On Friday, the Health Information Technology Policy Committee heard privacy experts' proposals for protecting patient data in the exchange of health information. The discussion focused around "patient consent."

Deborah Peel, MD, founder of the Coalition for Patient Privacy, recommended patient consent or refusal for every instance of disclosure, and creating different levels of disclosure. Obviously it's important for patients to have control over their data. Because of the Internet patients are more knowledgeable about diseases, wellness and prevention and other areas of health and healthcare. What that should mean is a more interactive, balanced communication and relationship between patient and physician.

In a perfect world, when a patient is presented with an opportunity to give consent or refuse when their information is about to be shared it would include a dialogue with the patient's physician as to why it's important that the information be shared. Okay, it's not a perfect world and it's highly doubtful that physicians have time at each instance to advise the patient and that both patient and physician can be available at the same time every time there's a need to share information. Having a patient-physician consultation is time-consuming and would create bottlenecks. So, in a nutshell, it's not practical. Okay, it's impossible.

Still, I recall a casual conversation at an IT user group dinner last fall in which a physician bemoaned the concept of patient control of their health information. He's the doctor, he said. He's in the best position to make a decision about sharing the patient's information with the right people at the right time. While he understood if a patient is hesitant to share information because of its sensitive nature, he argued that withholding information could do any number of things, such as altering the proper treatment plan.

Is it possible, when a physician office decides to participate in a health information exchange, regional health information organization or payer-led or health system-led initiative, to have the physician sit down with each patient and they both discuss what information would be shared? Granted, it's a tremendous amount of heavy lifting on the front end - dare I say insurmountable? But it would foster trust in the physician and the HIE, RHIO or initiative, and it could establish the patient consent process from here on out. Is it possible?

I guess what I'm getting at is the importance of having the physician involved with the patient's consent decisions, however that can be managed.