Data+Segmentation+User+Story+2.1

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User Story 2.1 – (Change Mind) Patient X goes to a Healthcare Provider Organization for a certain condition, receives treatment for the diagnosis and pays for the services out-of-pocket. Since the Patient paid for the services he/she informs the Healthcare Provider Organization to withhold Payer access to data related to the treatment received. In order to be compliant with HITECH §13405 and Proposed Rule 45 CFR Part 164.522(a) (1) (iv) the Healthcare Provider Organization enters the Patient data and disclosure preference into their EHR system. In addition to receiving care from the Healthcare Provider Organization the Patient had a blood test, which he/she did not pay for out-of-pocket. The laboratory sent the claim to the Patient’s Payor. The Payer sends an electronic information request to the Healthcare Provider Organization for Patient X’s treatment and services that led to the request for blood work, before approving payment. Healthcare Provider Organization responds to the information request and does not send the data, complying with the Patient’s disclosure preference. The Payer Information system does not receive Patient’s data. A period of time has elapsed. The Patient notifies his/her Healthcare Provider Organization and withdraws past restrictions on Payer access to data related to treatment received. The Healthcare Provider Organization then enters the Patient’s updated data into EHR system. The Payer sends a new electronic information request for Patient X’s treatment and services that led to the request for blood work, before approving coverage and payment. The Healthcare Provider Organization EHR system responds to the information request and electronically sends the Patient’s treatment and service data. The Payer Information system receives the Patient treatment and service data.

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