Comments by Bill Braithwaite, Posted on February 1, 2008

Page # Line # Comments
20 29-32 Consumer-centric portals should provide an easy way for the consumer to be notified that a provider is seeking access to their medical record, and have the ability to grant access in real-time. Otherwise, patients would have to complete one form in advance that authorizes access for a particular list of providers. Since patients often seek care from specialists based upon events, including accidental injury, providing an authorized list of providers would be impossible for most patients.
20 29-32 Providing the ability for consumers to grant access in real-time, would allow patients to do so online prior to visiting a care giver, which would eliminate the need for the care giver to require each patient to complete a WRITTEN consent form when they arrive for care. This might also be useful in an emergency.
20 39 Rather than conforming to the old requirements of a per practice paper based consent workflow, prior to an office visit, each practice will be able to gain real-time consent, if when querying the patient on the HIE, they don't find that prior consent has been given. This eliminates the need for the office to generate a paper form or search file cabinets every time a patient visits their office. Requiring a written consent per practice would make it nearly impossible for consulting physicians, referred to physicians, or potentially covering physicians to access information prior to a visit.
22 7-9 Allowing real-time consent would enable an owner-CDR model RHIO to receive results follwing an order requested by a physician via a direct one-to-one approach, rather than requiring a consent form to send results.
22 36-39 Enabling patients to provide real-time consent at any time, would enable any entity accessing information, including consultants and specialists to do so, even when such access was not previously anticipated, such as accessing results or clinical history prior to a new patient's physical visit. The current requirement of forcing a primary care physician to send practice notes and test results to a consulting physician would be eliminated in this new approach. Real-time consent would allow the granting of access to a patient's medical record by a specialist who got involved after a physician/referral.
23 39-42

Rather than requiring participating institutions and providers to be listed on the consent form or in some other manner available in the physicians office at time of consenting, solutions should enable dynamic enrollment in a RHIO via identity proofing and strong authentication. This approach would be ideal in the dynamic and ever changing RHIO environment and would eliminate the difficulty in keeping preprinted forms and rosters current.

In addition to real-time consent, patients should be allowed to choose various levels of access for a range of different pratices through both web based patient portals and telephone based authentication applications. The patient portal and telephone approach also allows for a more current roster of participating providers.

Levels of consent could vary, beginning with written consent within a RHIO, followed by online and by phone consent, which would include an audit trail for compliance, reporting and investigation. This could remove the weight of phyisicians offices having to manage consent broadly and replace the old world approach with a much more dynamic system of electronic health information exchange. This approach would also provide the kind of control that consumers demand.

As an example, some patients may opt to initially only grant access to their primary care physician, and then enable access subsequently to referred and consulting physicians as required. Some patients may hold careful control, choosing to grant access in real-time, when a physician orders a treatment or the patient schedules an appointment.
27 32 Ubiquity & engaging the consumer/patient in the anti-fraud continuum will increase their sense of trust in the system.