Despite years of development work on the Vermont Health Information Exchange (VHIE), in 2017 the health records of only 19 percent of Vermonters were accessible in the VHIE. One potential obstacle identified is the HIE’s opt-in consent policy, which is now under review.
In 2017, the Legislature required the state to conduct a comprehensive review of the VHIE, which is run by the nonprofit Vermont Information Technology Leaders (VITL). The state engaged HealthTech Solutions (HTS) to conduct an evaluation. Among the issues it studied was whether the opt-in consent policy is too administratively burdensome and whether individual consent should be on an opt-in or opt-out basis.
“Opt-in” presumes that consent is withheld unless stated otherwise. “Opt-out” presumes that consent is granted unless stated otherwise.
HTS’s survey of other states revealed that the vast majority of states have opt-out consent models (only three states besides Vermont use opt-in). All nine “Successful HIE Models” identified by HTS in its report to the state used some form of opt-out.
A majority of Vermont stakeholders surveyed by the researchers support change to opt-out. However, some stakeholders opposing change voiced concern that privacy and autonomy may be degraded by opt-out. The report notes that there is no Vermont statute that governs the issue of whether or what kind of patient consent may be required.
The report’s preliminary recommendation is that the consent policy should be changed to provide for an opt-out consent model, while taking into account the perspectives of those who remain concerned by making it easy to opt-out and implementing the change with care to ensure that all who want out, are out.
A Vermont publication called VTDigger published an account of an early January meeting of the Green Mountain Care Board, which works to improve health care quality and moderate cost for Vermonters by regulation, innovation and evaluation. It quoted Mike Smith, who took over as VITL’s top administrator last year. He noted that the organization has boosted the portion of Vermonters who have records in the exchange to nearly 39 percent since 2017. But he said that progress will “plateau” without a change in the way Vermonters agree or don’t agree to participate in the exchange.
“Currently, medical providers can only access a minority of Vermonters’ records,” Smith is quoted as saying. “Changing the policy would mean that they’d be able to access a majority of patient records in Vermont, with all the safeguards that are in place.”
VTDigger noted that several care board members expressed general support for the policy change, but the board took no action, and Department of Vermont Health Access officials said they would incorporate feedback from the meeting into their final report to the Legislature this month.
