Tara Ramanathan

Policy Surveillance: A Vital Public Health Practice Comes of Age

Governments use statutes, regulations, and policies, often in innovative ways, to promote health and safety. Organizations outside government, from private schools to major corporations, create rules on matters as diverse as tobacco use and paid sick leave. Very little of this activity is systematically tracked. Even as the rest of the health system is working to build, share, and use a wide range of health and social data, legal information largely remains trapped in text files and pdfs, excluded from the universe of usable data. This article makes the case for the practice of policy surveillance to help end the anomalous treatment of law in public health research and practice. Policy surveillance is the systematic, scientific collection and analysis of laws of public health significance. It meets several important needs. Scientific collection and coding of important laws and policies creates data suitable for use in rigorous evaluation studies. Policy surveillance addresses the chronic lack of readily accessible, nonpartisan information about status and trends in health legislation and policy. It provides the opportunity to build policy capacity in the public health workforce. We trace its emergence over the past fifty years, show its value, and identify major challenges ahead.

Impact of laws aimed at healthcare-associated infection reduction: a qualitative study

Background Healthcare-associated infections (HAIs) are preventable. Globally, laws aimed at reducing HAIs have been implemented. In the USA, these laws are at the federal and state levels. It is not known whether the state interventions are more effective than the federal incentives alone. Objective The aims of this study were to explore the impact federal and state HAI laws have on state departments of health and hospital stakeholders in the USA and to explore similarities and differences in perceptions across states. Methods A qualitative study was conducted. In 2012, we conducted semistructured interviews with key stakeholders from states with and without state-level laws to gain multiple perspectives. Interviews were transcribed and open coding was conducted. Data were analysed using content analysis and collected until theoretical saturation was achieved. Results Ninety interviews were conducted with stakeholders from 12 states (6 states with laws and 6 states without laws). We found an increase in state-level collaboration. The publicly reported data helped hospitals benchmark and focus leaders on HAI prevention. There were concerns about the publicly reported data (eg, lack of validation and timeliness). Resource needs were also identified. No major differences were expressed by interviewees from states with and without laws. Conclusions While we could not tease out the impact of specific interventions, increased collaboration between departments of health and their partners is occurring. Harmonisation of HAI definitions and reporting between state and federal laws would minimise reporting burden. Continued monitoring of the progress of HAI prevention is needed.

Transitioning from Paper to Digital: State Statutory and Regulatory Frameworks to Address Health Information Technology

Objectives: In all health system sectors, electronic health information (EHI) is created, used, released, and reused. We examined states’ efforts to address EHI uses in law to provide an understanding of the EHI legal environment. Methods: Attorney researchers used WestlawNext to search for EHI-related statutes and regulations of the US states, US territories, and the District of Columbia in effect as of January 2014. The researchers independently catalogued provisions by the EHI use described in the law. Researchers resolved discrepancies through peer review meetings and recorded the consensus codes for each law. Results: This study identified 2364 EHI-related laws representing 49 EHI uses in 54 jurisdictions. A total of 18 EHI uses were regulated by ≥10 jurisdictions. More than 750 laws addressed 2 or more EHI uses. Jurisdictions varied by the number of EHI laws in effect, with a mean of 44 laws. Texas had the most EHI laws (n = 145). Hawaii and South Carolina had the fewest (n = 14 each). Conclusions: The EHI legal landscape is complex. The large quantity and diversity of laws complicate legal analysis, likely delay implementation of public health solutions, and might be detrimental to the development of emerging health information technology. Research is needed to understand the effect of EHI-related laws.

The Role of Law in Supporting Secondary Uses of Electronic Health Information

For decades, health information has been collected and shared for health care delivery and public health purposes. While the “primary use” of patient data for providing direct health care services is the cornerstone of health care practice, health departments rely on data sharing for research and analysis to support disease prevention and health promotion in the population.1 As the U.S. health system undergoes a digital revolution, health information that was previously captured in paper form now can be captured electronically. Electronic health information (EHI) has transformed the efficiency, capacity, and functions of the U.S. health system.2 For this reason, there is increased attention to the “secondary use” of electronic patient data for public health uses,3 including disease reporting and investigation, syndromic surveillance, and patient-specific or population-level communications about health conditions and their associated risk factors. Secondary uses may also encompass clinical research, licensure, and payment for services. Laws play an instrumental role in facilitating the recording and sharing of health information and granting protections to patients and providers. However, the transition from paper to electronic health information systems pose challenges to the legal environment surrounding health data.4 Laws governing access to and disclosure of EHI for secondary uses describe the type of information that can be shared and whether it identifies individual patients, the types of entities sharing the information, and the reasons for which the information is shared.5 As the implications and challenges of EHI are understood, states are updating laws that once supported paper health records to include electronic health records (EHRs) and the secondary use of data. This article provides an overview of laws supporting secondary use of EHI data for public health purposes, the state law landscape surrounding the transition from paper to EHI systems, and legal tools available for public health uses of EHI.

Law as a tool to promote healthcare safety

PURPOSE The purpose of this paper is to inform healthcare providers and healthcare facility leadership about the statutory, administrative, criminal, and tort law implications related to preventable harms from unsafe injection practices. DESIGN/METHODOLOGY/APPROACH Review of legal theory and precedents. FINDINGS The law can address disputes over unsafe injection practices in a variety of ways. Administrative agencies may hold a provider or facility responsible for preventable harms according to specific statutory and regulatory provisions governing licensure. State courts can compensate victims of certain actions or inactions based on tort law, where a breach of a legal duty caused damages. Prosecutors and the public can turn to criminal law to punish defendants and deter future actions that result in disability or death. RESEARCH LIMITATIONS/IMPLICATIONS The state law findings in this review are limited to legal provisions and court cases that are available on searchable databases. Due to the nature of this topic, many cases are settled out of court, and those records are sealed from the public and not available for review. PRACTICAL IMPLICATIONS Preventable harm continues to occur from unsafe injection practices. These practices pose a significant risk of disease or even death for patients and could result in legal repercussions for healthcare providers and facility leadership. ORIGINALITY/VALUE This article reviews emerging law and potential legal implications for health care and public health related to unsafe medical practices related to needle, syringe, and vial use.

Health Information Blocking: Responses Under the 21st Century Cures Act

Interoperability, or the easy, secure exchange of electronic health information (EHI), is now vital to health care and public health functions, including disease and laboratory reporting. Conversely, “information blocking,” or activities that interfere with collecting, using, and exchanging EHI, can seriously harm public health. The 21st Century Cures Act (the Act), signed into law on December 13, 2016, establishes a legal framework to: address the use and exchange of health data through health information technology (HIT), strengthen interoperability, and prevent information blocking, among other health-related initiatives. Before the Act, information blocking was not defined or well understood and could not be effectively prevented, leaving interoperability unprotected. The Act defined these concepts and incorporated them into Title IV of the Public Health Service Act (PHSA) under “Delivery.” This article describes the issues involved in information blocking, including the federal actions taken to identify the problem, prohibit it, and impose civil penalties for engaging in it, as well as the implications for interoperability.