Why Health Information Professionals Should Get Involved in Medical-Legal Partnerships

Editor’s Note: This is an opinion piece submitted to the Journal of AHIMA. The opinions here reflect the author and not AHIMA. 

Recently, I earned a graduate degree in legal studies from the S.J. Quinney College of Law at the University of Utah. One of the core classes was legal ethics, and it discussed the inequities underserved communities experience in accessing legal services in the United States. The final project paper for this class asked us to come up with a way to improve the delivery of legal services to underserved communities with the career we wanted or our current career.  

Immediately, I began thinking of ways health information (HI) professionals can get involved in improving the delivery of legal services to underserved communities. Studying the needs of patients with social determinants of health (SDOH) factors is important to HI professionals, so I researched how healthcare organizations are helping patients whose health is impacted by SDOH issues. My research led to the discovery of a program called medical-legal partnerships (MLPs).  

What Are Medical-Legal Partnerships? 

MLPs are partnerships between medical and legal entities to help patients with SDOH issues by treating the medical condition and the legal circumstance that contribute to their condition. Many “complex health-harming social problems are entrenched in federal, state, and local policies and laws that require expertise in poverty law and administrative law,” and attorneys have an “in-depth understanding of relevant policies, laws, and systems,” according to the National Center for Medical-Legal Partnerships.  

Medical and legal partnerships “help the healthcare system disrupt the cycle of returning people to the unhealthy conditions that would otherwise bring them right back to the clinic or hospital,” notes the center.  

According to the National Center for Medical-Legal Partnerships, the positive impact of MLPs on patients with social needs are:  

• People with chronic illnesses are healthier and admitted to the hospital less frequently, saving health care costs, too.  For example, improved housing conditions led to improved health in asthma patients.  
• Health care spending on high-need, high-cost patients was reduced. 
• People are more stably housed, and their utilities are less likely to be shut off. 
• People have access to greater financial resources. For example, one MLP program recovered $200,000 in back benefits for families over a three-year period while another recovered more than $500,000 in financial benefits for families over a seven-year period.

In a 2016 survey of medical-legal partnership programs across the country, clinicians reported: 

• 86 percent improvement in health outcomes for patients 
• 64 percent improvement in patient compliance with medical treatment 
• 38 percent improvement in ability to perform at the top of their license 

The Challenge of Sharing Information among Medical and Legal Partners  

MLP models vary in how they help patients with social needs, yet they have a common challenge: the sharing of patient-client information among medical and legal partners. For example, electronic health records (EHRs) are not designed to help MLPs operate more efficiently, yet EHRs do have the capabilities to support MLPs. In a 2019 Iowa Case Study the Siouxland Community Health Center began “screening for health-harming needs in their EHR and faxing referrals to Iowa Legal Aid via a custom referral letter template built in the EHR.” 

Other challenges to sharing information involve medical partners’ concerns about protecting privacy when permitting attorneys to seek access to EHRs. For instance, some medical partners have concerns legal partners who seek access to EHRs will violate confidentiality because they fear patient information will “get out into the wrong hands” and lead to potential lawsuits. However, as medical partners are trained to protect patient privacy, attorneys who seek access to EHRs can also be trained to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Also, medical partners can track records that are accessed by legal partners and flag inappropriate access. Lastly, some medical partners limit the legal partners’ access to specific patient records and block access to other patient records. For these reasons, medical and legal partners should create guidelines to determine how much or little attorney access is needed.  

On the other hand, legal partners have concerns about the legal significance of sharing case updates with medical partners when it can negatively impact attorney-client privilege, according to a qualitative study of MLPs. Case updates are when patient-client information is shared back and forth between legal and medical partners, but there is no consensus about how much or little information medical partners need. The information that needs to be shared would depend on the needs of the medical partners. If it is used for tracking the success of the MLP program, then case updates are important. But some medical partners such as an emergency room physician may not be interested in case updates if there is no long-term investment in the care of the patient.  

Furthermore, attorneys are required by the American Bar Association Confidentiality of Information Rule 1.6 to give a client informed consent before disclosing confidential information. The attorney’s duty to comply with ABA Rule 1.6 is time-consuming because the risk and benefits of disclosing client information must be fully explained to achieve informed consent. Under such circumstances, legal and medical partners should create guidelines for case updates so they can share what is needed to suit the needs of their MLP model. 

Likewise, AHIMA’s SDOH Policy Statement acknowledges the same challenges that need to be addressed to serve patients with social needs. The statement recognizes there is a “lack of digital infrastructure and robust technical capabilities,” and the need to protect patient privacy “while allowing for appropriate sharing of information with community partners” must be given attention to serve these patients.  

Why Should HI Professionals Be Part of MLPs? 

HI professionals have expertise in the areas that challenge MLPs such as information technology and privacy. For instance, the Iowa case study project required a multidisciplinary team of experts to implement. The team provided insight on EHR workflow, integration with available technology, and customization. Though unidentified in the project, HI professionals may have been included in the study. HI professionals should have a substantial presence in projects that leverage EHRs for MLPs because informatics and consumer health information are emerging HI careers.  

Privacy, risk, and compliance of patient health information is another area where HI expertise would add value to improving the delivery of legal services in MLPs. HI professionals knowledgeable in these areas or those who have obtained the Certified Health Privacy and Security or Registered Health Information Administrator credential can leverage their experience to participate in MLPs to structure patient-client information with policies and procedures.  

These are only some areas where HI professionals can improve MLP models. MLPs are certainly a potential emerging career pathway for HI professionals who are interested or knowledgeable in healthcare, law, technology, and public health policies. And HI professionals should consider a graduate degree in legal studies or even a law degree if they want to further combine their HI expertise with law.  

Healthcare is constantly changing, so new career opportunities continue to emerge for HI professionals. The patient-client information sharing challenges of MLPs fall into several areas that are in a HI professional’s area of expertise. Health information should have a stronger presence in MLP-related projects to further develop better policies and procedures to improve the delivery of legal services for patients with social needs.  

HI professionals interested in MLPs should inquire at their organization first as well as look at community health centers and legal partners serving social needs.  

Ginger Tanks, MLS, RHIA, CDIP, CCS, CPMA, CRC, is based in Richmond, VA, and is a remote clinical documentation coding specialist IV for University of Utah Health in Salt Lake City, UT. She recently completed the Master of Legal Studies program at the S.J. Quinney College of Law at the University of Utah.