How do public health initiatives identify and treat diseases as effectively as possible? The need to provide comprehensive, consistent treatment for people with HIV/AIDS, STDs, viral hepatitis and tuberculosis has accelerated momentum toward collaboration and integration of prevention services by health departments. In 2009, the Centers for Disease Control and Prevention (CDC) developed a framework called “Program Collaboration and Service Integration Strategy” (PCSI) to improve health outcomes for these diseases. In fall 2012, National Nursing Centers Consortium (NNCC) and PHMC jointly began a new project through funding from the National Network of Public Health Institutes (NNPHI), of which PHMC has been a member for the last eight years.
The project, titled “Addressing Policy Barriers for State and Local Health Departments When Implementing the Program Collaboration and Service Integration Strategy,” involves a unique collaboration between PHMC, NNCC, the Temple Law Public Health Law Research Program (PHLR), and the PCSI Program at the Philadelphia Department of Public Health and five other PCSI sites across the country, and aims to improve the implementation of PCSI through awareness of confidentiality laws. The interdisciplinary PHMC team includes NNCC’s Policy Associate Sarah Hexem and Policy Director Jamie Ware and PHMC’s Senior Research Associate Jennifer Lauby, who is directing the overall project.
“The clients that health departments serve often suffer from a number of chronic conditions and behavioral health issues. Traditionally, they have had to go to separate service providers for each of their conditions, resulting in care that is fragmented and uncoordinated,” says Lauby. While PCSI develops strategies for more coordination among providers and healthcare agencies, one potential barrier to coordination is the need to protect the confidential health information of each patient. Care providers are required to work within the laws of their state to find ways to best share information and coordinate care, while also protecting their clients’ privacy. “Our project will make it easier for healthcare agencies and providers to find and understand the laws that govern sharing of health information in their state,” says Lauby.
Beginning in September 2012, the NNCC, PHMC, the NNPHI and the CDC met about the project and shortly thereafter began collecting relevant statutes and regulations that address reporting requirements for HIV/AIDS, STDs, viral hepatitis, tuberculosis and more. These data include confidentiality and permissible disclosure to service providers; laws affecting partner notification; and laws on the use and security of surveillance data. The inventory of laws will include statutes and regulations in all 50 states, Washington, DC, and the 10 cities with the highest HIV burden that are eligible for direct CDC funding: Atlanta, Baltimore, Chicago, Fort Lauderdale, Houston, Los Angeles, Miami, New York, Philadelphia and San Francisco.
After researching the laws, the team’s next steps include categorizing and evaluating the existing laws. Those results are then posted online on PHLR’s Law Atlas page (www.lawatlas.org). A final report will identify jurisdictions with the fewest barriers to data sharing that can be a model for other jurisdictions.
“Although all health departments across the country should be thinking about how laws, regulations and rules used to protect people’s confidential information can affect successful data-sharing within health departments, it takes a certain amount of resources,” says Ware. “An assessment of laws related to the confidentiality of patient data has not been conducted in the last 10 years, but in this time of dwindling resources, we think it’s vital work.”
The end result will be a website available to the public in May 2013. All the relevant laws will then be available online, via a policy surveillance page, where updates can be made. “This project maximizes the opportunity for programs in health departments to share data about shared patients.” says Ware.
