Taking your medical record out of the health information exchange

It is the right to say you do not want your health information circulating among providers through PRHIE, and to change your mind later. You exercise it by signing and submitting a voluntary exclusion form, and it takes effect prospectively from when the Participant receives written notice.

Every patient. The law does not condition the right on a diagnosis, an age or a health plan: it says every patient shall have the continuing right to opt out of, or rescind a decision on access to, their medical records. There is one express limit: the decision is not honoured where a legal requirement applies, such as the public health information exchange required by the Department of Health or the federal health agencies.

• Being a patient. The right belongs to every patient and is continuing: it can be exercised and also reversed.Verified against the official source
• Signing and submitting the voluntary exclusion form available through your health care provider or Participant.Verified against the official source
• That the Participant receive written notice of your decision: the opt-out is enforced prospectively from that date.Verified against the official source

• The "voluntary exclusion" form the law says will be available through your health care provider or Participant. The law publishes no form, number or link, so we reproduce none: ask for it where you are treated.

1. 1

   Step 1: Understand what PRHIE is and what it shares

   The Puerto Rico Health Information Exchange is attached to the Department of Health's Medicaid Program and is the State-designated entity for the requirements of the Assistant Secretary for Technology Policy (ASTP), the federal Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS). Through it, a participating covered entity may disclose your protected health information to other covered entities for any purpose HIPAA permits.

2. 2

   Step 2: Ask for the voluntary exclusion form

   Article 13 says the form is available through your health care provider or Participant. You sign it and submit it. The law adds that PRHIE, once implemented, will be responsible for maintaining a registry of consent preferences, giving providers a mechanism to report exclusions, and providing an electronic means for patients to opt out directly through PRHIE. That electronic route is a duty the law imposes, not something we verified already exists.

3. 3

   Step 3: Know from when it applies and from when it does not

   The opt-out is enforced prospectively, from the date the Participant receives written notice. And the law says it plainly: your decision does not affect in any way any disclosure made before that receipt. What was already shared was already shared; what the opt-out stops is what comes next.

4. 4

   Step 4: No one may punish you for opting out

   Article 13(5) says a Participant health care provider or covered entity shall not deny treatment, coverage or benefits to a patient because of their decision to opt out. The same provision clarifies that nothing in it seeks to restrict a provider from appropriately ending a relationship with a patient in accordance with the law and applicable professional ethical standards.

5. 5

   Step 5: If your decision is not honoured, there are fines

   Article 14 provides that non-compliance may carry a fine of no less than $1,000 and no more than $5,000 per violation, imposed by the Medicaid Program through the Department of Health, after notice and an opportunity to be heard. Where there is obstruction, negligence, bad faith, recklessness or capricious refusal in the exchange of health information, the fine shall be no less than $5,000 and no more than $10,000 per violation. Added to that is any civil or criminal sanction under state or federal law, and any other civil or administrative remedy. The law also notes that the 21st Century Cures Act empowers the federal Inspector General to impose civil penalties of up to $1,000,000 for information blocking practices.

With your health care provider or Participant, who holds the voluntary exclusion form. The law also requires PRHIE, attached to the Department of Health's Medicaid Program, to provide an electronic means to opt out directly.

• Believing the opt-out erases what was already shared: the law says it does not affect any disclosure made before the written notice was received.
• Thinking opting out is permanent: the right is continuing, and includes rescinding the opt-out later.
• Fearing you will be refused service: a Participant provider or covered entity may not deny treatment, coverage or benefits over that decision.
• Assuming the opt-out covers everything: it is not honoured where a legal requirement applies, such as public health information exchange required by the Department of Health or the federal agencies.
• Expecting an online portal: the law requires PRHIE to provide an electronic means once implemented; meanwhile, the route is the form where you are treated.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov