What鈥檚 more harmful to patients聽being treated for drug or alcohol abuse: risking their health by keeping other medical providers in the dark about their substance abuse treatment? Or risking their jobs, homes and child custody arrangements by allowing potentially damaging treatment details to be electronically shared among an array of medical providers?
Advocates have painted the possible patient outcomes in starkly different terms as they consider the federal government鈥檚 recently that govern the release of patient records for alcohol and drug abuse treatment.
What everyone聽can聽agree on is that protecting the privacy of people who are being treated for substance abuse is critical. If such information becomes public, it may have a devastating effect on their work and family lives. In some cases, it also may set off a cascade of legal repercussions, including arrest, prosecution and jail. The mere threat that treatment details might be disclosed can be enough to deter people from seeking help.
The current privacy guidelines 鈥� often referred to as 鈥淧art 2鈥� as an abbreviation for 鈥�42 CFR Part 2,鈥� the section of the code of federal regulations where the rules are published 鈥� last got a meaningful . Since that time, electronic medical records have proliferated, and integrated, patient-centered care has become the organizing principle for doctors, hospitals and health systems.
Existing privacy rules are too cumbersome for today鈥檚 integrated world, say proponents who favor loosening the rules. Under current Part 2 rules, providers can鈥檛 disclose聽treatment information unless patients give their consent to release the information to a specific health care provider.
Part 2 鈥渋s well intentioned, but it鈥檚 just not working,鈥� said Matt Salo, executive director of the National Association of Medicaid Directors. 鈥淭hese special [treatment] silos are actually hurting people.鈥� The federal/state Medicaid program for lower income people is responsible for a significant and growing share of the money spent on substance use disorder treatment, Salo said.
In family medicine, it鈥檚 not unusual for patients to have five to 10 different diagnoses, one of them being substance abuse, said Dr. Wanda Filer, president of the American Academy of Family Physicians who practices at a federally qualified health center in York, Pennsylvania. Not having access to all the relevant medical information can be difficult or even dangerous. If someone is taking methadone to treat a heroin addiction, for example, she may need to adjust his antidepressant or anti-anxiety medications.
鈥淔inding the right balance between getting access to information and protecting their privacy鈥� is challenging, said Filer. The AAFP is still reviewing the proposed changes.
The proposal from the Department of Health and Human Services would allow patients to give their consent to disclose their records not just to a specific provider but to the health care system or the accountable care organization with which the provider is affiliated, for example.
While the HHS proposal is an improvement over existing rules, it doesn鈥檛 go far enough, said Salo. His organization, along with others, would with the federal Health Insurance Portability and Accountability Act of 1996, which governs other types of health care records disclosure.
, health plans, providers and health care clearinghouses don鈥檛 have to get patients鈥� consent before disclosing their records to other similar groups and 鈥渂usiness associates,鈥� such as claims processing operations, if the disclosure is related to a patient鈥檚 health care treatment, payment or health care operations.
Strong protections must remain in place to prevent information from being used for criminal charges or to conduct criminal investigations, said Lindsey Browning, senior policy analyst at the National Association of Medicaid Directors.
That鈥檚 not good enough, say some patient advocates. They argue that the HHS privacy rule changes are too broad.
Under the HHS proposal, 鈥渁nybody throughout the system can get access鈥� to patient substance abuse treatment records, said Jim Pyles, a principal at Powers Pyles Sutter & Verville who is an expert on patient privacy and has represented the American Psychoanalytic Association on this issue. 鈥淲hen the patient is at their most vulnerable time, it gets them to sign 鈥� this聽very general consent form.鈥�
Patients can鈥檛 rely on health care systems to keep their information private, Pyles said, noting that in the past six years, more than 150 million Americans have been involved in health data breaches, according to an analysis of HHS聽data released by Melamedia, a healthcare research company.
In the midst of a privacy breach epidemic, 鈥渨e鈥檙e substituting the interests of integrated delivery systems and accountable care organizations for patients鈥� interests, when what we should be doing is asking patients what they want,鈥� Pyle said.
Comments on the proposed rules are due on April 11.
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