Patient Confidentiality: Drug Alert Systems Lam Dang, Neelima Ireddy, Pauline Lee, Jennifer Leonard, Thomas N’Damele, Tim Sweeney, and Melissa Wen

Introductory Dramatization

Introduction and Summary What are “Drug Alert Systems”? Alert systems that are initiated when a health care professional suspects that a patient may be abusing medications or attempting to falsify a prescription Information is generally communicated to other pharmacies and health care facilities Also known as “Pharmacy Alert Systems” or “Patient Alert Systems”

Introduction and Summary What is “patient confidentiality”? Basically means PROTECTING all patient health information by keeping it PRIVATE Under current law, patient health information can be communicated among health care professionals that are directly involved with a patient’s care

Types of “Drug Alert Systems” Patient “Hot Lines” Patient “Drug Alert” faxes Websites posting patient-specific “Drug Alerts” Patient “Drug Alert” cards

Problem Definition So, what is the big deal with ‘Drug Alert Systems,” anyway? They generate biases! Lack of equality! We are supposed to treat patients with compassion, not condemnation!

What We Don’t Want to See

An Ethics Case to Ponder Imagine a patient presenting to an emergency room with acute pain (a disabling headache), whose name has been circulated to emergency rooms within the area. The patient has a history of a head injury, ten years prior. The patient also has had a past record of drug-seeking, but today, he has a legitimate pain issue. The patient is refused narcotic medication to alleviate the problem by the ER doctor and is sent home, based on the information received from a “Drug Alert System.”

Language of Proposed Law Health Information Portability and Accountability Act (HIPAA) Implemented to ensure that patient-specific information is protected Permits disclosure of patient health information for the purposes of treatment, payment, and healthcare operations No mention of allowing for the disclosure of patient information for the purpose of preventing drug seeking

Language of Proposed Law RCW 70.02.050 (Disclosure without patient’s authorization) Outlines when a health care provider may disclose health care information about a patient, without the patient’s authorization No mention in law for the allowance of the disclosure of such information to various health care providers for the purpose of preventing drug seeking (only to those health care providers directly involved with the patient)

Language of Proposed Law Our point: Washington State law and HIPAA prohibit certain “Drug Alert System” practices/methods that may currently be in use We think that the best way to protect our patients is by not disclosing or transmitting patient-specific information, by any measures, as a means of preventing abuse of controlled prescriptions, except directly to the authorities and healthcare provider(s) involved in the creation or filling of the prescription in question

Confidentiality Starts Here!

Letter to Don Williams What we are trying to accomplish by adding to Mr. Williams’ workload? As a state-appointed official, Mr. Williams has the ability to request an “official opinion” from the Washington State Attorney General about health care issues What good is the “official opinion” of the Washington State Attorney General? If the AG makes a statement that is in agreement with our own, all healthcare professionals in Washington State will likely have to “adjust” their “Drug Alert Systems”, in accordance to the AG’s opinions and suggestions (if they are wise…)

Evaluation Criteria Obviously, the Board of Pharmacy and the Attorney General express strong feelings about breaking the law We would like to see an amendment to the WAC to assure that these practices will not occur This amendment should not lead to an increase in illegal drug acquisition; it should only serve to ensure the protection of patient health information Patients should find this amendment very agreeable, as it is one step further in protecting the confidentiality of their private health information Change can be measured by visiting pharmacies, hospitals, and websites that currently participate in “Drug Alert Systems” and determining whether or not their protocols have changed, after learning of the AG’s opinion Current and future pharmacists can be trained, using real-life scenarios, to provide unbiased pharmaceutical care to all patients (including drug-seeking patients)

Alternatives to Existing Law Change RCW 70.02.050 Insert another section (section e.) that would not allow the disclosure or transmission of patient-specific information, by any measures, as a means of preventing abuse of controlled prescriptions Provide guidelines for “Drug Alert Systems” Using physician-specific, drug-specific, and date-specific information in “Drug Alert Systems”, as opposed to patient-specific information, to preserve patient confidentiality Modify HIPAA BAD IDEA: HIPAA is a lengthy document, already very protective, and it would be painfully difficult to amend

Stakeholders Patients Pharmacists Prescribers Legislators Healthcare Administrators Police Pharmacy Associations

Conclusions As health care providers, we have to decide whether we should assume the role of patient policemen, or patient advocates The best way to protect our patients, in our opinion, is by not disclosing or transmitting patient-specific information, by any measures, as a means of preventing abuse of controlled substances, except directly to the authorities and healthcare provider(s) directly involved in the creation or filling of the prescription in question We feel that the benefits of using patient-specific information in “Drug Alert Systems” do not outweigh the potential damage caused by disclosure to unnecessary individuals We want the Washington State Attorney General to take an official stand on the issue of patient confidentiality and “Drug Alert Systems”, because we believe that it compromises the quality of healthcare to our patients by introducing biases into the minds of other healthcare providers

Websites of Interest http://www.apha.net/drugseek.htm http://ncadi.samhsa.gov/govpubs/prevalert/v6/10.aspx http://www.drug-addiction.com/prescription_drugs.htm http://www.teenchallenge.com/drugs/prescriptiondrugs.cfm?doc_id=49

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