03/10/2023
I am committed to protecting all of my clients private information.
Dear fellow Oklahomans –
In May of 2021 Oklahoma SB 574 created OKSHINE – and in May of 2022, the State of Oklahoma passed SB 1369 which required all health care providers across the state of Oklahoma to report data by utilizing a State Designated Entity (SDE) for Health Information Exchange (HIE) beginning July 1, 2023.
SB 1337 provides for managed care entities and providers to submit “data” to the HIE.
The proposed policy changes are currently in effect as Emergency Rules and must be promulgated as Permanent Rules. The proposed policy was presented at the September 6, 2022, Tribal Consultation. Additionally, this proposal was presented to the Medical Advisory Committee on September 8, 2022. Furthermore, this proposal was presented at a Public Hearing scheduled for March 7, 2023. Finally, the proposed changes are scheduled to be presented as Permanent Rules to the OHCA Board of Directors on March 22, 2023.
Very few providers across the state were aware of this bill until this week; the public comments received by Oklahoma Health Care Authority (OHCA) reached almost 200 comments – all in opposition of the implementation of the statewide HIE.
The majority of those comments have come from those of us in the mental health field; licensed providers who have sworn to protect the records and information of those we serve. We would like to take this opportunity to tell you what we know, what we want you to know and how you can get active to fight this bill.
From the OKSHINE website:
“The HIE provides the capability to electronically collect, store, and share clinical information among disparate healthcare information systems while maintaining its privacy and security. The HIE facilitates appropriate and secure access to and retrieval of clinical data to provide safe, more timely, efficient, effective, equitable, patient-centered care. The HIE is helpful for connecting with multiple public health authorities to assist in the analyses of population health and the effectiveness of treatments.
OKSHINE connects providers throughout the state through our secure, online network to share patients’ virtual health records. Members include hospitals, ambulatory practices, ancillary services, behavioral health, specialty care providers, emergency medical services, social services organizations, and payers. Through OKSHINE, members track their patients care received outside of their facility to facilitate greater care coordination.”
The OKSHINE website goes on to share that the HIE will be accessible to Dept of Corrections, Dept of Human Services and even the Dept of Defense. For those who are seeking mental health services, it is your RIGHT to the privacy of these services and your right to be free from bias based on the services you are seeking.
As licensed mental health providers, we want to share our concerns with the public and those we serve to help you better understand the risks involved with the overreach by our state Government in obtaining access to your mental health records.
First – state law specifically states that mental health records have greater protections than regular medical records. (Oklahoma Statutes §43A-1-109 (2021) - Confidential and privileged information)
As an attendee of mental health services, you have a right to privacy and confidentiality; this HIE gives access to too many across the state and poses risk to some of the most vulnerable in our state. As providers, we have many concerns that this could create undue bias for our clients with other providers and with the various social service organizations that the HIE has indicated they will give access to. The OKSHINE website also states that the HIE will have the ability to communicate with other HIEs across the country, not just within our state.
This law does not grant any additional safety or privacy that each client is not already promised under State and Federal law, Licensure rules and ethics and Professional Organizations Code of Ethics. This law does pose an increased risk of client safety by compromising the privacy of their records. This would include those experiencing domestic violence for example.
Clients who are employed in fields with a negative mental health stigma would avoid seeking mental health services. This would include police officers, first responders, doctors and more. Those serving in these fields need access to mental health services free from the fear of exposing their medical history to their colleagues. For many doctors, they are forced to receive services within their own hospital systems due to the hospital insurance benefits; now their own staff could be informed of any mental health services obtained.
OHCA and the HIE has stated that a client has the right to “opt-out” of this HIE; however, the opt-out form still must be submitted to OHCA/MyHealth; therefore still further violating the right to privacy and identifying the relationship between the client and the provider(s). The rules surrounding this law do not indicate the extent of information that will be shared or required to be shared.
While there are a multitude of other direct impacts that we could continue to discuss, we also cannot ignore the impact on providers and eventually the impact on access to medical and mental health services across our state.
This law requires all licensed providers to participate regardless of affiliation or contract status with OHCA/Medicaid. This means that providers in solo/private practices are required to incur high fees to get set up with this State Designated System, and to also incur monthly charges as well that can be raised at any time. Many solo/small practices cannot afford this fee and would be left to pass those charges down to the clients or forced to close their doors and stop practicing all together. For those who opt out of insurance and choose private pay services for added privacy, you are not protected by this law and your information must be shared.
In a state where we are already suffering a mental health crisis, an opioid crisis and we are desperately lacking in access to mental health providers to meet the needs of our communities, this law will force many to practice in other states or not at all.
As constituents and members of the communities we serve, you deserve to be heard by your representatives as quickly as possible regarding this bill. You are encouraged to contact them to let them know that you are not ok with your protected information being shared freely; and that you do not support a law that would force providers to choose between protecting your rights and protecting our license.
Please feel free to comment and share - we need your help!
We are asking everyone to write letters of concern to all of the OHCA board members and also to express your concerns directly to the Governor's office, as he has the power to refuse to allow the policy to go into effect if the OHCA board does vote to approve it.
OHCA Contact Information
OHCA Board Members:
Marc Nuttle - Chairman
[email protected]
Alex Yaffe - Vice Chairman
[email protected]
Tanya Case
[email protected]
John Christ
[email protected]
Jeffrey Cruzan, M.D.
[email protected]
Corey Finch, M.D.
[email protected]
Phillip Kennedy
[email protected]
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Steve Miller - OHCA HIE Coordinator
[email protected]
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