This article discusses proposed changes to privacy regulations to allow for less-restricted health information exchange.
COVID-19 has created unprecedented challenges to the United States health care system. To safely care for patients, health information must flow across provider platforms seamlessly. Given that patients are likely to interact with multiple providers, their health information is fragmented into different systems (e.g., telehealth screening, “drive-through” testing, laboratory testing, primary care follow-up, hospitalization). This complex process requires safe, secure, and standardized health information exchange. Unfortunately, current state and privacy regulations create barriers to providing effective health information exchange. Immediate action is necessary to ensure regulations preserve patient privacy while balancing continuity of care. Additionally, loosening borders of anonymization and changing the definition of what constitutes protected health information may allow for more data scientists to access cellular geolocation information, for example, to assess the effectiveness of various prevention strategies such as social distancing, contact tracing, and testing strategies.
The current state of emergency declared by the president allows the secretary of health to waive, or override, some federal (e.g., Health Insurance Portability and Accountability Act [HIPAA]) and state regulations through a Stafford Act declaration. To enact the efficiencies of rapid communication of health data during a pandemic, three considerations must be addressed when considering the legal barriers of health information exchanged:
- Enactment of HIPAA’s complete federal preemption of all other data sharing and consent laws
- The Office of Civil Rights (OCR) should create a Safe Harbor business associates agreement (BAA) that covered entities and other supporting organizations can rapidly adopt for health information exchange about COVID-19
- The OCR should issue guidance to clarify that there is no requirement for minimal information in exchange of data for care of patients as noted in HIPAA
Finally, utilizing better tools for contact tracing to study the transmission during the pandemic is essential. Taiwan successfully slowed transmission of the virus, likely in part because of its ability to link medical records of COVID-19 patients to their cellular devices to obtain histories of their movement. Then, individuals who came into contact with a known infected person were informed through their devices that they should self-quarantine and obtain testing if symptomatic. This approach is currently being tested in Israel.