House
File
2623
-
Introduced
HOUSE
FILE
2623
BY
COMMITTEE
ON
HEALTH
AND
HUMAN
SERVICES
(SUCCESSOR
TO
HSB
623)
A
BILL
FOR
An
Act
relating
to
the
Iowa
health
information
network
1
including
functioning
as
the
state-designated
health
data
2
utility.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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Section
1.
Section
135D.2,
Code
2024,
is
amended
to
read
as
1
follows:
2
135D.2
Definitions.
3
As
used
in
this
chapter
,
unless
the
context
otherwise
4
requires:
5
1.
“Board
of
directors”
or
“board”
means
the
entity
that
6
governs
and
administers
the
Iowa
health
information
network.
7
2.
1.
“Care
coordination”
means
the
management
of
all
8
aspects
of
a
patient’s
care
to
improve
health
care
quality.
9
2.
“Community
information
exchange”
means
an
ecosystem
10
comprised
of
multidisciplinary
network
participants
that
11
use
standardized
technical
language,
a
resource
database,
12
and
an
integrated
technology
platform
to
deliver
enhanced
13
community
care
planning
using
care
planning
tools
that
enable
14
participants
to
integrate
data
from
multiple
sources
and
make
15
bidirectional
referrals
to
create
a
shared
longitudinal
record.
16
3.
“Department”
means
the
department
of
health
and
human
17
services.
18
4.
“Designated
entity”
means
the
nonprofit
corporation
19
designated
by
the
department
through
a
competitive
process
as
20
the
entity
responsible
for
administering
and
governing
the
Iowa
21
health
information
network.
22
5.
“Exchange”
means
the
authorized
electronic
sharing
of
23
health
information
and
data
between
health
care
professionals,
24
payors,
consumers,
public
health
agencies,
the
designated
25
entity,
the
department,
and
other
authorized
participants
26
utilizing
the
Iowa
health
information
network
and
Iowa
health
27
information
network
services.
28
6.
“Federally
qualified
health
center”
means
a
health
care
29
entity
that
receives
grant
funding
under
section
330
of
the
30
federal
Public
Health
Service
Act,
Pub.
L.
No.
78-410.
31
7.
“Governing
board”
means
the
board
of
directors
that
32
governs
and
administers
the
designated
entity.
33
6.
8.
“Health
care
professional”
means
a
person
who
is
34
licensed,
certified,
or
otherwise
authorized
or
permitted
by
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the
law
of
this
state
to
administer
health
care
in
the
ordinary
1
course
of
business
or
in
the
practice
of
a
profession.
2
9.
“Health
data
utility”
means
a
locally
governed,
3
statewide,
multifaceted
resource
that
provides
services
for
the
4
interchange
of
health
data
within
the
health
care
and
public
5
health
ecosystems
for
the
purpose
of
advancing
health
care
6
and
improving
public
health
outcomes.
A
“health
data
utility”
7
combines,
enhances,
and
exchanges
electronic
health
data
across
8
care
and
service
settings
for
treatment,
care
coordination,
9
quality
improvement,
and
public
and
community
health
purposes,
10
in
accordance
with
applicable
state
and
federal
laws
protecting
11
patient
privacy.
12
7.
10.
“Health
information”
means
health
information
as
13
defined
in
45
C.F.R.
§160.103
that
is
created
or
received
by
an
14
authorized
a
participant.
15
11.
“Health
information
exchange”
means
participants
16
contributing
to
the
sharing
and
movement
of
health
information
17
electronically
across
participants
within
a
state,
region,
18
community,
or
health
care
delivery
system.
19
12.
“Health
information
network”
means
participants
in
the
20
health
information
exchange
in
the
aggregate.
21
8.
13.
“Health
information
technology”
means
the
22
application
of
information
processing,
involving
both
computer
23
hardware
and
software,
that
deals
with
the
storage,
retrieval,
24
sharing,
and
use
of
health
care
information,
data,
and
25
knowledge
for
communication,
decision
making,
quality,
safety,
26
and
efficiency
of
clinical
practice,
and
may
include
but
is
not
27
limited
to:
28
a.
An
electronic
health
record
that
electronically
compiles
29
and
maintains
health
information
that
may
be
derived
from
30
multiple
sources
about
the
health
status
of
an
individual
and
31
may
include
a
core
subset
of
each
care
delivery
organization’s
32
electronic
medical
record
such
as
a
continuity
of
care
record
33
or
a
continuity
of
care
document,
computerized
physician
order
34
entry,
electronic
prescribing,
or
clinical
decision
support.
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b.
A
personal
health
record
through
which
an
individual
and
1
any
other
person
authorized
by
the
individual
can
maintain
and
2
manage
the
individual’s
health
information.
3
c.
An
electronic
medical
record
that
is
used
by
health
care
4
professionals
to
electronically
document,
monitor,
and
manage
5
health
care
delivery
within
a
care
delivery
organization,
is
6
the
legal
record
of
the
patient’s
encounter
with
the
care
7
delivery
organization,
and
is
owned
by
the
care
delivery
8
organization.
9
d.
A
computerized
provider
health
care
professional
10
order
entry
function
that
permits
the
electronic
ordering
of
11
diagnostic
and
treatment
services,
including
prescription
12
drugs.
13
e.
A
decision
support
function
to
assist
physicians
and
14
other
health
care
providers
professionals
in
making
clinical
15
decisions
by
providing
electronic
alerts
and
reminders
to
16
improve
compliance
with
best
practices,
promote
regular
17
screenings
and
other
preventive
practices,
and
facilitate
18
diagnosis
and
treatments
treatment
.
19
f.
Tools
to
allow
for
the
collection,
analysis,
and
20
reporting
of
information
or
data
on
adverse
events,
the
quality
21
and
efficiency
of
care,
patient
satisfaction,
and
other
health
22
care-related
performance
measures.
23
9.
14.
“Health
Insurance
Portability
and
Accountability
24
Act”
or
“HIPAA”
means
the
federal
Health
Insurance
Portability
25
and
Accountability
Act
of
1996,
Pub.
L.
No.
104-191,
including
26
amendments
thereto
and
regulations
promulgated
thereunder.
27
10.
15.
“Hospital”
means
a
licensed
hospital
as
defined
in
28
section
135B.1
.
29
11.
16.
“Interoperability”
means
the
ability
of
two
or
more
30
systems
or
components
to
exchange
information
or
data
in
an
31
accurate,
effective,
secure,
and
consistent
manner
and
to
use
32
the
information
or
data
that
has
been
exchanged
and
includes
33
but
is
not
limited
to:
34
a.
The
capacity
to
connect
to
a
network
for
the
purpose
of
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exchanging
information
or
data
with
other
users.
1
b.
The
ability
of
a
connected
,
authenticated
user
2
participant
to
demonstrate
appropriate
permissions
to
3
participate
in
the
instant
transaction
over
the
network.
4
c.
The
capacity
of
a
connected
,
authenticated
user
5
participant
to
access,
transmit,
receive,
and
exchange
usable
6
information
with
other
users
participants
.
7
12.
17.
“Iowa
health
information
network”
or
“network”
means
8
the
statewide
health
information
technology
network
that
is
the
9
sole
statewide
health
information
network
for
Iowa
pursuant
to
10
this
chapter
.
11
13.
18.
“Medicaid
program”
means
the
medical
assistance
12
program
as
defined
in
section
249A.2
.
13
19.
“Nursing
facility”
means
a
licensed
nursing
facility
as
14
defined
in
section
135C.1.
15
14.
20.
“Participant”
means
an
authorized
health
care
16
professional,
payor,
patient,
health
care
organization,
public
17
health
agency,
or
the
department
entity
described
in
section
18
135D.4,
subsection
4,
paragraph
“d”
,
that
has
agreed
entered
19
into
an
agreement
to
authorize,
submit,
access,
or
disclose
20
health
information
and
data
through
the
Iowa
health
information
21
network
in
accordance
with
this
chapter
and
all
applicable
22
laws,
rules,
agreements,
policies,
and
standards.
23
15.
21.
“Patient”
means
a
person
who
has
received
or
is
24
receiving
health
services
from
a
health
care
professional.
25
16.
22.
“Payor”
means
a
person
who
makes
payments
for
26
health
services,
including
but
not
limited
to
an
insurance
27
company,
self-insured
employer,
government
program,
individual,
28
or
other
purchaser
that
makes
such
payments.
29
23.
“Payor
information
exchange”
means
a
large-scale
30
database
that
systematically
collects
health
care
claims
data
31
from
a
variety
of
payor
sources,
including
claims
from
health
32
care
professionals.
33
24.
“Pharmacy”
means
a
pharmacy
as
defined
in
section
34
155A.3.
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25.
“Pharmacy
information
exchange”
means
the
participants
1
contributing
to
the
sharing
and
movement
of
dispensed
pharmacy
2
information
electronically
across
participants
within
a
state,
3
region,
community,
or
health
care
delivery
system.
4
17.
26.
“Protected
health
information”
means
protected
5
health
information
as
defined
in
45
C.F.R.
§160.103
that
is
6
created
or
received
by
an
authorized
a
participant.
7
18.
27.
“Public
health
activities”
means
actions
taken
by
8
a
participant
in
its
the
participant’s
capacity
as
a
public
9
health
authority
under
the
Health
Insurance
Portability
and
10
Accountability
Act
or
as
required
or
permitted
by
other
federal
11
or
state
law.
12
19.
28.
“Public
health
agency”
means
an
entity
that
is
13
governed
by
or
contractually
responsible
to
a
local
board
of
14
health
or
the
department
to
provide
services
focused
on
the
15
health
status
of
population
groups
and
their
the
population
16
groups’
environments.
17
20.
29.
“Record
locator
service”
means
the
functionality
of
18
the
Iowa
health
information
network
that
queries
data
sources
19
to
locate
and
identify
potential
patient
records.
20
30.
“Rehabilitative
services”
means
the
same
as
defined
in
21
section
135C.1.
22
31.
“Social
care”
means
any
care,
service,
good,
or
supply
23
related
to
an
individual’s
social
needs.
“Social
care”
24
includes
but
is
not
limited
to
support
and
assistance
for
an
25
individual’s
food
stability
and
nutritional
needs,
housing,
26
transportation,
economic
stability,
employment,
education
27
access
and
quality,
child
care
and
family
relationship
needs,
28
and
environmental
and
physical
safety.
29
32.
“Social
care
referral
system”
means
a
system
that
shares
30
an
individual’s
social
care
information
for
the
purpose
of
31
referrals
among
health
care
entities,
public
health
agencies,
32
and
community-based
organizations.
“Social
care
referral
33
system”
includes
but
is
not
limited
to
a
network,
software,
or
34
technology
platform.
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Sec.
2.
Section
135D.3,
subsection
1,
paragraph
c,
Code
1
2024,
is
amended
to
read
as
follows:
2
c.
A
health
information
network
involves
the
secure
3
electronic
sharing
of
health
information
across
the
boundaries
4
of
individual
practice
and
institutional
health
settings
and
5
with
consumers.
The
broad
use
of
health
information
technology
6
and
a
health
information
network
should
improve
improves
health
7
care
quality
and
the
overall
health
of
the
population,
increase
8
increases
efficiencies
in
administrative
health
care,
reduce
9
reduces
unnecessary
health
care
costs,
and
help
helps
prevent
10
medical
errors.
11
Sec.
3.
Section
135D.4,
Code
2024,
is
amended
to
read
as
12
follows:
13
135D.4
Iowa
health
information
network
——
principles
14
——
technical
infrastructure
requirements
——
function
as
15
state-designated
health
data
utility
.
16
1.
The
Iowa
health
information
network
shall
be
17
administered
and
governed
by
a
designated
entity
using,
at
a
18
minimum,
the
following
principles:
19
a.
Be
patient-centered
and
market-driven.
20
b.
Comply
with
established
national
standards.
21
c.
Protect
the
privacy
of
consumers
and
the
security
and
22
confidentiality
of
all
health
information.
23
d.
Promote
interoperability.
24
e.
Increase
the
accuracy,
completeness,
and
uniformity
of
25
data.
26
f.
Preserve
the
choice
of
the
patient
to
have
the
patient’s
27
health
information
available
through
the
record
locator
28
service.
29
g.
Provide
education
to
the
general
public
and
provider
30
communities
on
the
value
and
benefits
of
health
information
31
technology.
32
2.
Widespread
adoption
of
health
information
technology
is
33
critical
to
a
successful
Iowa
health
information
network
and
is
34
best
achieved
when
all
of
the
following
occur:
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a.
The
network,
through
the
designated
entity
complying
1
with
chapter
504
and
reporting
as
required
under
this
chapter
,
2
operates
in
an
entrepreneurial
and
businesslike
manner
in
which
3
it
is
accountable
to
all
participants
utilizing
the
network’s
4
products
and
services.
5
b.
The
network
provides
a
variety
of
services
from
which
to
6
choose
in
order
to
best
fit
the
needs
of
the
user
participant
.
7
c.
The
network
is
financed
by
all
who
benefit
from
the
8
improved
quality,
efficiency,
savings,
and
other
benefits
that
9
result
from
use
of
health
information
technology.
10
d.
The
network
is
operated
with
integrity
and
freedom
from
11
political
influence.
12
3.
The
Iowa
health
information
network
technical
13
infrastructure
shall
provide
a
mechanism
for
all
of
the
14
following:
15
a.
The
facilitation
and
support
of
the
secure
electronic
16
exchange
of
health
information
between
participants.
17
b.
Participants
The
opportunity
for
the
participants
18
without
an
electronic
health
records
system
to
access
health
19
information
from
the
Iowa
health
information
network.
20
4.
a.
Beginning
July
1,
2024,
the
Iowa
health
information
21
network
shall
function
as
the
state-designated
health
data
22
utility
or
state-designated
HDU,
operated
and
governed
by
the
23
designated
entity.
The
state-designated
HDU
shall
operate
as
a
24
public-private
partnership
to
facilitate
the
secure
electronic
25
sharing
of
health
information
and
data
across
a
variety
of
26
settings
including
health
care
delivery
settings,
payors,
27
social
care
entities,
and
consumers.
28
(1)
The
state-designated
HDU
is
designed
to
achieve
better
29
health
care
outcomes,
improve
the
overall
health
and
well-being
30
of
the
people
of
the
state,
and
reduce
the
cost
of
health
31
care
by
creating
a
more
seamless,
transparent,
and
modernized
32
approach
to
the
sharing
of
health
information
and
data.
33
(2)
Utilization
of
health
information
and
data
requires
34
appropriate
governance
and
policy
leadership.
The
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state-designated
HDU
provides
clear
data
governance,
privacy,
1
and
security
policies
to
facilitate
the
sharing
of
health
2
information
and
data,
ensuring
that
the
health
information
and
3
data
follow
the
patient
and
improve
the
health
of
all
citizens
4
of
the
state.
5
(3)
Health
care
professionals
and
entities
have
been
6
subject
to
HIPAA
since
1996,
and
HIPAA
has
driven
initial
7
efforts
to
develop
a
culture
and
infrastructure
of
health
8
information
governance.
As
holders
of
personal
information,
9
state
agencies
have
a
responsibility
to
demonstrate
to
the
10
public
the
state’s
commitment
to
respecting
personal
privacy.
11
(4)
Health
care
entities
have
a
duty
to
share
health
12
information
and
data,
in
accordance
with
applicable
law,
with
13
other
health
care
entities
to
ensure
that
optimal
patient
14
and
population
health
is
achieved.
To
further
demonstrate
15
the
commitment
to
privacy,
the
state-designated
HDU
provides
16
opt-out
policies
and
procedures
to
allow
patients
to
opt
out
of
17
health
information
and
data
sharing.
18
b.
The
purposes
of
the
state-designated
HDU
include
all
of
19
the
following:
20
(1)
The
transmittal,
collection,
aggregation,
and
analysis
21
of
clinical
information,
public
health
data,
and
health
22
administrative
and
operations
data
to
assist
the
department,
23
local
health
departments,
health
care
professionals,
patients,
24
policymakers,
and
the
governing
board
in
understanding
the
25
population
health
of
Iowa.
26
(2)
The
enhancement
and
acceleration
of
the
27
interoperability
of
health
information
and
data
throughout
the
28
state,
ensuring
compliance
with
all
applicable
privacy
and
29
security
laws
and
regulations.
30
(3)
The
empowerment
of
patients
in
accessing
and
directing
31
their
health
information
and
data,
health
care
costs,
and
32
overall
health
to
improve
quality
of
life
in
the
state.
33
c.
The
state-designated
HDU
shall
provide
health
information
34
and
data,
in
accordance
with
applicable
law,
to
patients
and
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organizations
involved
in
the
treatment
and
care
coordination
1
of
patients,
and
shall
support
the
health
goals
of
the
2
community
and
the
state.
The
state-designated
HDU
shall
be
3
comprised
of
all
of
the
following
data
sources:
4
(1)
A
health
information
exchange.
The
governing
board
5
shall
adopt
health
care
information
interoperability
standards
6
for
the
health
information
exchange.
The
minimum
standard
of
7
sharing
shall
be
the
most
recently
approved
version
of
the
8
United
States
core
data
of
interoperability.
The
minimum
9
standard
of
sharing
may
be
enhanced
by
the
governing
board.
10
(2)
A
pharmacy
information
exchange.
11
(a)
Unless
otherwise
prohibited
by
state
or
federal
law,
12
each
licensed
pharmacy
that
dispenses
prescription
drugs
to
13
patients
in
the
state
shall
provide
all
dispensed
prescription
14
information
to
the
state-designated
HDU
in
compliance
with
all
15
applicable
state
and
federal
rules.
16
(b)
The
governing
board
shall
adopt
interoperability
17
standards,
data
elements,
and
terminologies
necessary
to
18
provide
data
in
as
close
to
real
time
as
possible
to
facilitate
19
data
exchange.
20
(3)
A
payor
information
exchange.
The
governing
board
shall
21
adopt
the
interoperability
standards
for
claims
data
sharing
by
22
all
payors
required
to
share
data.
23
(4)
A
community
information
exchange.
The
governing
board
24
shall
adopt
the
interoperability
standards
for
data
sharing
by
25
social
care
entities
specified
by
the
governing
board.
26
d.
(1)
By
December
31,
2024,
all
hospitals,
critical
access
27
hospitals,
general
acute
care
hospitals,
and
rehabilitative
28
hospitals
in
the
state
shall
be
participants
with
the
29
state-designated
HDU,
and
shall
share
all
data
in
accordance
30
with
standards,
policies,
and
procedures
adopted
by
the
31
governing
board
pursuant
to
this
chapter.
32
(2)
By
December
31,
2025,
all
provider
clinics,
ambulatory
33
surgical
centers,
mental
health
and
substance
use
treatment
34
centers,
psychiatric
or
mental
hospitals,
facilities
providing
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rehabilitative
services,
imaging
centers,
laboratories,
1
federally
qualified
health
centers,
and
payors
in
the
state
2
shall
be
participants
with
the
state-designated
HDU,
and
shall
3
share
all
data
in
accordance
with
standards,
policies,
and
4
procedures
adopted
by
the
governing
board
pursuant
to
this
5
chapter.
6
(3)
By
December
31,
2025,
all
health
clinics,
public
7
health
clinics,
urgent
care
facilities,
nursing
facilities,
8
and
pharmacies
shall
be
participants
with
the
state-designated
9
HDU,
and
shall
share
all
data
in
accordance
with
policies
and
10
procedures
adopted
by
the
governing
board
pursuant
to
this
11
chapter.
12
(4)
By
December
31,
2028,
all
entities
utilizing
digital
13
technology
for
the
purposes
of
social
care
referral
and
14
care
coordination
in
the
state,
including
but
not
limited
to
15
community-based
organizations,
shall
be
participants
with
the
16
state-designated
HDU,
and
shall
share
data
in
accordance
with
17
federal
interoperability
guidance
and
policies
adopted
by
the
18
governing
board
pursuant
to
this
chapter.
19
e.
Any
entity
specified
in
paragraph
“d”
that
does
not
own
20
or
has
not
contracted
for
an
electronic
records
management
21
system
or
service
on
or
before
July
1,
2024,
shall
not
be
22
required
to
purchase
or
contract
for
an
electronic
records
23
management
system
or
service
in
order
to
comply
with
paragraph
24
“d”
.
25
f.
Paragraph
“d”
shall
not
apply
to
any
of
the
following:
26
(1)
A
facility
or
institution
controlled,
managed,
27
directed,
or
operated
under
the
jurisdiction
of
the
department
28
of
health
and
human
services,
including
the
state
mental
health
29
institutes.
30
(2)
Medicaid
fee-for-service
programs
under
the
Medicaid
31
program.
32
4.
5.
Nothing
in
this
chapter
shall
be
interpreted
to
33
impede
or
preclude
the
formation
and
operation
of
regional,
34
population-specific,
or
local
health
information
networks
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or
the
participation
of
such
networks
in
the
Iowa
health
1
information
network.
2
6.
The
Iowa
health
information
network
shall
not
constitute
3
a
health
benefit
network
or
a
health
insurance
network.
4
Sec.
4.
Section
135D.5,
Code
2024,
is
amended
to
read
as
5
follows:
6
135D.5
Designated
entity
——
selection,
administration
,
and
7
governance.
8
1.
The
Iowa
health
information
network
shall
be
9
administered
and
governed
by
a
designated
entity
selected
by
10
the
department
through
a
competitive
process.
The
designated
11
entity
shall
be
established
as
a
nonprofit
corporation
12
organized
under
chapter
504
.
Unless
otherwise
provided
in
13
this
chapter
,
the
corporation
is
subject
to
the
provisions
of
14
chapter
504
.
The
designated
entity
shall
be
established
for
15
the
purpose
of
administering
and
governing
the
statewide
Iowa
16
health
information
network.
17
2.
The
designated
entity
shall
collaborate
with
the
18
department,
but
the
designated
entity
shall
not
be
considered,
19
in
whole
or
in
part,
an
agency,
department,
or
administrative
20
unit
of
the
state.
21
a.
The
designated
entity
shall
not
be
required
to
comply
22
with
any
requirements
that
apply
to
a
state
agency,
department,
23
or
administrative
unit
and
shall
not
exercise
any
sovereign
24
power
of
the
state.
25
b.
The
designated
entity
does
not
have
authority
to
pledge
26
the
credit
of
the
state.
The
assets
and
liabilities
of
27
the
designated
entity
shall
be
separate
from
the
assets
and
28
liabilities
of
the
state
and
the
state
shall
not
be
liable
29
for
the
debts
or
obligations
of
the
designated
entity.
All
30
debts
and
obligations
of
the
designated
entity
shall
be
payable
31
solely
from
the
designated
entity’s
funds.
The
state
shall
32
not
guarantee
any
obligation
of
or
have
any
obligation
to
the
33
designated
entity.
34
3.
The
articles
of
incorporation
of
the
designated
entity
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shall
provide
for
its
the
designated
entity’s
governance
and
1
its
efficient
management.
In
providing
for
its
the
designated
2
entity’s
governance,
the
articles
of
incorporation
of
the
3
designated
entity
shall
address
the
following:
4
a.
A
governing
board
of
directors
to
govern
the
designated
5
entity.
6
b.
The
appointment
of
a
chief
executive
officer
by
the
7
governing
board
to
manage
the
designated
entity’s
daily
8
operations.
9
c.
The
delegation
of
such
powers
and
responsibilities
to
the
10
chief
executive
officer
as
may
be
necessary
for
the
designated
11
entity’s
efficient
operation.
12
d.
The
employment
of
personnel
necessary
for
the
efficient
13
performance
of
the
duties
assigned
to
the
designated
entity.
14
All
such
personnel
shall
be
considered
employees
of
a
private,
15
nonprofit
corporation
and
shall
be
exempt
from
the
personnel
16
requirements
imposed
on
state
agencies,
departments,
and
17
administrative
units.
18
e.
The
financial
operations
of
the
designated
entity
19
including
the
authority
to
receive
and
expend
funds
from
public
20
and
private
sources
and
to
use
its
property,
money,
or
other
21
resources
for
the
purpose
of
the
designated
entity.
22
Sec.
5.
Section
135D.6,
Code
2024,
is
amended
to
read
as
23
follows:
24
135D.6
Board
of
directors
Governing
board
——
composition
——
25
duties.
26
1.
The
designated
entity
shall
be
administered
by
a
27
governing
board
of
directors
.
28
2.
A
single
industry
shall
not
be
disproportionately
29
represented
as
voting
members
of
the
governing
board.
The
30
governing
board
shall
include
at
least
one
member
who
is
a
31
consumer
of
health
services
and
a
majority
of
the
voting
32
members
of
the
governing
board
shall
be
representative
of
33
participants
in
the
Iowa
health
information
network.
The
34
director
of
health
and
human
services
or
the
director’s
35
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designee
and
the
director
of
the
Medicaid
program
or
the
1
director’s
designee
shall
act
as
voting
members
of
the
2
governing
board.
The
commissioner
of
insurance
shall
act
3
as
an
ex
officio,
nonvoting
member
of
the
governing
board.
4
Individuals
serving
in
an
ex
officio,
nonvoting
capacity
shall
5
not
be
included
in
the
total
number
of
individuals
authorized
6
as
members
of
the
governing
board.
7
3.
The
governing
board
of
directors
shall
do
all
of
the
8
following:
9
a.
Ensure
that
the
designated
entity
enters
into
contracts
10
with
each
state
agency
necessary
for
state
reporting
11
requirements.
12
b.
Develop,
implement,
and
enforce
the
following:
13
(1)
A
single
patient
identifier
or
alternative
mechanism
14
to
share
secure
patient
health
information
and
data
that
is
15
utilized
by
all
health
care
professionals.
16
(2)
Standards,
requirements,
policies,
and
procedures
for
17
access
to,
use,
secondary
use,
privacy,
and
security
of
health
18
information
and
data,
including
clinical
information,
exchanged
19
through
the
Iowa
health
information
network,
consistent
with
20
applicable
federal
and
state
standards
and
laws.
21
c.
Direct
a
public
and
private
collaborative
effort
to
22
promote
the
adoption
and
use
of
health
information
technology
23
in
the
state
to
improve
health
care
quality,
increase
patient
24
safety,
reduce
health
care
costs,
enhance
public
health,
25
and
empower
individuals
and
health
care
professionals
with
26
comprehensive,
real-time
medical
information
to
provide
27
continuity
of
care
and
make
the
best
health
care
decisions.
28
d.
Educate
the
public
and
the
health
care
sector
about
29
the
value
of
health
information
technology
in
improving
30
patient
care,
and
methods
to
promote
increased
support
and
31
collaboration
of
state
and
local
public
health
agencies,
32
health
care
professionals,
and
consumers
in
health
information
33
technology
initiatives.
34
e.
Work
to
align
interstate
and
intrastate
interoperability
35
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standards
in
accordance
with
national
health
information
1
exchange
standards.
2
f.
Provide
an
annual
budget
and
fiscal
report
for
the
Iowa
3
health
information
network
to
the
governor,
the
department
4
of
health
and
human
services
,
the
department
of
management,
5
the
chairs
and
ranking
members
of
the
legislative
government
6
oversight
standing
committees,
and
the
legislative
services
7
agency.
The
report
shall
also
include
information
about
the
8
services
provided
through
the
network
and
information
on
the
9
participant
usage
of
the
network.
10
g.
Ensure
any
health
information
and
data
within
the
Iowa
11
health
information
network
is
shared
and
accessed
according
to
12
all
applicable
state
and
federal
laws
and
standards,
including
13
HIPAA,
to
uphold
the
privacy
and
security
of
a
patient’s
14
protected
health
information.
15
Sec.
6.
Section
135D.7,
Code
2024,
is
amended
to
read
as
16
follows:
17
135D.7
Legal
and
policy
——
liability
——
confidentiality.
18
1.
The
governing
board
shall
implement
industry-accepted
19
security
standards,
policies,
and
procedures
to
protect
the
20
transmission
and
receipt
of
protected
health
information
and
21
data
exchanged
through
the
Iowa
health
information
network,
22
which
shall,
at
a
minimum,
comply
with
HIPAA
and
shall
include
23
all
of
the
following:
24
a.
A
secure
and
traceable
electronic
audit
system
to
25
document
and
monitor
the
sender
and
recipient
of
health
26
information
exchanged
through
the
Iowa
health
information
27
network.
28
b.
A
required
standard
participation
agreement
which
29
defines
the
minimum
privacy
and
security
obligations
of
all
30
participants
using
the
Iowa
health
information
network
and
31
services
available
through
the
Iowa
health
information
network.
32
c.
The
opportunity
for
a
patient
to
decline
exchange
of
the
33
patient’s
health
information
or
data
through
the
record
locator
34
service
of
the
Iowa
health
information
network.
35
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(1)
A
patient
shall
not
be
denied
care
or
treatment
for
1
declining
to
exchange
the
patient’s
health
information
or
data
,
2
in
whole
or
in
part,
through
the
network.
3
(2)
The
governing
board
shall
provide
the
means
and
process
4
by
which
a
patient
may
decline
participation.
The
means
and
5
process
utilized
shall
minimize
the
burden
on
patients
and
6
health
care
professionals.
7
(3)
Unless
otherwise
authorized
by
law
or
rule,
a
patient’s
8
decision
to
decline
participation
means
that
none
of
the
9
patient’s
health
information
or
data
shall
be
accessible
10
through
the
record
locator
service
function
of
the
Iowa
health
11
information
network.
A
patient’s
decision
to
decline
having
12
health
information
or
data
shared
through
the
record
locator
13
service
function
shall
not
limit
a
health
care
professional
14
with
whom
the
patient
has
or
is
considering
a
treatment
15
relationship
from
sharing
health
information
concerning
the
16
patient
through
the
secure
messaging
function
of
the
Iowa
17
health
information
network.
18
(4)
A
patient
who
declines
participation
in
the
Iowa
health
19
information
network
may
later
decide
to
have
the
patient’s
20
health
information
or
data
shared
through
the
network.
A
21
patient
who
is
participating
in
the
network
may
later
decline
22
participation
in
the
network.
23
2.
A
participant
shall
not
be
compelled
by
subpoena,
court
24
order,
or
other
process
of
law
to
access
health
information
or
25
data
through
the
Iowa
health
information
network
in
order
to
26
gather
records
or
information
not
created
by
the
participant.
27
3.
A
participant
exchanging
health
information
and
data
28
through
the
Iowa
health
information
network
shall
grant
to
29
other
participants
of
the
network
a
nonexclusive
license
to
30
retrieve
and
use
that
health
information
or
data
in
accordance
31
with
applicable
state
and
federal
laws,
and
the
policies
and
32
standards
established
by
the
governing
board.
33
4.
A
health
care
professional
who
relies
reasonably
and
34
in
good
faith
upon
any
health
information
or
data
provided
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through
the
Iowa
health
information
network
in
the
treatment
of
1
a
patient
who
is
the
subject
of
the
health
information
or
data
2
shall
be
immune
from
criminal
or
civil
liability
arising
from
3
the
damages
caused
by
such
reasonable,
good-faith
reliance.
4
Such
immunity
shall
not
apply
to
acts
or
omissions
constituting
5
negligence,
recklessness,
or
intentional
misconduct.
6
5.
A
participant
who
has
disclosed
health
information
or
7
data
through
the
Iowa
health
information
network
in
compliance
8
with
applicable
law
and
the
standards,
requirements,
policies,
9
procedures,
and
agreements
of
the
Iowa
health
information
10
network
shall
not
be
subject
to
criminal
or
civil
liability
11
for
the
use
or
disclosure
of
the
health
information
or
data
by
12
another
participant.
13
6.
The
following
records
shall
be
confidential
records
14
pursuant
to
chapter
22
,
unless
otherwise
ordered
by
a
court
or
15
consented
to
by
the
patient
or
by
a
person
duly
authorized
to
16
release
such
information:
17
a.
The
health
information
contained
in,
stored
in,
submitted
18
to,
transferred
or
exchanged
by,
or
released
from
the
Iowa
19
health
information
network.
20
b.
Any
health
information
or
data
in
the
possession
of
the
21
governing
board
due
to
its
administration
and
governance
of
the
22
Iowa
health
information
network.
23
7.
Unless
otherwise
provided
in
this
chapter
,
when
24
sharing
health
information
or
data
through
the
Iowa
health
25
information
network
or
through
a
private
health
information
26
network
maintained
in
this
state
that
complies
with
the
privacy
27
and
security
requirements
of
this
chapter
for
the
purposes
28
of
patient
treatment,
payment
or
health
care
operations,
29
as
such
terms
are
defined
in
HIPAA,
or
for
the
purposes
of
30
public
health
activities
or
care
coordination,
a
participant
31
authorized
by
the
designated
entity
to
use
the
record
locator
32
service
is
exempt
from
any
other
state
law
that
is
more
33
restrictive
than
HIPAA
that
would
otherwise
prevent
or
hinder
34
the
exchange
of
patient
information
or
data
by
the
participant.
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8.
A
patient
aggrieved
or
adversely
affected
by
the
1
designated
entity’s
failure
to
comply
with
subsection
1,
2
paragraph
“c”
,
may
bring
a
civil
action
for
equitable
relief
as
3
the
court
deems
appropriate.
4
Sec.
7.
NEW
SECTION
.
135D.8
Funding.
5
The
department
may
expend
funds
appropriated
to
or
received
6
by
the
department
for
the
purposes
of
this
chapter
to
carry
out
7
the
requirements
of
this
chapter.
8
EXPLANATION
9
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
10
the
explanation’s
substance
by
the
members
of
the
general
assembly.
11
This
bill
relates
to
the
Iowa
health
information
network
12
(IHIN)
under
Code
chapter
135D
(Iowa
health
information
13
network)
and
the
functioning
of
the
IHIN
as
a
state-designated
14
health
data
utility
(state-designated
HDU).
15
The
bill
includes
definitions
used
in
the
bill.
16
The
bill
requires
the
designated
entity
to
administer
17
and
govern
the
IHIN
and
thereby,
also
operate
and
govern
the
18
state-designated
HDU
for
the
state.
“Health
data
utility”
is
19
defined
under
the
bill
as
a
locally
governed,
multifaceted
20
resource
that
provides
services
for
the
interchange
of
health
21
data
within
the
health
care
and
public
health
ecosystems
for
22
the
purpose
of
advancing
health
care
and
improving
public
23
health
outcomes.
A
“health
data
utility”
combines,
enhances,
24
and
exchanges
electronic
health
data
across
care
and
service
25
settings
for
treatment,
care
coordination,
quality
improvement,
26
and
public
and
community
health
purposes,
in
accordance
with
27
applicable
state
and
federal
laws
protecting
patient
privacy.
28
The
bill
provides
the
principles,
purposes,
and
composition
29
requirements
for
the
state-designated
HDU,
including
that
the
30
state-designated
HDU
include
information
and
data
from
a
health
31
information
exchange,
a
pharmacy
information
exchange,
a
payor
32
information
exchange,
and
a
community
information
exchange.
33
The
bill
requires
certain
entities
to
participate
with
the
34
state-designated
HDU
by
specified
dates.
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The
bill
provides
that
the
department
of
health
and
human
1
services
(HHS)
may
expend
funds
appropriated
to
or
received
by
2
HHS
for
the
purposes
of
the
bill
to
carry
out
the
requirements
3
of
the
bill.
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