Comments by Christopher P. Tirabassi, Posted on January 31, 2008

Page # Line # Comments/Criticisms Suggested Alternatives
20 29-32

Affirmative consent at the provider level places the ultimate responsibility and burden on physicians and their staff.

Multiple consents are too cumbersome and will simply delay or discourage providers as well as patients.

Allow consumers the option to authorize release of their information to all providers (which are covered entities under HIPAA) participating in the exchange. Enable patients to submit their participation agreements to RHIO naming all the providers they wish to include.

Once a provider in one organization has received patient consent to access a patient's information, also allow his / her access to that patients information at any facility that the patient receives care.

Standardized consent forms should indicate the benefits of participating in the RHIO.
21 5-7 Consumers who choose to withhold specific items from their health record could hinder effective treatment by a physician who is unaware that data is being withheld. Consents should indicate in an obvious manner that the patient has chosen to withhold data. The physician should be given an opportunity to decide whether or not to establish or maintain a professional relationship with the patient. (other than emergency situations)
28-29 35-40 Payer access to the data without expressed consent by the physician should not be permitted absolutely. Payers currently have sufficient data for case management through the claim adjudication process. They will use the health data for underwriting and other actuarial purposes. Unabated access to their data will hinder physician participation. Physicians should be given the option to opt-out of having their data available to payers. This can be accomplished at the RHIO level as physicians sign on to participate.
29 12-16 Payers will undoubtedly use their marketing leverage, financial clout and political contacts to gain access to health data. They certainly appreciate the value of the data. Enable an opt-out for physicians to protect the data that is a necessary and valuable by-product of their medical practices.
29 17-25   Enable payer access to data that has been stripped of any information that identifies the patient and physician.
30 34-42 Just as experience with health plans in general and Medicare managed care plan and HIPAA, specifically, the onus has fallen on physicians and their staff to educate and assist patients who are unable or are disinclined to grasp the complexities of each. Education should be integrated with the consent process at the RHIO level.