Joining an HIE or RHIO? Navigate the Opt-In/Opt-Out Decision Carefully

Once you’ve deployed an EHR system in your practice, your next step will be getting connected with other providers. Engaging in health information exchange (HIE) is a tenet of meaningful use and extremely valuable utilization of EHR technology.

Whether you’re joining a statewide HIE network or a regional health information organization (RHIO), you’ll be communicating the transition to your patients, who must be notified of the change in accordance with state laws.

Some states, such as Tennessee and New York, have legally mandated the framework for HIE patient consent methodology. If yours hasn’t, you’ll need to choose your approach and should be prepared for the consequences of what you select.

HIE is both a welcome innovation and a divisive issue, and there are advocates on both sides of the opt-in/opt-out debate.

Different Options
If you’re going with an “opt-in” method, each of your patients must express their authorization to take part in the HIE program or RHIO in order to become enrolled. Usually, a consent form is presented to patients, which they sign and return to participate in the network.

Consumer rights activists and patients with strong concerns about health information privacy – such as those with illnesses they consider stigmatizing – advocate for the opt-in approach.

With the “opt-out” method, patients are notified that their provider is joining an HIE network and informed that unless they formally and explicitly request to be excluded, they’re automatically enrolled in it. Following notification, their health information becomes exchangeable through the program.

Opt-out is supported more by patients with chronic ailments, who usually embrace HIE’s ability to facilitate easy communication about their care between multiple providers. It’s also favored by more medical practice managers and providers since simply mailing notices requires less administrative capacity than obtaining signed consent forms.

There are other consent models, including “opt-in with exceptions”-type blended methods and the “notice only” no-consent approach – still legal in some states – which does not present patients with the option of declining participation.

Whichever of these methods you choose has implications that will affect how many patients end up enrolled in your HIE network. Those implications are partially rooted in the psychology of decision-making.

Question Structures Have Impact
When faced with a difficult decision, individuals are more likely to follow the path of least resistance to avoid the challenge of choosing. A major study in behavioral economics illustrated that phenomenon through findings on the number of registered organ donors in different nations.

Countries that enroll organ donors by default (unless they are opt-out), such as Sweden and Portugal, have national organ donation rates of 80% or higher. Others, like the U.S. and U.K., that require consumers to opt-in to donating, have rates around 20%.

“The questions on the forms are clear, transparent and simple,” writes marketing consultant Laura Villevielle in a piece on behavioral economics. “The truth is people are being forced to make an extremely complicated decision, one that they don’t really want to make. So by phrasing the question in different ways, we are, in part, making the decision for them.”

Strategic Approach
Participation in an HIE or RHIO can have such huge benefits on the quality of care your patients receive that your selection of either an opt-in or opt-out method won’t define your patients’ involvement nearly as drastically as 80% or 20%.

But it could have an effect. Patients on the peripheries of both sides of the issue and those less educated on the topic altogether may not know what to do when it comes to enrolling.

Your choice as a provider to either enroll them automatically or ask them to join will ultimately make the decision for those patients who choose not to choose when presented with consent paperwork.

It’s Up to You
Whichever approach you take, be sure to emphasize your privacy and security policies in the notification material you provide to patients.

Consider even appointing an HIE-knowledgeable staff member as a dedicated “Patient Educator” during your transition. That person can assuage consumer concerns and tout the benefits of your use of HIE technology.

If it’s in your hands to decide, the opt-in or opt-out choice will reflect the healthcare philosophy of your practice. Educate yourself on your options, inform your patients and choose wisely.

Are you part of an HIE or RHIO? Did your patients provide consent by opt-in or opt-out means?

Madelyn Young is a Content Writer for CareCloud and an expert on practice management, medical billing, HIPAA 5010, ICD-10 and revenue cycle management. You can read her work on Power Your Practice and the CareCloud Blog. Contact Madelyn with story suggestions, contributor articles, or any other feedback at madelyn@poweryourpractice.com or follow her on Twitter @madelyn_young.


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