[A] publicly funded nonprofit is weighing a policy that would give doctors and hospitals more access to patients’ health records, and one of the state’s leading privacy advocates opposes the move.
Officials with the Vermont Information Technology Leaders (VITL) are talking with stakeholders about a policy change that would give doctors automatic access to patient records unless a patient objects.
The American Civil Liberties Union of Vermont is concerned about protection of patient privacy.
VITL warehouses data from patients’ electronic medical records across the state and runs the Vermont Health Information Exchange, which is designed to enable different electronic medical records systems used by doctors and hospitals to talk to each other.
The Green Mountain Care Board oversees the Montpelier-based nonprofit and has scrutinized VITL's performance, financial management and privacy protections.
The company's signature program, VITL Access, gives doctors and other clinicians information about patients. Under current policy, patients must give doctors permission to view their records.
Rob Gibson, the vice president of marketing for VITL, said his organization are hearing from doctors who say that the policy causes an administrative burden.
About 96 percent of patients give doctors access to their records, Gibson said, and the remaining 4 percent don't want to share records. Gibson says VITL is considering a system that would automatically give doctors access to patient records unless patients "opt-out."
In two-thirds of states that have health information exchanges, according to Gibson, only the patients who don’t want doctors to see the records must fill out paperwork.
“What we’re starting to hear from people is that having a requirement like we do now, with having everybody being required to opt in creates extra work and administrative burden and sort of limits the flow of information sometimes,” Gibson said.
“That would be certainly easier to manage, and it would certainly increase the flow of information and help information be shared,” he said. “We’ve been looking at it. We’ve had a discussion with our provider advisory committee about it.”
Kristina Choquette, the vice president of operations for VITL, told state regulators last month that doctors and other clinicians describe the current opt-in patient consent policy as "HIPAA on steroids.” (The Health Insurance Portability and Accountability Act is a federal law that mandates strict privacy rules for patient information.)
Doctors want to know why they have to ask each patient for consent, Choquette said.
VITL is required to discuss the policy change with the Office of the Health Care Advocate at Vermont Legal Aid, and the American Civil Liberties Union of Vermont.
Allen Gilbert, the outgoing executive director of the ACLU of Vermont, said the organization has always favored an “opt-in” policy for VITL’s systems, because patients will be more likely to know what they’re agreeing to that way.
“There is a greater likelihood of informed consent when people have to make a decision to ‘opt in,’ and the ‘opt out’ starts with a default that the person is in, and it requires no fault to have the person essentially enrolled in the system,” Gilbert said.
He said that even in its current state, VITL Access has limited privacy controls for patients. A staff member in a doctor’s office can access a patient’s records without typing in a code or signing a document.
“We worry about the way the VITL system works even when someone does give consent because there’s no PIN number or code that’s needed to access someone’s records,” Gilbert said, comparing the system to an automated teller machine.
“With VITL you have neither a card, nor a PIN number,” he said. “A staff member of a hospital or a doctor’s office is sitting in front of a terminal that allows access to anybody’s accounts. They just press a button that says they are authorized to access a record.”
Betty Rambur, a nurse practitioner who sits on the Green Mountain Care Board, praised Choquette and other VITL executives for considering the effects of an “opt-out” policy on Vermonters.
“It is really this complicated balance between providers having the data they need and the people having the privacy that they deserve,” Rambur said.
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