Patient Confidentiality: Drug Alert Systems

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Patient Confidentiality Drug Alert Systems

• Lam Dang, Neelima Ireddy, Pauline Lee, Jennifer
  Leonard, Thomas NDamele, Tim Sweeney, and
  Melissa Wen

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Introductory Dramatization
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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

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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
  patients care

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Types of Drug Alert Systems

• Patient Hot Lines
• Patient Drug Alert faxes
• Websites posting patient-specific Drug Alerts
• Patient Drug Alert cards

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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!

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What We Dont Want to See
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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.

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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

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Language of Proposed Law

• RCW 70.02.050 (Disclosure without patients
  authorization)
• Outlines when a health care provider may
  disclose health care information about a patient,
  without the patients 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)

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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

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Confidentiality Starts Here!
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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
  AGs opinions and suggestions (if they are wise)

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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 AGs opinion
• Current and future pharmacists can be trained,
  using real-life scenarios, to provide unbiased
  pharmaceutical care to all patients (including
  drug-seeking patients)

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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

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Stakeholders

• Patients
• Pharmacists
• Prescribers
• Legislators
• Healthcare Administrators
• Police
• Pharmacy Associations

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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

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Websites of Interest

• http//www.apha.net/drugseek.htm
• http//ncadi.samhsa.gov/govpubs/prevalert/v6/10.as
  px
• http//www.drug-addiction.com/prescription_drugs.h
  tm
• http//www.teenchallenge.com/drugs/prescriptiondru
  gs.cfm?doc_id49

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Questions?
Thank you for not falling asleep!