For the last several years, Maine's medical community has been working with the non-profit HealthInfoNet to create an electronic system that makes someone's medical records accessible to doctors anywhere in Maine. Nationwide, these systems are being adopted to improve the quality of care given, regardless of where the patient is, avoid medical errors and reduce the duplication of pricy tests. Patient records for about 900,000 Mainers have already been entered in a system. But some groups say that not enough people know that this is going on--and that they should know, given increasing concerns about Internet privacy and online security breaches.

"It's never a question of if a database will be breached but when and to what consequence," says Shenna Bellows of the Maine Civil Liberties Union. "The examples of Hannaford, Bank of America, the Veterans Administration--it seems that every week there's a new report of breach."

The group, along with some doctors' organizations, are backing legislation that would require patients to opt into HealthInfoNet. The way it's set up now, patients must opt-out of the system.

Supporters of an opt-in, including sponsors Sen. Roger Katz and Rep. Stacey Fitts, both Republicans, say it would require more of a discussion about HealthInfoNet between a patient and a doctor.

Doctors and hospitals participating in HealthInfoNet inform patients, but some are more explicit about it than others through mailing letters home, while others mention the system in the health privacy papers patients sign off on during a doctor's visit.

"We know our clients are worried about what happens to the information they give us," says Ruth Lockhart of the Mabel Wadsworth Women's Health Center in Bangor.

Lockhart says an opt-in provision would give patients more control over their health records. She notes that some patients may be comfortable with some providers seeing their health records, but not all of them. "We believe that people should be able to control where, when and how much of their personal and intimate information is shared."

Similar health information systems set up in Massachusetts, New York and Vermont are using opt-in. But HealthInfoNet's executive director, Devore Culver, points to Rhode Island, where he lives, as an example of an opt-in model that is not working.

"I absolutely opted into my state exchange two years ago; my state's exchange is still not operational because they cannot get critical mass," he says.

And he says if not enough patients are participating in the system, there's little incentive for physicans to use it, defeating the whole purpose. He says the discussion should not be about opt-in or opt-out but about increasing patient education about HealthInfoNet.

"We would really welcome the opportunity to develop and enhance ideas about how to educate consumers on how best to approach understanding whether the value of being in the exchange is offset by the risk of being in the exchange, and that really is a decision we need each consumer to make," Culver says.

Culver says that HealthInfoNet is reducing risk by always encrypting information so that's it's unreadable by hackers.

For Carol Carothers, the pros of HealthInfoNet outweigh the risks. Carothers heads the National Alliance for the Mentally Ill in Maine, which supports the current opt-out option as a way to maximize the benefits of the system.

"It helps to prevent people from having to tell their stories over and over again, or from having to remember which pill they took 10 years ago or what doctor they saw, or any of the rest of their healthcare information they don't remmeber. Most of us don't, I don't remember," Carothers says.

In contrast, the Maine Psychological Association is pushing for an opt-in measure, out of concerns about the highly sensitive nature of mental health data.

As it stands now, HealthInfoNet does not accept data related to HIV/AIDS status or mental health, regardless of whether a patient allows it or not. But another bill proposed this session would give the patient the option to allow this information into the database.

In the meantime, more and more medical providers are entering their patient's data into HealthInfoNet. Coordinators say that about 30 Maine hospitals will be participating by year's end.