Interoperability Part I
As a nurse or healthcare professional, it is vital to realize that Interoperability can be a
significant issue in the continuum of care. Despite efforts, it’s still a long journey until
Interoperability is fully achieved. Until then, Interoperability efforts may be at odds with
fundamental regulations such as HIPAA privacy rules. The Health Insurance Portability
and Accountability Act (HIPAA) Privacy Rule permits, but does not require, covered
health care entities to obtain patient consent before using or disclosing Protected Health
Information (PHI) for treatment, payment, and health care operations. Entities can share
PHI digitally, or by phone, fax, or mail.
Although HIPAA does not require that health care entities offer patients a choice about
the sharing of their PHI, many entities and states have adopted policies or laws that
require patient consent. HIPAA is designed to work in tandem with other privacyprotective policies, so in those states, the entity is required to get the patient’s basic
consent preference (e.g., the entity must document if the patient wishes to opt-in or optout of electronic exchange). Below are a few examples of patient consent scenarios
illustrating how data flows in line with the patient’s consent preference. This is not a
comprehensive list of scenarios.
Patient is Not Asked for a Consent Decision – HIPAA background rules apply
When patient consent is not required, and HIPAA background rules apply, PHI can flow
as shown in the graphic below.
Flow of PHI When Patient is Not Asked for a Consent Decision
Patient Declines Digital Sharing
If patient consent is required by state law (called “opt in / opt out” laws [PDF – 429 KB])
to share information electronically and a patient makes a consent decision that does not
allow her health information to be shared digitally, entities can still exchange the
patient’s information. However, in line with HIPAA, the entities must use phone, fax, or
mail. These methods can be much slower and costlier than digital sharing. This type of
scenario is shown in the graphic below.
Flow of PHI when Patient Declines Digital Sharing
Patient Allows Partial Sharing

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Sensitive health information, which includes mental health records, adds another layer
of complexity to the Computable Privacy environment. The graphic below shows
what happens when there are specialized rules for specific clinical categories, such
as mental health. In this scenario, a patient chooses to stop her health care entities from
sharing her mental health records, but she allows them to share her physical health
records.
Flow of PHI when Patient Does Not Consent to Mental Health Record Sharing
Evaluate the impact of patient consent in achieving full interoperability.
Include the following aspects in the assignment:
• Assess one of the patient consent scenarios listed above
• Find two recent (less than three years) scholarly articles on your chosen scenario
• Create recommendations on how Patient Consent based on your selected
scenario could be integrated without constituting an obstacle to achieving
Interoperability
• In your own perspective, discuss the impact of wearable technologies in
achieving interoperability.
• At all times, proper sentence structure, grammar, and spelling are required.
Grammarly is a free tool to assist you. All references used must be placed.