0 Laws and Mandates for E-Health

Section 0.4 Overview

Laws and Mandates for e-Health

This tool includes some of state and federal laws and mandates that guide and support e-health activities. In addition, it includes some laws and mandates that local public health providers need to be aware of when planning for e-health.

Time needed: 2 hours Suggested other tools: NA

1. How to Use 1. Review the material below to understand laws and mandates that apply to your profession.

2. Minnesota Laws and Mandates for e-Health The table below lists the Minnesota mandates for e-health. See the following discussion of some of the most important points below.

Title Statute Resources

Electronic Health Minnesota Statutes Minnesota’s 2015 Interoperable EHR Mandate Record Technology 62J.495 (2015 Interoperable Electronic Health Record Mandate)

Electronic Prescribing in Minnesota Electronic Prescription Minnesota Statutes Drug Program 62J.497

Minnesota Statutes Health Information Exchange Oversight Health Information 62J.498,62J.4981 and62J.4982 Exchange (HIE) Oversight

Minnesota Health Minnesota Statutes Health Records Act Fact Sheet (pdf 44Kb/2 pgs) Records Act 144.291 through144.298

Uniform Electronic Minnesota Statutes Healthcare Administrative Simplification Transactions & 62J.536 Implementation Guide Standards

3. The Minnesota Mandate for Interoperable Electronic Health Records

Section 0 Overview—Laws and Mandates for e-Health - 1 In the table above, there is a link to information about Minnesota’s 2015 Interoperable EHR Mandate. This mandate became law in 2007. The law mandates that all health care providers in the State of Minnesota implement and interoperable electronic health record by January 1, 2015. This mandate extends to select public health (PH) providers. The Minnesota Department of Health, Office of Health Information Technology (OHIT) has developed comprehensive documents that explain the mandate. Read their overview here: http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf In addition to the overview, OHIT maintains a web page on this topic, which includes Frequently Asked Questions (FAQs). Read those FAQs here: http://www.health.state.mn.us/e-health/hitimp/. One important requirement of the mandate is that the interoperable EHR must be either ONC Certified EHR Technology or Qualified EHR Technology. See below for guidance from OHIT on certified and qualified technology.

4. Certified EHR The EHR must be certified by the Office of the National Coordinator (ONC) pursuant to the Federal Health Information Technology for Economic and Clinical Health (HITECH) Act. This criterion applies to providers if a certified EHR is available for their setting. This criterion shall be met if a provider is using an EHR that has been certified within the last three years, even if a more current version of the EHR has been certified within the three-year period. A comprehensive list of currently certified EHRs is available at http://www.healthit.hhs.gov/chpl.

5. Qualified EHR If a provider does not have a certified EHR available for their setting, then the provider must have a qualified EHR. This is an electronic record of health-related information on an individual that includes patient demographic and clinical health information, and has the capacity to:  provide clinical decision support  support physician order entry  capture and query information relevant to health care quality  exchange electronic health information with, and integrate such information from, other sources In addition, the e-Health Advisory Committee and MDH encourage providers to have an EHR with the capacity to securely:  incorporate clinical lab test results as structured data  support transitions of care, population health and quality improvement  allow patients or their representatives access to view online, download and transmit their health information1

6. Federal Incentives for Meaningful Use

1 http://www.health.state.mn.us/e-health/hitimp/2015mandateguidance.pdf 2 Since 2009, the most important national incentive for e-health has been the HITECH Act, which provides funding for eligible providers and hospitals in the United States to adopt and “meaningfully use” EHRs by 2015. Follow this link to learn more about Meaningful Use (MU): http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html and (http://www.healthit.gov/policy-researchers-implementers/hitech-act-0) Unfortunately, many divisions of public health care (behavioral health, chemical dependency, etc.) are not eligible for Meaningful Use incentives. This is because incentives go only to MDs or Advance Practice Registered Nurses like CNSs, Nurse Midwives, or Nurse Practitioners2 . In some rare cases Physician’s Assistants are eligible. However, Meaningful Use does affect public health. There are three public health objectives included in the Meaningful Use criteria. Providers are required to have the capability to submit electronic data to public health agencies for:  Immunization registries  Reportable lab results  Syndromic surveillance Language from the final rule is as follows: Policy Priority: improve population and public health 1. "Capability to submit electronic data to immunization registries or Immunization Information Systems, and actual submission in accordance with applicable law and practice." 2. "Capability to submit electronic data on reportable (as required by state or local law) lab results to public health, and actual submission in accordance with applicable law and practice." 3. "Capability to submit electronic syndromic surveillance data to public health agencies, and actual submission in accordance with applicable law and practice." Reference: http://www.federalregister.gov/articles/2010/07/28/2010-17207/medicare-and-medicaid- programs-electronic-health-record-incentive-program According to the Frequently Asked Question section of the MU program: (http://www.cdc.gov/ehrmeaningfuluse/faq.html): Meaningful use activities will improve the collaboration between clinical and public health care at local and state levels through:  Implementation of electronic reporting to PH (immunization, laboratory and syndromic surveillance)  Improvement of a patient-centric preventive care (preventive care-oriented quality care measures)  MU rules bring attention to the readiness of State public health agencies for a "bidirectional communication" with clinical care providers. MU will bring into play the development of standardized data elements and messaging implementation guides (data exchange) for MU public health measures.

7. Laws and Mandates Specifically for Public Health

2 All these APRNs are eligible only if they serve 30% or more Medicaid clients.

Section 0 Overview—Laws and Mandates for e-Health - 1 Other important laws and mandates may also apply to public health professionals when working with providers and health data.

 Local Public Health Act Minnesota Statute §145A http://www.health.state.mn.us/divs/cfh/lph/index.html Full text of the Statute: https://www.revisor.mn.gov/statutes/?id=145a  Minnesota Statute 124D.23 Family Services and Community-Based Collaboratives https://www.revisor.mn.gov/statutes/? id=124D.23&year=2013&keyword_type=all&keyword=124D.23  Minnesota Statutes around immunization data o Minnesota Statute 121A.15 Health Standards; Immunizations; School https://www.revisor.mn.gov/statutes/?id=121A.15 o Minnesota Statute 144.3351 Immunization Data https://www.revisor.mn.gov/statutes/?id=144.3351  Minnesota Department of Health Document: Local Public Health Authorities and Mandates: http://www.health.state.mn.us/divs/cfh/lph/docs/authorities-mandates.pdf  Health Information Technology for Economic and Clinical Health (HITECH) Act and associated rules. (Discussed in the previous section.)  HIPAA Everyone has heard of HIPAA, the set of regulations that control access to and privacy controls for health information. This toolkit has a number of tools that help you address privacy and security concerns associated with e-Health. Here is a list of the regulations.  Health Insurance Portability Accountability Act (HIPAA), 45 CFR section 164.501  Health Insurance Portability Accountability Act (HIPAA) Privacy and Security Rule added in 2000  Health Insurance Portability Accountability Act (HIPAA) Omnibus Final Rule added in 2013  Minnesota Data Privacy Act Minnesota has additional laws governing data privacy. See link below  Minnesota Government Data Practices Act, Minnesota Statute Chapter 13 (https://www.revisor.mn.gov/statutes/? id=13.01&year=2013&keyword_type=exact&keyword=Minnesota+Government+Data+Practice s+Act)  Interoperability Standards Standards recommended to achieve interoperability in Minnesota can be found at: http://www.health.state.mn.us/e-health/standards/g2standards2011.pdf

Section 0 Overview—Laws and Mandates for e-Health - 1