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Interoperability and Patient Access

Connecting Your Healthcare

New Options For Managing Your Digital Medical Records

Imagine:

  • You go to a new healthcare provider because you don’t feel well and that provider can pull up your health history from the past five years.
  • The provider uses that information to diagnose you and quickly finds the right specialist by checking an up-to-date provider directory.
  • You have a question about a claim, so you go to your computer and see if it’s paid, denied, or still being processed.

Starting in 2021, a new federal rule will make it easier for Peach State Health Plan members* to do all of this and more.

The Interoperability and Patient Access rule (CMS-9115-F) puts patients first by giving you control and easy access to your health information when you need it most. Complete access to your health information allows you to manage your health better and know what healthcare resources are available to you.

The new rule makes it so you can easily find information** on:

  • claims (paid and denied)
  • past test results
  • your cost of care
  • healthcare providers
  • provider appointments
  • health status
  • specific parts of your clinical information
  • pharmacy directory data***

Patient Demographics                                  

  • first name                            
  • last name
  • previous name
  • middle name
  • suffix
  • birth sex
  • date of birth
  • race
  • ethnicity
  • preferred language

 

New Demographics

  • current address
  • previous address
  • phone number
  • phone number type
  • email address

 

Clinical Notes

  • consultation note
  • discharge summary note
  • history & physical
  • imaging narrative
  • laboratory report narrative
  • pathology report narrative
  • procedure note
  • progress note

 

Allergies & Intolerances

  • substances (medications)
  • substances (drug class)
  • reaction

 

Vital Signs****

  • body height
  • body weight
  • BMI percentile (2-20 years)
  • blood pressure
  • heart rate
  • respiratory rate
  • body temperature

 

Health Concerns

Immunizations

Procedures

Medications

Laboratory Tests & Results

Assessment & Treatment Plan

Care Team Members

 


* Applies to Medicare Advantage, Medicaid and CHIP Managed Care, and federally funded ACA exchange plans.

** Data will be available for dates of service on or after Jan. 1, 2016.

*** For Medicare Advantage Prescription Drug (MAPD) plans.

**** Vital Signs maintained by the Health Plan will be available.

Having your medical information in one place helps you and your providers understand your health better so you can make better decisions and improve your health outcomes. This often reduces healthcare costs. This information will follow you to any provider or health plan in the future.

At Peach State Health Plan, your privacy and the security of your PHI is a top concern. The new rule allows you to look up your information using an app from a third-party application developer (a company with no connection to Peach State Health Plan).  We promise to give you information on what to consider when selecting an app, the ways your data can be used by the third party, and the importance of understanding the security and privacy practices of the app.  We will give you information on federal agencies you can contact if you feel your rights to patient privacy have not been protected.

The CARIN alliance is a bipartisan, multi-sector collaborative working to advance consumer-directed exchange of health information.  Learn more about third-party application privacy standards on the CARIN Alliance website.  The CARIN Code of Conduct is a set of industry-leading best practices these applications have voluntarily adopted to protect and secure your health information.   We will require third-party application developers to prove they will follow certain privacy standards by attesting to the CARIN Code of Conduct.  Visit My Health Application for a list of apps that have attested to the CARIN Code of Conduct.

Find a trusted app. Visit My Health Application for a list of apps that have attested to the CARIN Code of Conduct ensuring they meet the strictest privacy and security guidelines.

Download the app. Smartphone apps are available through the Google Play Store (Android) and the App Store (iOS), and web apps are available for computers.

Create your account. Follow the instructions in the app of your choice to sign up and link your health information.

Use your information to manage your healthcare. Now you have the information you need to make the best healthcare decisions for yourself.

Check out the Frequently Asked Questions or call Peach State Health Plan at 1-800-704-1484.

Call Peach State Health Plan at 1-800-704-1484 or visit PSHPGeorgia.com.

For more information on CMS Policies and Technology for Interoperability and Burden Reduction visit the CMS website

Any health information maintained by the Health Plan with a date of service January 1, 2016 or later will be made available.

You will have access to your health information, no matter what health plan or provider you go to.

Yes, you can use an app to see what shots you’ve had with a date of service January 1, 2016 or later.

No, the app you use will not be affiliated with Peach State Health Plan. You may also visit My Health Application for a list of apps that have attested to the CARIN Code of Conduct ensuring they meet the strictest privacy and security guidelines.  Follow the instructions on the app to connect it with your health record.

There may be some apps that don’t follow all the privacy provisions. We will let you know which apps have agreed to follow our guidelines for your privacy. If you have already selected an app prior to us receiving a response from the app provider on their privacy policies, you will have a chance to select another app within a certain timeframe. We recommend that you request a Notice of Privacy Practices from the app. If the app does not provide you with a Notice of Privacy Practices, we recommend that you choose another app. You may also visit My Health Application for a list of trusted apps.

Starting July 1, 2021, you will be able to access your Peach State Health Plan information through the apps.

No, you do not have to use an app to access your healthcare info. You can contact your provider or health plan for needed information.

The app will collect your health data including, but not limited to, your claims, medications, diagnoses, procedures, and doctor visits.  When you enroll in the app, you are giving your permission for the app to collect this information.

Apps do have the ability to collect non-health data such as location. Some apps let you have the option to provide that information. We recommend that you ask your app provider.

Requesting your health data via an app could potentially include the health data of family members who are associated with your health account.

To correct mistakes in your health data, you will need to contact your provider or health insurance company. The health app only makes data available from healthcare sources. The app does not create this data.  If the app is showing incorrect information that was not sent to the app then the app must correct this problem.

We recommend that you ask the app provider for their notice of privacy and security practices.

Most apps will not be covered by HIPAA. Most apps will instead fall under the jurisdiction of the Federal Trade Commission (FTC) and the protections provided by the FTC Act. The FTC Act, among other things, protects against deceptive acts (e.g., if an app shares personal data without permission, despite having a privacy policy that says it will not do so).

The FTC provides information about mobile app privacy and security for consumers on the FTC consumer information website

For apps that are subject to HIPAA, you can find more information about patient rights under HIPAA and who is obligated to follow HIPAA

You can also see the HIPAA FAQs for Individuals.

We recommend that you request a Notice of Privacy Practices from the app provider to understand your rights.

We recommend that you request a Notice of Privacy Practices from the app provider to understand how they respond to a privacy and security incident. You have the right to file a complaint with enforcement agencies including the Office for Civil Rights (OCR) and the Federal Trade Commission (FTC).

Most apps will not be considered covered entities under HIPAA. Most apps will instead fall under the jurisdiction of the Federal Trade Commission (FTC) and the protections provided by the FTC Act. The FTC Act, among other things, protects against deceptive acts (e.g., if an app shares personal data without permission, despite having a privacy policy that says it will not do so).

Learn more about filing a complaint with OCR under HIPAA.

Individuals can file a complaint with OCR using the OCR complaint portal.

Individuals can file a complaint with the FTC using the FTC complaint assistant

Although the purpose of the app is for you to be able to see your data in one place, we recommend that you request a Notice of Privacy Practices to understand how the app will use your data.

We recommend that you request a Notice of Privacy Practices from the app provider to understand if the app will share your data with third parties.

We recommend that you request a Notice of Privacy Practices from the app provider to understand what happens to your data after you stop using the app.

We recommend that you request a Notice of Privacy Practices from the app provider to understand what happens to your data after you stop using the app.

The best way to stop sharing data is through the Third Party Application or by contacting the Third Party Application support. If you are unable to successfully stop sharing data through the Third Party Application or using the Third Party Application Support then you may call Peach State Health Plan member services for assistance.

We recommend that you request a Notice of Privacy Practices from the app provider to understand if the app will share your data with third parties for advertising and research.

App providers may respond to user complaints in different ways. We recommend that you ask this question to your app provider.

We recommend that you request a Notice of Privacy Practices from the app provider to understand how the app stores your data.

We recommend that you request a Notice of Privacy Practices and additional information on security practices from the app provider to understand how they handle a security incident.

We recommend that you request a Notice of Privacy Practices from the app provider to understand how you can limit the use and release of your data.