract language that spells out how the HIE is going to protect patient data.

"If there's anybody who needs to understand how that data is going to be used, besides the patient, it's that physician," he said.

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Meeting notes: Medical practice

Issue: Reducing state Medicaid programs as a cost-saving measure might cost states more in the long run if patients who are knocked off Medicaid are forced to receive care from emergency departments.

Proposed action: Direct the AMA to study successful Medicaid patient-centered medical home models, including pregnancy medical home models, and report back. [Adopted]

Issue: Interpreting services for patients with limited English proficiency often cost more than what Medicaid pays for the visit, causing the physician to incur a financial burden.

Proposed action: Direct the AMA to support efforts encouraging hospitals to pay for interpreting services for the follow-up care of patients physicians are required to accept as a result of the patient's emergency department visit. [Adopted]

Issue: A previous report from the AMA Council on Medical Service regarding increased violence directed toward physicians in the hospital environment did not address incidences of violence and threats toward physicians in office settings.

Proposed action: Direct the Association to survey its membership regarding the threats and violence in nonhospital work environments and draft a written report for the 2012 Interim Meeting with suggested solutions. [Adopted]

Issue: Advance care planning is critical to improving end-of-life care. But such discussions do not occur as often as they should because they are not compensated due to an inaccurate caricature of the talks as constituting "death panels."

Proposed action: Encourage the Centers for Medicare & Medicaid Services to designate such voluntary discussions as covered services in the 2012 physician fee schedule. [Adopted]

Issue: Physicians should be protected from retaliation for exercising their independent judgment in medical staff affairs.

Proposed action: Direct the AMA to endorse a clause to be included in physician employment agreements that guarantees physicians independent judgment in all organized medical staff affairs. [Referred]

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