New Patient Information System Sparks Privacy Debate

Apr 28, 2014

Doctors and privacy advocates say a new statewide system designed to make it easier to share patient data is too open for abuse.

The Vermont Health Information Exchange (not to be confused with the state's health insurance exchange) is a state-funded system being built by Vermont Information Technology Leaders that stores patient care information such as medication lists and diagnoses. The goal of the system is to make it easier for doctors involved in a given patient’s care to learn about them.

But a new policy set to take effect this summer would make it possible for doctors not involved in a given patient’s care to view their file. The “global consent” policy will make it so that once a patient signs the form authorizing a release of their file, any doctor’s office connected to the system will have access to that record.

“If you sign it for anybody to get it, everybody can get it,” said John Matthew, a doctor at The Health Center in Plainfield.

Matthew said he isn’t comfortable with the idea of recommending the new policy to his patients, but the company that designed the policy and the regulators tasked with overseeing it both say it is safe for patients.

The other benefit, said John Evans, the CEO of Vermont Information Technology Leaders, is that it reduces the number of forms patients have to sign at doctors’ offices.

“All the health care providers involved in their care would have access to the clinical information needed to care for them and reduce the burden of the patient of needing to make that designation visiting each provider involved in their care,” Evans said.

With a technological tracking system that keeps tabs on who is viewing which record, Evans said the new system is even more secure than the old system of paper records in a file drawer.

Concerns with the global consent policy, which was approved by the Green Mountain Care Board earlier this year, stem from the fact that there is very little stopping doctors and their staffs from viewing records of any patient.

Allen Gilbert is the executive director of the Vermont chapter of the American Civil Liberties Union. He said he won’t be signing the global consent form.

"I've not been reassured that the system would protect my patients' information to the extent that I think it should be protected. That's the bottom line." - Dr. John Matthew

“The only thing stopping somebody from unauthorized access of a record is some words from an agreement you’ll supposedly sign when you get employed at a practice that you will not access a record unless you’re authorized to do so,” he said.

The same is true of paper records, of course, and Evans says the health information exchange’s audit system makes it even more accountable than those.

But unlike paper records, which are only entrusted to the patient’s provider and clinic staff, records on the state information exchange can be accessed by any provider or staff connected to the system. Anyone logging into the system must actively agree that they are viewing the records only to provide care, but once they do so, they technically have access to the file of any patient who has signed the global consent form.

“I’ve not been reassured,” says Matthew, “that the system would protect my patients’ information to the extent that I think it should be protected. That’s the bottom line.”

With or without Matthew’s and Gilbert’s trust, the system is set to go live this summer once the Green Mountain Care Board’s conditions of approval are met.

Al Gobeille, the chairman of the Green Mountain Care Board, said he voted to approve the global consent policy because in his view, the global consent policy will allow the system to better streamline care without compromising privacy.

“When I voted, what I was voting for was the belief that a global opt-in where a patient is educated, knowledgeable about the document they’re signing and that they’re giving caregivers the right to look at their medical records – that that is a high enough burden to meet federal law and to meet the state’s intent to protect the patient’s rights,” he said.

Gobeille said that even after the global consent policy goes into effect, debate over privacy versus the convenience and cost control in Vermont’s health care system isn’t likely to go away.

“These are the big decisions we have to make as we balance the need for integration and really good care,” he said, “and how do we guarantee privacy.  What you’re hearing in anyone who’s got feelings on the subtleties of the issue or a big divide over the issue, you’re hearing the passion of those two things rubbing up against each other.”