Comment on FR Doc # 2012-11775

Regarding: Question 30: The process of giving patients a meaningful choice may be delegated to providers or other users of NVE services (as opposed to the patient receiving the choice from the NVE directly). In such instances, how would the provision of meaningful choice be validated? Show Opt in and Opt out are not meaningful choices when it is practically unknowable by patients what kind of exchange will take place. However, the Directed Exchange protocol clearly supports cc functionality, just like email does. IT is trivial to simply "cc the patient" on all health information exchange. Requiring a "cc the patient" option is unlikely to fly b/c of technical and political limitations initially. Eventually it should be required in meaningful use. For now, it would be wonderful if providers that chose to "cc the patient" could be exempted from any kind of "meaningful choice oversight". If all of a providers patients are always in the loop regarding healthcare exchange then "opting" in any case is always a meaningful choice in an ongoing manner. That should be rewarded by less reporting requirements at this stage.