1. Beth DeLair, JD, RN DeLair Consulting, LLC

2. Discussion Topics Background Existing WI Requirements State Efforts to Change Law Senate Bill 487 Changes to 51.30 Changes to 146.82 Future Efforts Broader changes to 146.81-84? Technology changes HISPC Phase III 2

3. Wisconsin Statute Chapter 51.30 Today Informed Consent Requirement  Except as provided below, for treatment purposes treatment records created in the course of providing services to individuals for mental illness, developmental disabilities, or AODA at a treatment facility require consent before disclosing Exceptions to Informed Consent requirement  In a medical emergency  The following elements in a related health care entity: Patient’s name Medications Address Allergies Date of birth Other relevant demographic information Date of service (s) Name of mental health provider (s) Diagnosis 3

4. “Current” 146.82-146.83 Requires all disclosures of patient health care records to be documented 146.82(2)(d) 146.82(3)(c) Does not permit re-disclosures of patient health care records received except by court order 146.82(2)(b) Requires written, informed consent to disclosure patient health care records to family and/or friends that accompany or request information about a patient 146.82(1) 146.82(2) 146.836 4

5. State Efforts to Address Changes November 2, 2005—Governor Doyle signs executive order creating the eHealth Care Quality and Patient Safety Board Develops Wisconsin ehealth Action Plan—a roadmap for the adoption of electronic health records and the exchange of health information in Wisconsin Wisconsin applies for and receives funding through DHHS Office of the National Coordinator via Research Triangle Institute (HISPC Grant) Phase I--July 2006-March 2007 4 workgroups assigned to: Assess variations in organization-level business policies and state laws that affect health information exchange Review and account for all relevant state and federal legal requirements Propose practical solutions that protect privacy and security of health information and permit interoperable exchange Develop plans to implement solutions 5

6. State Efforts to Address Changes HIPSC Grant Phase II-July 2007-December 2007 Refined recommendations from Phase I A 51.30 workgroup was convened Stakeholders were approached regarding changes to 146.82 and 146.83 Bill drafted January-February 2008 Draft bill is reviewed/amended Draft bill is discussed and introduced into senate and assembly March 17, 2008—Governeor Doyle signs bill 6

7. Changes 51.30 Adds to the list of elements that may be disclosed Diagnostic test results Symptoms Removes “within” a covered entity 7

8. Changes to 146.82-146.83 Deletes 146.82(2)(d) and 146.83(3) Deletes 146.82(2)(b) and replaces it with language that: Allows re-disclosure for any purpose otherwise permitted under 146.82 for covered entities Limits re-disclosure of health care records by non-covered entities to those made Pursuant to court order Per patient written authorization For the purpose initially received Creates 146.82(4), which Allows disclosure to :family and friends” involved in the care of the patient” with informal permission from the patient If patient is not available, or is not cognitively or physically able to give permission, clinician may use “professional judgment” 8

9. Future Efforts Broader Changes to 146.81-84 to make it more aligned with HIPAA? Changes in state law to accommodate technology? HISPC Phase III-interstate collaboration 9