Tuesday, December 3, 2013

2nd Reason Why Health Insurance Exchanges Will Continue Floundering in 2014

Last December I offered 3 reasons why I thought the deployment of Federally-facilitated Marketplace (FFM) would flounder in October 2013.

In my previous post I outlined Reason 1 –Enrollment Transaction Processing Generates Widespread Heartburn. Now I’m going to outline the 2nd reason why I believe health insurance exchanges (HIX) will continue floundering into 2014 and likely beyond.

Billing, Payment and Reconciliation Issues Galore

The current 834-related enrollment issues we’re hearing about will lead to payment-related issues; which in turn will lead to coverage and claims payment issues. Stories about incorrect subsidy calculations impacting the accuracy of premium amounts surfaced shortly after healthcare.gov went live. These stories arose from the state-based exchanges and we’ve yet to hear from the FFM.

The important thing to keep in mind is that very few – if any – exchanges have actually deployed functionality for submitting HIPAA 820 (Premium Payment/Order Remittance Advice) to their QHP partners. Of course the fact that these accounting and payment functions have not yet been developed only increases the likelihood of major heartburn arising in Q1 of 2014.

Topics You Won’t Hear About from Main Stream Media

But some things aren’t very sensational nor easy to understand so you won’t hear about them from the main stream media. Here are some accounting and payment related issues you likely won't hear about:

Multiple Sources of Payment

Since all those receiving a subsidy will necessitate a split-billed premium where more than one party is responsible for payment of the premium, the likelihood of premium payment issues leading to eligibility issues is certain to increase. What are the policy and technical requirements for processing members receiving subsidies who do not pay their portion.? Under what conditions can the member re-enroll? Must they pay all their costs that are in arrears?

People Grow Older - Subscribers are not Dependents

There is a dearth of guidance from CMS on handling common life events like aging off dependents, aging into Medicare, how retroactive terminations will be communicated, etc via the 834 transaction.

For families, these processing scenarios are made worse as each scenario needs to clearly differentiate between the subscriber and dependents. Anyone who’s familiar with the 834 transactions knows how finicky the “2300 Loop” can be! :)

The Most Wonderful Time of the Year?

All of the above are being worked on in the most hectic, cut-up month of the year: December. Years from now, I don’t suspect this will be one Christmas that will be memorialized among the “tales of glories of Christmases long, long ago.”

For more information on health insurance exchanges and other health IT topics, be sure to follow me on Twitter.

Friday, November 22, 2013

3 Reasons Health Insurance Exchanges Will Continue Floundering in 2014 (Part 1/3)

Last December I offered 3 reasons why I thought the deployment of health insurance exchanges (HIX) would flounder in October 2013. Now I’m going to share 3 more reasons why I believe health insurance exchanges will continue floundering into 2014 and likely beyond. Here’s reason #1:

Reason 1 –Enrollment Transaction Processing Generates Widespread Heartburn

By law, health insurance exchanges are the system of record for all enrollment transactions originated by a consumer to a qualified health plan (QHP.) The 834 Benefit Enrollment and Maintenance transaction is used by HIX’s to submit new enrollments, changes to enrollment and disenrollments to QHP’s. Unfortunately, there are not any clear operating rules defining how the 834 is to be used for the myriad of new enrollment, change enrollment and enrollment termination transactions that result from the life events a consumer will experience. Moreover, the 834 transaction was never widely adopted across the healthcare industry. Most QHP’s and 3rd parties use their own variation of the 834 transaction to process key enrollment events into their backend systems.

So far, 834’s have trickled out of the exchange and once the flood starts (assuming it ever does), the variability in how QHP’s have implemented their 834 handling will surface.

Note: Operating Rules for enrollment will not even be finalized until July of 2104 and not effective until January 2016.

Then Life Events Occur

After initial enrollment, all subsequent enrollment changes must be originated through the exchange, not the QHP. So when someone loses their job, gets a job, has a child, or has some other life event they need to go back to the HIX and make their required changes. And the 834 exchange process between the HIX and QHP starts over again.

Currently the business rules and edits associated with effecting these changes are largely performed by the QHP. Any incomplete or incorrect data must be caught by the QHP. Then the QHP has to work with the consumer and HIX to correct the issues. It’s not clear there are sufficient automated edits and controls in place to handle the wide range – but common – enrollment scenarios. 

So m belief is that these enrollment issues will create undue heartburn and lead to other issues as 2104 unfolds. I will describe these other issues in subsequent posts.

For more information on health insurance exchanges and other health IT topics, be sure to follow me on Twitter.

Friday, November 15, 2013

Early Enrollment – Why is it Supposed to be Slow?

Earlier this week, attorney and health care blogger David Harlow made a post titled “Health Exchange Enrollment: Speed of Light or . . . Molasses.” Harlow suggested that people need to “cool their jets” about the low numbers of ACA enrollees because “early enrollment is supposed to be slow” - apparently because that’s the way it was in Massachusetts back in 2006-2007.

So early enrollment in the ACA is supposed to be slow in 2013 because the experience in Massachusetts was ‘slow’ in 2006? Seriously? These two roll-outs hardly seem comparable:

1. The ACA has been touted all over the media for 3-4 years now.  One cannot watch TV, read anything anywhere, listen to the radio, browse the web and/or drive anywhere without being inundated with information about the benefits of enrolling in Obamacare. Moreover, the ACA was front and center through last years presidential election and a high-visibility Supreme court case.

2. Hundreds of millions of dollars in paid marketing/advertising has been spent on the ACA. An equal or larger amount of exposure has been provided via supportive main stream media.

3. Internet access and technologies supporting awareness and enrollment are way more ubiquitous now – nearly a decade later - than when MA was being implemented in 2006.

4. ACA subsidies benefit those up to 400% FPL – Massachusetts up to 300%.

So far, only the easy to deploy and no-cost/low-cost parts of Obamacare have been implemented: primarily kids on their parent’s plan, elimination of pre-ex on children and removal of lifetime limits. As Harlow states, current ACA enrollee counts are likely dominated by the long-uninsured and under-insured. Yes, it’s still early, human nature is to procrastinate and a turnaround might occur. Maybe. But given the above, the overall low number of enrollees these first 6 weeks, the remaining as yet widely un-publicized issues and the challenge getting the “young invincibles” to enroll, the belief that the Obamacare death spiral may have officially begun is probably not be the fantasy Harlow makes it out to be.

We’ll all know in the next couple months.

Thursday, October 17, 2013

When it’s a government IT project, how do you know it’s a glitch?

As overheard earlier this week...(with all due respect to Monty Python and The Holy Grail... Original scene here )

American Public: We have found a glitch! (A glitch! a glitch!) Fix it… Fix it!

American 1: We have found a glitch, can you fix it? (cheers)

Sebelius: How do you know it’s a glitch?

American 2: My PC rebooted! Look at this screen shot.

Sebelius: Bring it forward. (advance)

Contractor: It’s not a glitch! It’s not a glitch!

Sebelius: ehh... but the blue color and cryptic hexadecimal notation says it’s one.

Contractor: The GOP forced us to use that color and incomprehensible message!

GOP Senator: Naah, no we didn't... no.

Contractor: And this isn’t our responsibility. We never got paid to do it right the first time around!

(Sebelius holds up $400M contract)

Sebelius: Well?

Contractor 1: Well we did get a couple hundred million to do THAT work.

Sebelius: And all the contract amendments?

Contractor 1: ...they were only for $300M. But it’s not a glitch!

(All: yeah, fix it, fix it!)

Sebelius: Did you overwhelm healthcare.gov like this?

American 1: No! (no no... no) Yes. (yes yeah) a bit (a bit bit a bit) But I still couldn’t create an account!

(Senator 1 points at source code)

Sebelius: What makes you think it is a glitch?

Senator 2: Well, when I tried to create an account it turned me into a newt!

Sebelius: A newt?!

(Senator 2 pauses & looks around)

Senator 2: I got better.

American 2: Fix it anyway! (fix it, fit it!)

(Aneesh Chopra walks in)

Sebelius: There are ways of telling whether it is a glitch.

Senator 1: Are there? Well then tell us! (tell us)

Sebelius: Tell me... what do you do with glitches?

Senator 2: Pay to fix'em! Pay to fix them up! (pay pay pay)

Sebelius: What do you pay to fix apart from glitches?

Senator 1: More glitches! (Senator 2 nudges Senator 1)

Senator 3: Elections!

Sebelius: So, why must glitches be fixed?
(long pause)

Senator 2: Cuz the contractors didn’t get them right the first time around?

Sebelius: Gooood.
(crowd congratulates Senator 2)

Sebelius: So, how do we tell when the glitches are fixed?

Senator 1: The contractors send us an invoice for their fixes!

Sebelius: Ahh, but haven’t the contractors already charged us for the original work?

Senator 1: Oh yeah...

Sebelius: Do we always pay 2 or 3 or 4 times for the same work?

Senator 1: Usually

Senator 2: Let's throw the contractors into the bog! (yeah yeah ya!)

Sebelius: Who also charges us for work they’ve never done or previously been paid for?

Senator 1: Other contractors

Senator 2: Politicians

Senator 3: HHS procurement staff
(Sebelius looks annoyed)

Senator 1: Lobbyists

Senator 3: Criminals

Chopra: Prime contractors!
(all look and stare at Chopra)

Sebelius: Exactly! So, logically...

Senator 1 (thinking): If a prime contractor was previously paid for their code, and their code is not working now…

Sebelius: Therefore…
(pause & think)

Senator 3: it’s a contract amendment! (Senator 1: an amendment)(Senator Public 2: an amendment)(all: an amendment!)

Sebelius: We shall use our most liberal amendment!
(Sebelius jumps down)
(walk over while cheering)
(signs a high value contract amendment)
Sebelius: Overnight this to the contractor!

All: A glitch! fix it, fix it!

Friday, August 16, 2013

How I separate the 'signal' from the 'noise' on Twitter

When I first started out on Twitter, I had a limited number of topics I was interested in and I wasn’t following many people.  It wasn’t too difficult to separate the wheat from the chaff. But as I started to follow more people and as I expanded my topics of interest, I developed an approach to maximize the value of my Twitter feed. 

Here’s an overview of my approach.

1.    Use a good desktop Twitter client – paired with its mobile counterpart

Personally, I think there are only two choices for a good Twitter client: Tweetdeck or Hootsuite.  Each are very similar and each have some unique features.  I’m actually using both right now but plan to move to only one of them – someday. In the meantime, I’ve rarely had any tweet limit or throttling issues by using both at once.

2.    Use an extra monitor – or multiple monitors

My desktop includes three monitors and I use one 24” monitor largely dedicated to Tweetdeck and Hootsuite. I have the resolution set at the highest level possible.

3.    Use multiple columns & smallest font size possible

Since I have a large monitor set with a high resolution, I configure my Twitter clients to use multiple columns – with each column dedicated to a specific purpose. To squeeze in even more columns, I set the font size as small as possible.

4.    Setup columns for specific purposes & areas of interest

I have about a dozen columns set up in my Twitter clients and I use hashtags, lists, custom search terms and the standard Twitter filters (Timeline, Interactions, Mentions, Favorites, etc.) to customize the tweets displayed in each column. Of all the techniques possible, I think my use of lists and custom search terms provides me with the most capability and flexibility to manage the signal to noise ratio.

A note on lists: I use all the lists Twitter lets me create to segregate what I consider certain high-value Tweeps. I’m constantly adding to and pruning these lists based on the topics and areas of interest of these Tweeps. This helps call out good signals.  Lists are very useful for me because I follow just about everyone who follows me (except for the XXX, MLM and obvious nutcases) and the sheer volume of tweets from 1000’s of people is clearly unmanageable.

5.    Tag and forward

Many times, especially when I’m browsing using my smart phone, I see things that I want to share with others or save for later when I have more time to review them.  In these cases I usually add a tag or short note and forward the tweet to myself via email.  I used to mark these as favorites but then decided I might be sending the wrong message since some of the items I marked would  not be considered a ‘favorite.’

Follow Me for More Info, Ideas & Insight

On Twitter as @ShimCode 

Sunday, August 11, 2013

3 IT-intensive Medicare Reporting Programs Few People Know or Talk About

The complexities  and overhead associated with implementing EHR’s, health insurance exchanges (HIX), ICD-10, health information exchanges (HIE) and ACO’s all get a lot of attention among those involved with health information technology. And there are a few other programs that many health care entities – mainly health plans and payers – have been scrambling to implement the last few years; all in an effort to comply with government regulations. 
Medicare STARS Measures

STARS is intended to help educate consumers on quality and help make quality data more transparent to Medicare enrollees. Stars ratings consist of over 50 measures originating from 5 different rating systems: HEDIS (Healthcare Effectiveness Data and Information Set) , CAHPS (Consumer Assessment of Healthcare Providers and Systems), CMS (Centers for Medicare and Medicaid Services) http://www.cms.gov/, HOS (Health Outcomes Survey), and IRE (Independent Review Entity).
   Learn more about STARS here.

Risk Adjustment & Reporting - Edge Server and 3R’s
Part of the ACA, the "3R's" program is designed to protect health plans against adverse risk selection and mitigate the impact of high cost membership. It’s required of those selling individual plans within and outside of the exchanges.  The mechanism creates substantial data collection and processing challenges.

   Learn more about 3R's here.

Coordination of Benefits Agreement (COBA)
The Coordination of Benefits Agreement (COBA) Program establishes a standard method of sharing enrollee eligibility data and Medicare adjudicated claim data between CMS and other health insurance organizations. It provides for the establishment of unique identifiers (COBA IDs) to be associated with each contract and creates a national repository for COBA information.

   Learn more about COBA here.
So What’s the Big Deal?

The above programs include complex data capture, processing and exchange requirements that are exacerbated by the need to collect data from disparate source systems - some of which are maintained by external business partners. Addressing the data access, quality assurance and data transfer challenges associated with these programs – while simultaneously addressing other mandates like health insurance exchanges, ICD-10 and health information exchanges is (HIE) and ACO’s – is a big deal; particularly in light of the dearth of knowledgeable, experienced resources.

Tuesday, August 6, 2013

Thoughts on #HIT100 – The Good, The Bad & The Ugly – Part 3 (The Ugly)

Previously, I offered some of my thoughts about The Good and The Bad aspects of the recent #HIT100 event.  In this post I’ll share thoughts and facts about The Ugly part of the event. To be clear, The Ugly are aspects of the event that, in my opinion, should not have occurred, are ethically shaky and/or tarnished the overall spirit of the #HIT100 event.

Note: I suppose this post is not going to endear me to those who may have been involved with some of these aspects. Those who know me, have followed me for any length of time or who may have been unfortunate enough to only sample a subset of my tweets know that I'm not the most politically correct person. I’m not calling out specific accounts and perhaps some of the accounts involved may not even be aware of their involvement.

The Ugly

1.    Voter Fraud – One Vote per Person Please!

What ever happened to one vote per voter? It’s a shame a few people – maybe from my home town of Chicago – voted for their candidate(s) multiple times. For example, the following was observed:

a. A company having multiple twitter accounts used each account to vote for their candidate(s.)
b. One dad voted for his son using – at least - 3 separate accounts; all within one minute of each other.
c. Some created a new twitter account specifically to vote for their candidate. Some of these accounts didn’t even have any followers or even make any other tweets after voting!

What’s next? Employing gangs of low-paid ‘click farm’ workers in Bangladesh to generate votes?

2.    Extreme Self-Promotion

There’s nothing wrong with promoting oneself and many of those making the top 20 did a little promotion. But some were a few that were just over the top with the following - even a few days into the event after several requests were made to avoid excessive RT's and "non-voting" chatter.

a. RT’ing every single tweet that mentioned them.
b. Thanking every single tweet that mentioned them and then RT’ing that tweet just for good measure. Gratitude is a nice thing – within moderation.
c. Creating specific instructions and a template to make it easy for people to nominate themselves or their candidate – or was that their boss?

I imagine all the above also made tallying the results more cumbersome?

3.    Company Affiliations

A couple company accounts really went overboard with their enthusiasm for their brand and executive. I’ve read several posts about the #HIT100 being limited to individuals and I totally agree.

4.    Naysayers

There’s one (or two or three) in every crowd.  Shortly after the event started, a couple disgruntled tweeps started complaining that most of those at the top of the list were not deserving of their rank. Talk about painting all the pennies with the same brush!

Another moaned and groaned that some high-level health care IT folks were not high enough up the list or not even listed - even though most of the people they noted are not active users of social media and/or even involved with information technology.

5.    Hashtag Hijackers and Hookers

The #HIT100 hashtag got hijacked a few times and quite a few XXX and other ‘cretins of the Net’ came out in their attempt to collect clicks.  I suppose this is actually a sign of the growing reach of the #HIT100?

Fortunes and Influence Do Change

One web site that listed the 2013 #HIT100 nominees noted the following:

Many of the "winners", identified by their Twitter handles, will be familiar to most readers, but a comparison with last year's list reveals how fortunes, or perhaps influence, can rise and fall as the years go by.

Indeed fortunes and influence can wax and wane as years go by. And in the case of this year’s #HIT100, some fortunes and influence – at least as measured by ranking in the HIT100 – rised and fell due to a few people who decided to Ugly Up in an attempt to garner votes for themselves and/or their candidates.


Monday, July 29, 2013

Thoughts on #HIT100 – The Good, The Bad & The Ugly – Part 2 (The Bad)

source: yourmoneyguide.co.uk
In a previous post, I offered some thoughts about The Good aspects of the #HIT100 event. In this post I’ll share thoughts and facts about The Bad aspects of #HIT100 event. In a future post I’ll address what I think are some of The Ugly aspects.

The Bad (ok, not ‘bad’ – but could use some improvement)
To be sure, the following are not necessarily “bad,” but they're not among “The Good” or “The Ugly” – but perhaps aspects that might be addressed in next year’s #HIT100 event.

1. More tweets = more votes?

Neil Versel (@nversel) notes in a recent post that many highly ranked HIT100’ers are prolific tweeters and supposes there’s a direct correlation between noise and list ranking. To me, ‘noise’ implies junk tweets, excessive RT’s, and lots of 1 on 1 banter. This is not always the case for some people; witness #2 Justin Barnes (@HITAdvisor) with less than 500 tweets (as of 7/27).

2. “A” is better than “Z?”

Remember all those kids in grade school who were always first up because they had a last name that started early in the alphabet?  Well, that’s not always a undesirable thing because in the #HIT100, people with identical vote counts are assigned a ranking based on how their Twitter handle sorts relative to others having the same count. 

If you got 8 votes this year, you were better off being @annelizhannan (#65) vs. @WittRZ (#78) since that Twitter handle starting with an 'A' vs. a 'W' resulted in a 14 place improvement even though both of these worthy #HIT100 nominees received the same number of votes. Note: I don't imply that either #HIT100 member is better or worse than the other - they just represent the edge cases for those receiving 8 votes.

Technically, if nominees were ranked by number of votes, the #HIT100 would actually be the #HIT31. :)

3. Few votes separated the majority of the #HIT100

Only 19 votes separated 74 nominees! And only three votes separated @HJluks (#89) and @harrygreenspun (#61) – a rise of 28 places! So in my opinion this is a major blemish on the ranking process.

 4. Adding the #hcsm and #hitsm hashtags clouded many Twitter streams

There sure were a lot of extraneous tweets with #hcsm and #hitsm. As @tyrulallc tweeted: “Going cross-eyed scrolling through all the #HIT100 nominations in my home feed.”

5. What else was not so good about #HIT100?

What Else?

In my next post I’ll share some thoughts that I – and others I’ve heard from – have about some of The Ugly aspects of the #HIT100 event.  I’ll then close with a post outlining some ideas for addressing some of The Bad and The Ugly aspects; and what I consider are the qualities of a good #HIT100 nominee.


Sunday, July 28, 2013

Thoughts on #HIT100 – The Good, The Bad & The Ugly – Part 1 (The Good)

No one can argue the #HIT100 event hasn’t helped socialize the importance and value of using social media to share information and ideas about information technology and services in the healthcare space. It’s definitely a “good thing.” Alas, like most good things that grow in size and prominence over time, there are always a few bad and ugly aspects. And the #HIT100 event is no exception.

In this post I offer some thoughts and facts that I – and others I’ve read from – have about The Good aspects of the #HIT100 event.  I’ll share more about The Bad and The Ugly of the #HIT100 event in two future posts.

The Good

1. Generates awareness of people using social media to advance information technology in the healthcare space

Over 30 – or about one-third – of the 2013 #HIT100 nominations didn't make the 2012 #HIT100 list. Personally I’ve become aware of about 15 new sources of health information technology and related services who frequently share via social media channels.

2. Helps socialize the importance and value of information technology and services in the healthcare space

As Elin Silveous (@ElinSilveous – ranked #23) tweeted: “#HIT100 & #HITsm will serve to broaden reach, encourage more #HIT folks to get involved in SM.”

Or, as David Shaywitz (@DShaywitz – ranked #67) noted:  “A freakishly smart way to generate buzz.”

3. Offers recognition to those who invest their time in social media

There’s no doubt being included in the #HIT100 list brings attention. I can attest: Last year I (@ShimCode - ranked #29) was ranked in 5th place in the #HIT100 and received a lot of recognition including several interviews, 100’s of new followers (who work in the health IT industry) over the ensuing days, an increase in being quoted in articles covering my area of expertise and literally dozens of inquiries as to whether I was interested in new job opportunities.

4. Helps individuals develop their personal brand

This is a natural by-product of my previous comment.  Indeed I’ll mention the flip side of this in my future post on The Bad aspect of the #HIT100 event.

5.     Provided opportunity for others to share why they think someone deserves recognition in HIT space.

Many “voters” added a note to their nomination and I found that valuable.

6.     Offers a little levity over the typically slow and long 4th of July holiday

The “HIT100 Song” is evidently a candidate for a future Grammy Award nomination (@RossMartin ranked #37) 

7.    What else did you think about the #HIT100 event?

What Else?

As we all learned in kindergarten, if you can’t say anything nice about someone or something, don’t say anything at all.  So now I've shared what I think are the nice/good things about the #HIT100 event. In my next two posts I’ll share some thoughts that I – and others I’ve heard from – have about The Bad and TheUgly aspects of the #HIT100 event.


Wednesday, July 17, 2013

Helping Decode the Business of Healthcare IT: One Blog Post at a Time

A couple of years ago I made a pledge to myself to make a blog post at least 4-5 times a month. But blogging on a regular basis takes focus and dedicated effort; and due to some major new, positive events on the work and home front, I’ve not made the time needed to work this blog. 

Today I’m starting at it again. And I credit @HealthBizDcoded for providing this post as the inspiration to get me going again.  Being listed along with some real health IT blogging pros has incented me to clean up my act and get back at it.  Thanks @HealthBizDcoded!

In addition to continuing a focus on ICD-10, I plan to offer information and opinion on the IT and service-related aspects on the topics listed below.  Why?  Because these are the primary areas I’m involved with and focus on every work day (and many weekend days too).

Medicare Advantage Rollout
Project to begin offering a MA plan - addressing the IT aspects including eligibility/enrollment aspects, provider network and covering providers, referral capabilities, care management aspects, EOB’s, and product financials.

Medicare Stars Measures
Collecting various data points, interfacing to 3rd party vendor for measure calculations and receiving actual measures and reports.

Medicare Advantage EOB
Project to provide a new explanation of benefits complying with new format requirements.

Risk Adjustment & Reporting  - Edge Server and 3R’s
Project to deploy the Direct Data Entry (DDE) Edge Server mandated by CMS. Includes services to address provider contracting and incentives, suspect identification and outreach, chart review and HCC coding, member outreach and medical risk management and interfacing to various vendors.

Coordination of Benefits Agreement (COBA)
Project to improve the way eligibility and Medicare claims payment data within a claims crossover context is exchanged.

Accountable Health System
Project to rollout IT and services infrastructure to support an Accountable Care Organization (ACO) including provider network and referrals, provider channeling, Capitation payment and risk sharing, and medical/care management tools.

The original topic that got me started in blogging: ICD-10.  I’ll continue a focus on testing, implementation and post-implementation topics.

So if you’re interested in the IT and service-related aspects of the above aspects of healthcare, check back here a few times each month for more information.  You can also get more of the same by following me on Twitter at @ShimCode

Wednesday, May 1, 2013

Collection of info on 'consent' relative to Health Information Exchanges #HIE

Just put this up for the #hitsm crowd on Friday, October 16th. I may take this down so take what you want now/soon:

“Defining Consent and Authorization in an #HIE” http://t.co/cpoDFuMvgF
"Can Big Data and patient-informed consent coexist?" http://t.co/9e3ItJBdgZ
"The Conundrum of Consent in Health Information Exchange" http://t.co/72C4TLMItg
Tiger team clarifies patient consent rules for #HIE http://ow.ly/2rOAi
"The assumption now is the Internet of Things is opt-out, not opt-in" http://t.co/60oXzq1N73  
For state #HIE, patient opt-out a thorny technical issue
Opt-In landing pages should be carefully considered at 'Click Through?'
Health information exchanges and the problem of consent http://t.co/HzIUvhV6
ONC and OCR publish customizable model privacy notices for covered entities. http://t.co/38INZ95jKB
Options for various patient consent models used by health information exchanges  http://bit.ly/cs1vi2
“California continues to experiment w/ consent models for exchanging patient data” http://t.co/CFnkqC30  
Trust your life records to an unnamed chain of HIE software vendors
Consumer confidence about health data safety is key to #EHR adoption
“Many patients don't even know they're in the HIE in the first place.”
"Relying on Electronic HIE to Deliver Data Raises Concerns of Liability and Insurance Coverage" http://bit.ly/g8KT5s 
“Consumer Consent Options for #HIE: Policy Considerations and Analysis”(Good, detailed info) http://t.co/qlwap6utOo 
Patient Centric Service Oriented #Architecture #SOA for #HIE Integration & Exchange http://bit.ly/aO4h35
Recommendation for Consent Model
“Patient Consent for Electronic Health Information Exchange”
Video - Meaningful Use across State lines - What every HIE should consider - http://eepurl.com/cozp9 
"HHS launches Meaningful Consent site: New tools available to help providers engage and educate patients" http://t.co/QEAVqVdjRZ 
"If patient does not consent to using the HIE, the physician has to go through a dual track,"   http://chilp.it/729302
CMIO editorial recaps ICA's Daly's Opt-Out Consent Model #HIE - Key: increase value while limiting risk
Consent Notification and Opt Out Toolkit - instructions & samples to assist setting up notification & opt out process