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

2. Introductory Dramatization

3. 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”

4. 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

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

6. 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!

7. What We Don’t Want to See

8. 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.”

9. 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

10. Language of Proposed Law
RCW (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)

11. 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

12. Confidentiality Starts Here!

13. 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…)

14. 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)

15. Alternatives to Existing Law
Change RCW
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

16. Stakeholders Patients Pharmacists Prescribers Legislators
Healthcare Administrators
Police
Pharmacy Associations

17. 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

18. Websites of Interest http://www.apha.net/drugseek.htm

19. Thank you for not falling asleep!
Questions?
Thank you for not falling asleep!