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Vermont Health Information Exchange Considering Op-Out Consent

The Vermont health information exchange may switch to an opt-out consent policy in an effort to boost patient participation.

A Vermont health information exchange is working to increase patient participation.

Source: Thinkstock

By Kate Monica

- After years of struggling to boost the number of patient health records included in the exchange, leaders of Vermont’s health information exchange (HIE) are considering changing their consent policy from opt-in to opt-out.

Opt-in policies require patients to explicitly agree to participate in the exchange, while opt-out consent models automatically include patient health records in the exchange unless a patient requests that their records not be included.

The proposal to change the HIE’s consent policy has raised concerns among some members of the state’s Green mountain Care Board about the potential for problems with patient privacy, according to VTDigger.  

“I cannot look at the (exchange) experience of the majority of states and believe that opt-in remains the most effective way to operate the program and to maximize our chances for success and protect the public investment that went into it,” said Department of Vermont Health Access Deputy Commissioner Michael Costa at a January Green Mountain Care Board meeting, according to VTDigger.

Since its inception, the HIE operated by Vermont Information Technology Leaders (VITL) has received a total of $44.3 million in state and federal funding. In 2017, VITL administrators and Vermont state officials began laying the groundwork for a multi-year strategy to improve the efficiency, effectiveness, and accountability of the HIE.

In February 2018, officials first considered changing the HIE’s opt-in policy to promote increased participation in the exchange. As of 2017, only 19 percent of Vermont residents allowed their health records to be included in the HIE.

A preliminary report presented an argument suggesting switching from an opt-in to an opt-out consent policy would increase HIE participation without risking patient privacy.  

According to the report, a “vast majority of states have either opt-out consent or no consent requirement at all (only three states besides VT use opt-in.)”

Furthermore, officials reported nine successful HIE models identified by HealthTech Solutions utilized some form of opt-out exchange.

Still, some stakeholders oppose the proposal to change the consent policy, arguing patients may not have enough information to decide whether they want their health data included in the exchange.

 “I would urge the Green Mountain Care Board to not agree to a change in policy without first reviewing a compelling plan to ensure that consumers understand their options,” said Vermont Developmental Disabilities Council Executive Director Kirsten Murphy.

Specifically, the Office of the Health Care Advocate and the American Civil Liberties Union of Vermont have spoken out against the proposed policy change.

“For the population we represent, which generally has a low level of health literacy, shifting the burden from provider to consumer would compromise the ability of people with developmental disabilities to make an informed decision about their personal health information,” said Murphy.

Most Green Mountain Care board members voiced support for the policy change. Department of Vermont Health Access officials stated they will include stakeholder feedback from the January meeting in a forthcoming final report about the proposal.

VITL has been working steadily to overcome financial and administrative problems since an unfavorable report revealed persistent problems with the exchange. VITL administrators have taken steps to reduce hundreds of thousands of duplicate patient EHRs logged into the system under various version of each patient’s name.

VITL leadership has also been successful in reducing operating expenses and improving the exchange’s financial situation.

Additionally, the team of executives increased the number of patient health records included in the database to 38 percent in 2018. VITL has also strengthened its partnership with the state.



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