Opt-in consent policies: potential barriers to hospital health information exchange

Abstract

Objectives: First, to assess whether hospitals in states requiring explicit patient consent ("optin") for health information exchange (HIE) are more likely to report regulatory barriers to HIE. Second, to analyze whether these policies correlate with hospital volume of HIE.Study Design: Cross-sectional analysis of US non-federal acute care hospitals in 2016. Methods:We combined legal scholarship surveying HIE-relevant state laws with the AHA Annual IT Supplement for regulatory barriers and hospital characteristics. Data from CMS reports for hospitals attesting to Meaningful Use Stage 2 in 2016 (MU2, renamed "Promoting Interoperability" in 2018) captured hospital HIE volume. We used multivariate logistic regression and linear regression to estimate the association between opt-in state consent policies and reported regulatory barriers and HIE volume, respectively.Results: Hospitals in states with opt-in consent policies were 7.8 percentage points more likely than hospitals in opt-out states to report regulatory barriers to HIE (p=0.03). In subgroup analyses, this finding held among hospitals that did not attest to MU2 (7.7pp, p=0.02). Among hospitals attesting, we did not find a relationship between opt-in policies and regulatory barriers (8.0pp, p=0.13), nor evidence of a relationship between opt-in policies and HIE volume (ß=0.56, p=0.76). Conclusions:Our findings suggest that opt-in consent laws may carry greater administrative burdens compared to opt-out policies. However, less technologically advanced hospitals may bear more of this burden. Furthermore, opt-in policies may not impact HIE volume for hospitals that have already achieved a degree of technological sophistication. Policymakers should carefully consider the incidence of administrative burdens when crafting laws pertaining to HIE.

Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients

“…While developed as intended safeguards, these restrictive policies may be misaligned with patients’ preferences for greater access to their information, and have the unintended consequence of reducing the exchange of heath information. For example, Apathy and colleagues 55 found that the administrative and legal burdens of opt-in regulations decreased health organizations’ capacity to engage in provider HIE. Similarly, in their study of patient portal use within a safety-net ambulatory clinic, Ancker and colleagues 56 found significant racial and socioeconomic disparities existed when patients had to opt in to receive a portal account; however, racial differences in portal use disappeared when universal (i.e., opt-out) policies were installed.…”

Findings from the 2021 Yearbook Section on Health Information Management

“…Over half (56.8%) of Caucasian respondents expressed preferences for an opt-out policy, while less than half (38.3%-48.3%) of non-White respondents (Native Americans, African-Americans, Latinos, and Asian/Pacific Islanders) preferred an opt-out policy. Apathy and Holmgren examined regulatory barriers and consent policies regarding data sharing and exchange of individual hospitals [ 5 ]. They found that in states with opt-in consent requirements for HIE, there was overall less HIE than in states that allowed opt-out consent for HIE.…”

Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange

“…Healthcare organizations operating in an opt-in policy environment, as were all the HIOs in this study, face greater administrative burdens. 27 Problematically, healthcare organizations and HIOs have limited options for eliminating consent challenges as patient consent requirements are defined at the state and federal levels. 28 Mitigation is a more likely path through such efforts as simplifying consent language, consenting through the patient portal and EHR, and incorporating broader members of the care team in the process.…”