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Knotty Problems Surround Substance Abuse Data Sharing via EMRs

Posted on May 27, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As I see it, rules giving mental health and substance abuse data extra protection are critical. Maybe someday, there will be little enough stigma around these illnesses that special privacy precautions aren’t necessary, but that day is far in the future.

That’s why a new bill filed by Reps. Tim Murphy (R-PA.) and Paul Tonko (D-N.Y.), aimed at simplifying sharing of substance misuse data between EMRs, deserves a close look by those of us who track EMR data privacy. Tonko and Murphy propose to loosen federal rules on such data sharing  such that a single filled-out consent form from a patient would allow data sharing throughout a hospital or health system.

As things currently stand, federal law requires that in the majority of cases, federally-assisted substance abuse programs are barred from sharing personally-identifiable patient information with other entities if the programs don’t have a disclosure consent. What’s more, each other entity must itself obtain another consent from a patient before the data gets shared again.

At a recent hearing on the 21st Century Cures Act, Rep. Tonko argued that the federal requirements, which became law before EMRs were in wide use, were making it more difficult for individuals fighting a substance abuse problem to get the coordinated care that they needed.  While they might have been effective privacy protections at one point, today the need for patients to repeatedly approve data sharing merely interferes with the providers’ ability to offer value-based care, he suggested. (It’s hard to argue that it can’t be too great for ACOs to hit such walls.)

Clearly, Tonko’s goals can be met in some form.  In fact, other areas of the clinical world are making great progress in sharing mental health data while avoiding data privacy entanglements. For example, a couple of months ago the National Institute of Mental Health announced that its NIMH Limited Datasets project, including data from 23 large NIMH-supported clinical trials, just sent out its 300th dataset.

Rather than offer broader access to data and protect individual identifiers stringently, the datasets contain private human study participant information but are shared only with qualified researchers. Those researchers must win approval for a Data Use Certification agreement which specifies how the data may be used, including what data confidentiality and security measures must be taken.

Of course, practicing clinicians don’t have time to get special approval to see the data for every patient they treat, so this NIMH model doesn’t resolve the issues hospitals and providers face in providing coordinated substance abuse care on the fly.

But until a more flexible system is put in place, perhaps some middle ground exists in which clinicians outside of the originating institution can grant temporary, role-based “passes” offering limited use to patient-identifiable substance abuse data. That is something EMRs should be well equipped to support. And if they’re not, this would be a great time to ask why!

What’s the Story on 21st Century Cures Legislation?

Posted on May 21, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I just saw that the 21st Century Cures legislation passed the house committee process. Word on the street is that Congress probably won’t take this up even if the house passes it this summer. The legislation looks pretty interesting for those of us in healthcare IT. Blair Childs, Premier’s senior vice president of public affairs, offered the following statement on the legislation:

Members of Premier wish to thank House Energy and Commerce Chairman Fred Upton (R-MI) and Representative Diana Degette (D-CO) for their leadership to advance interoperability standards as part of the landmark 21st Century Cures legislation. With today’s vote, the vision for a fully interoperable health information technology ecosystem is one step closer to becoming a reality.

We also wish to thank Committee members Joe Pitts (R-PA), Frank Pallone (D-NJ), Gene Green (D- TX), Michael Burgess (R-TX) and Doris Matsui (D-CA) for their support of interoperability standards in the legislation, and for their efforts to ensure that the technology systems of the future will be built using open source codes that enable applications to seamlessly exchange data/information across disparate systems in healthcare.

Today’s vote is an essential step to optimize HIT investments, improve the quality of care across settings and avoid the cost burdens associated with the work around solutions that are needed today for systems to “talk” to one another. We strongly urge the full House of Representatives to support these interoperability standards and to vote in favor of moving the legislation forward as it stands today.

Many of the comments he offers about ensuring interoperability is open source and support for standards of healthcare interoperability are great things. Although, as I think we learned with the meaningful use regulations, the devil is in the details and the 21st Centure Cures legislation is not simple. I’d love to hear from people who are following the legislation. Is this a good piece of legislation? Should it be passed? Are their hidden land mines? What are the unknowns or uncertain outcomes of the legislation?

When I saw this legislation hit my email inbox it has me asking how people keep up with legislation. Not to mention, what’s the process for creating this legislation? Just thinking of the process makes me tired and overwhelmed. Is it any wonder that lobbyists are so powerful? It really takes someone whose full time job it is to track and influence legislation to really get something done. The process and legislation is so complex that a casual follower just can’t keep up. I think that’s really unfortunate. I’m not sure the solution though either.