Law and the Public's Health

Abstract

In this issue, Law and the Public’s Health examines the legal issues that arise in the context of health information. The effort to secure more comprehensive and better health information about patient care has intensified in recent years, as a result of concerns over health care quality and the effectiveness of health care for an increasingly diverse patient population.1 Expert consensus regarding the value of incorporating personal health information into the health care process has reached the point at which it is possible to see the day when the routine collection and analysis of such information becomes a basic element of the professional standard of care for all patients. Indeed, in December 2004, the Joint Commission on Accreditation of Healthcare Organizations ( JCAHO) published draft standards that would, if adopted, require managed care organizations and integrated delivery systems to collect patient information on race, ethnicity, and language. These draft standards follow on the heels of earlier JCAHO standards covering other accredited institutions. The professional standard of care evolves slowly over time and in response to advances in science, information, and technology.2,3 When the professional standard of care is poised to take a leap of the magnitude envisioned by the information revolution in health care, it is important to understand the legal landscape in which such a transformation would occur. The law can strongly affect the course of events, and longstanding legal principles may need revisiting as part of the evolution of health care itself. Most readers are familiar with the legal issue of health information privacy because of the enormous attention paid to the subject in recent years as a result of federal HIPAA health information privacy standards. (For an excellent discussion of HIPAA in a public health practice context, see James G. Hodge, Health Information Privacy & Public Health, 31 J.L. Med. & Ethics, 2003.) But the legal issues related to health information extend beyond privacy considerations. The law can affect the development of modern electronic health care information systems and the growth of Regional Health Information Networks (RHIOs), as well as the extent to which data collected for patient health care management ultimately can be aggregated, assembled, and disseminated for broader public use. It is important to remember in considering the legal landscape for health information that although the conversion to electronic data systems is technologically complex and raises legal issues of its own, many of the most important legal considerations now on the radar screen have long been part of the legal landscape, even when information was collected purely in paper form. Indeed, some of the legal that move to the fore in today’s world (such as privacy considerations and liability for health care quality) date back hundreds of years, to the origins of the modern physician/ patient relationship.