The proposed revisions to protect privacy of substance-abuse patients such as opioid users are a step in the right direction and present solid ideas for improved information sharing. But the proposed changes don’t go far enough to ensure providers have access to all the information they need in the moment they’re making life-changing decisions.
In the 1970s, when 42 CFR Part 2 was first enacted to protect the privacy and dignity of patients with substance-use disorders (SUDs), we didn’t have EHRs, HIPAA, or even smartphones.
We weren’t embroiled in an opioid crisis, either. According to the National Institute on Drug Abuse, deaths resulting from drug overdose rose from 16,849 in 1999 to 70,237 in 2017. These figures are even more staggering when compared with similar figures nearly 50 years ago when the rate of drug overdose deaths was around 1 per 100,000 individuals.
On August 22, when the Substance Abuse and Mental Health Services Administration (SAMHSA) proposed its latest updates to 42 CFR Part 2, the opioid crisis was top of mind. The new regulation calls for several modifications with the purpose of easing provider access to information — and eliminating barriers to effective care coordination.
The proposed revisions are a step in the right direction and clarify some of the confusion and concerns for non-Part 2 providers regarding what is and isn’t allowable. They present solid ideas for improved information sharing. Should the current proposal pass into law unchanged, providers would have an easier time verifying that a patient has a history of substance-use disorders.
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But the proposed changes don’t go far enough to ensure providers have access to all the information they need in the moment they’re making life-changing decisions.
We’re experiencing a critical moment in history when the need for better healthcare must be balanced with the need for privacy and security — a challenge that is increasingly perplexing. In the 1970s, individuals who sought treatment for addiction were often stigmatized and discriminated against, denied job opportunities and sometimes shamed by providers. While progress has been made, today, patients with SUDs still experience these things, which is why privacy advocates are skeptical of these updates to Part 2 which appear to diminish the importance of patient privacy.
They’re not wrong. But to make any sort of big impact on the opioid crisis, we need to make big changes. We must change the way we’re sharing information so providers have the information they need at the exact moment when they need it most. This is evident to anyone who’s worked in an emergency department (ED), anywhere in the United States, where individuals with SUDs are regularly seen in the ED.
In the ED, healthcare providers need to make hard decisions and fast. For example, whether to administer morphine to a patient who is screaming and complaining of chest pains. Does the patient get pain medications? Is the patient experiencing withdrawal? Are tests needed to confirm something?
The latest version of Part 2 builds upon the 2017 Part 2 update by offering more concrete, specific ideas for easing these challenges with access to patient data. It calls for the creation of central registries, which a doctor or nurse could use “to query … in order to determine whether their patients are already receiving opioid treatment through a member program.”
But while this idea is sensible, it’s merely a first step. Most registries don’t operate as bidirectional networks, alerting doctors with critical information when they need it. They’re more like data repositories. It can take several minutes or even hours to skim droves of medical documentation to unearth the critical data needed to make a potentially life-changing decision. When every minute counts, medical professionals need robust technology that enables quick, convenient access to critical information exchange.
Another concerning provision in the proposal is SAMHSA’s allowance for data “segmentation” on the part of providers – sharing some, but not all, information as needed. Withholding any information goes against the purpose of true interoperability and could ultimately hinder care and harm patients. Again, providers shouldn’t have to worry about whether they have all of the facts when they’re treating a patient.
As SAMHSA moves toward a final rule, the organization also needs to ensure the 42 CFR Part 2 guidelines for care coordination between Part 2 and non-Part 2 providers in different states are clarified.
SAMHSA is undoubtedly in a difficult position, trying to balance the needs of multiple stakeholders. Ultimately, the agency’s latest proposal makes a clear step in the right direction by acknowledging the need for changes that would make it easier for providers to save lives, by helping patients receive the timely interventions and care they need. With some changes and by adding additional guidelines for healthcare providers looking for ways to more quickly access this patient data, we’ll be on our way to better interoperability and thus better care for those who need it.
Date: October 03, 2019
Source: Medcity News
