Patient Privacy, Consent, and Identity Management in Health Information Exchange: Issues for the Military Health System

The Military Health System MHS and the Veterans Health Administration VHA have been among the nation s leaders in health information technology IT, including the development of health IT systems and electronic health records EHRs that summarize patients care from multiple providers. Health IT interoperability within MHS and across MHS partners, including VHA, is one of ten goals in the current MHS Strategic Plan the ability to exchange health information between military and nonmilitary health care providers is especially important in light of the role played by civilian providers in MHS s TRICARE program, which provides care to 9.7 million beneficiaries. The MHS has taken several steps toward achieving improved interoperability, including collaborating with the Department of Veterans Affairs VA to develop an integrated EHR, a virtual lifetime electronic record VLER, and Joint Federal Health Care Centers. The MHS is also seeking to develop a research roadmap to better coordinate health IT research efforts, address MHS IT capability gaps, and reduce programmatic risk for enterprise projects in the MHS. This report contributes to that effort by identifying key research and policy issues involving patient privacy, patient consent, and patient identity management as relevant to health information exchange HIE in the Department of Defense DoD. Our study used a multimethod approach consisting of a review of policy regarding privacy, patient consent, and patient identity management a literature review on these topics as relevant to the MHS and semistructured telephone interviews with 31 subject-matter experts. We use a sociotechnical framework to organize our findings and to suggest topics for future research.