Background
In recent years, the Bush administration has placed increased emphasis on development of electronic medical records (EMRs). Secretary Leavitt has responded by creating the Office of the National Coordinator for Health Information Technology (ONC), charged with developing technical and coding standards for EMR interoperability, intended to improve access to, and effectiveness and efficiency of health care in the U.S. But before clinical information may be exchanged, there must be accepted conventions in the industry regarding business practices for secure exchange of clinical information that respects individual privacy.

The National Privacy and Security Collaboration
Healthcare organizations adopt business practices and policies based on patient care needs and interpretation of the 1996 Health Insurance Portability and Accountability Act (HIPAA). It has been acknowledged that different organizations have adopted different interpretations of HIPAA, some more liberal, others more conservative. These different patient care needs and interpretations of HIPAA have spawned variations in business practices and policies that sometimes work to inhibit exchange of clinical information.
The Agency for Healthcare Research and Quality (AHRQ) and the National Governor’s Association has contracted with Research Triangle Institute (RTI) to engage states in a national dialogue designed to identify standard business practices for safe and secure exchange of personal health information. Utah was awarded one of the subcontracts to participate in this dialog, along with 32 other states and Puerto Rico.

UNIFY-Privacy and Security
Utah’s project is called UNIFY-PS for the Utah Network for Electronic Public Health Information, Privacy and Security component. As part of the national collaboration, all states, including Utah, will adhere to the workplan established by AHRQ and RTI.
That workplan involves establishing five workgroups, as follows:

• Variations Workgroup. Chaired by Dr. John Nelson and sponsored by HealthInsight, this group will broadly canvass Utah healthcare community to identify current privacy and security business practices and policies regarding exchange of personal health information. Members of this group, along with additional healthcare community stakeholders, will identify variations in business practices and policies that present barriers to exchange of information.
• Legal Workgroup. Chaired by Lyle Odendahl and sponsored by the Utah Attorney General’s Office, this group will review the business practices and policies identified by the Variations Workgroup, and identify the relevant law.
• Solutions Workgroup. Chaired by Linn Baker and sponsored by the Utah Health Information Network (UHIN), this group will examine any problematic variations and propose solutions for Utah, and respond to national solutions generated by AHRQ and RTI. They will seek solutions that are legal and ethical, and feasible in Utah’s healthcare and public health contexts.
• Implementation Workgroup. Chaired by Barry Nangle, Ph.D. and sponsored by the Utah Department of Health, this group will explore implementation strategies for the identified privacy and security solutions.
• Steering Committee. This group, Chaired by Dr. Joe Cramer and consisting of all four workgroup chairs and the members of Utah Digital Health Services Commission, will provide project oversight and will review the work processes and work products of each of the other four workgroups.

The project will follow an especially tight time schedule, with the four workgroups meeting in roughly consecutive periods.

Unify-PS Timeline

Project Deliverables / Workgroup Reports

• Variations and Legal Workgroups Report: Assessment of Variation Report [PDF]
• Solutions Workgroup: Solutions Report [PDF]
• Implementation Workgroup Plan: Interim Implementation Plan [PDF]
• Final Assessment and Analysis Report: Final Report [PDF]
• Final Implementation Plan [PDF]

Web Portal
The project work products will be reviewed by a large group of healthcare stakeholders, statewide. Their efforts will be facilitated by a Web portal, designed by RTI. A calendar of events, work products, and online discussions will be enabled through the Web portal. All workgroup and steering committee members have access to the Web portal. Others interested in participating should register to be a stakeholder (below) to get access to the Web Portal.

UNIFY-PS Staff and Contact
Project Coordinator: Francesca Lanier, MS, 892-6649, flanier@utah.gov
Policy Analyst: Kyle Ryan, PhD, 892-6654, kyleryan@utah.gov
Administrative Support: Humaira Shah, 892-6628
Variations Workgroup Analyst: Dave Cook, MBA, 892-0155

Principal Investigator: Lois M. Haggard, PhD, 538-9455
Executive Manager: Barry Nangle, PhD, 538-6907
Executive Sponsor: David N. Sundwall, MD, 538-6111

**Stakeholder Involvement Is Critical to the Project Success**
Persons wishing to have input to this nationwide security and privacy collaboration may go to the UNIFY-PS Stakeholder Invitation page to register for access to the Web portal.

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Utah's UNIFY-PS project is the result of a subcontract with RTI, International as part of Contract Number 290-05-0015 awarded to RTI in October 2005 by the Agency for Healthcare Research and Quality (AHRQ) within the U.S. Department of Health and Human Services (DHHS), and in collaboration with the National Governor's Association. For more information on the national Privacy and Security Collaboration, visit the HISPC website at http://www.rti.org/hispc