By Michael L. Gagnon

Several national reports released in 2019 show that doctors are experiencing an increased level of burnout at work, leading to job dissatisfaction and depression. A common thread in the studies is the clerical burden that comes with navigating administrative tasks, specifically to technology as the health-care industry catches up to the modernization of electronic health records (EHRs).

Medscape’s recent report on national physician burnout declared that exhaustion is a huge issue among doctors and has even led to tragic instances of physician suicide. The study includes insight from more than 15,000 physicians in nearly 30 specialties. When asked what contributes most to burnout, the top three answers included: too many bureaucratic tasks such as charting and paperwork; spending too many hours at work; and increasing computerization of practice – in other words, EHRs.

But EHRs and the ability to share clinical data on patients is also crucial to improving the quality of care and lowering costs to drive value-based payment reforms. In fact, clinical data sharing will only proliferate further. Imagine doing away with email, text messages and social media. It’s just not going to happen anytime soon.

So let’s do our providers and patients a huge favor by improving the process and making methods of sharing health information as seamless as possible. Organizations such as HealtHIE Nevada provide electronic connections among physicians, hospitals, labs and other health care organizations, streamlining the transfer of clinical data and allowing doctors to focus on the patient at the point of care. Data such as patient encounters, medications, medical images, test results and care summaries are delivered instantly when they are needed, and there is no waiting around for faxes or physical mail.

Great solution, right? Sure, but there’s a little bit more work that needs to be done before the system is fully optimized. Particularly in Nevada and a few other states, we have a huge barrier to overcome, and it has to do with laws pertaining to patient consent.

When it comes to sharing health data, state consent policies and regulations generally fall under one of two possible solutions: Opt out, which means that patient data in health information exchanges (HIEs) can be shared with treating providers by default but patients are allowed to opt out of having their information shared if they choose; and Opt in, which means that patient consent is needed before any patient data may be shared with their providers.

Nevada is an Opt in state, which severely undercuts the value of the patient data within the HIE. There is a compelling case to be made to change the law to Opt out:

• The number of patients who actually opt-out is minimal. Despite having clinical data on nearly all Nevadans, only about half of them have completed a consent form (46 percent), mostly because they have not been asked. When asked, 96 percent of patients either fully opt in or opt in for emergencies. Only about 4 percent opt out.
• Obtaining consent adds to the existing administrative burden. When all patients must opt in for data to be shared, we must collect a form, often a paper form, for all 3 million Nevada residents and all non-resident patients as well. We already have 3.5 million patients in our database and expect this number to grow substantially over time as new residents move in, and we treat visitors and many others who are not residents. The forms and associated brochures must be printed, presented to patients and then entered into a computer system. Many patients are asked more than once. This takes time and money. If we use an estimate of 4 million as a baseline for how many opt-in forms must be collected and the cost of collecting these forms is about $3 each, we are spending at least $12 million collecting consents. If we change to an opt out system, we would only need to collect approximately 4 percent of the 4 million forms, which would cost 160,000 times $3 or $480,000.
• Privacy is not improved via the current system. The 4 percent of people who do not wish their data to be shared can still opt out if they really are concerned with their privacy.
• Patient safety is a concern. Perhaps the most compelling concern is that the 96 percent of patients who want their data to be shared are at risk until they opt in. If data exists in the HIE and an unconscious patient presents in an emergency department and has not previously consented, that patient is at risk. The patient may have medical conditions, allergies to medications or other important clinical data that could save their life readily available in the HIE — but inaccessible because of the opt-in requirement. There could also be legal implications for withholding this data from a treating provider.

The ability to capture, analyze and present clinical data to all care providers is a crucial function of our statewide HIE and can only improve the state of wellness to all Nevadans. HealtHIE Nevada is in the process of developing a bill draft to change Nevada to an opt out. It will take support from our business and health care provider community. However, if we are successful, it will alleviate stress for our valued physicians and ultimately allow for the best in patient care.

Michael L. Gagnon, CPHIMS is the Executive Director of HealtHIE Nevada, the statewide health information exchange in Nevada. He is the former chief technology officer of Vermont Information Technology Leaders, the state HIE. Michael also serves as the chair of the Western Member Council of the Strategic HIE Collaborative’s Patient Centered Data Home initiative. You can contact him at [email protected].