Outdated privacy laws hinder coordinated care, especially in the fight against addiction
The City of Philadelphia announced in May that opioid overdose deaths were down in 2018 for the first time in nearly 30 years. Nationally, we’ve seen a similar trend. The Centers for Disease Control and Prevention reports that the U.S. has seen a reduction of drug overdose deaths of 2.8% between April 2018 and April 2019.
In addition, national opioid prescribing rates dropped by 19% from 2006 to 2017. In southeastern Pennsylvania, Independence Blue Cross members received 350,000 fewer bottles of opioids in 2018 than in 2014.
While this is good news, much more needs be done to significantly reduce overdose deaths and lessen the impact substance use disorder has on people suffering from the disease and their families. One critical objective: We must revise outdated privacy laws that prohibit sharing of medical records with the physicians, nurses and other clinicians trying to help those struggling with addiction. Without this vital health information, prescribing physicians can unwittingly expose patients to the medications they are recovering from. These laws, including 42 CFR Part 2, prevent care teams from providing support for substance use disorder that is commonly available for other chronic diseases like cancer, diabetes and asthma.
Here’s why well-intentioned privacy laws put patients in harm’s way. After hip surgery in 2016, a young woman named Jessica Grubb was given a prescription for 50 OxyContin pills by her physician. The doctor didn’t know Jessica was in recovery from an addiction to heroin. She died the next day from an overdose. This tragedy drove Jessica’s family, federal lawmakers and others to push for changes to the law to help doctors better coordinate care for people in recovery.
The Protecting Jessica Grubb’s Legacy Act, introduced in the U.S. Senate in April, would be consistent with modern privacy laws and allow doctors, insurers and other care coordinators to have the information they need to provide access to safe, effective, and high-quality coordinated care. Information about a patient’s recent detox or rehab stay, for example, will allow physicians to deliver more informed, holistic care. These proposed changes have wide support from the American Hospital Association, the American Medical Association, the National Governors Association and 39 attorneys general across the country, including Pennsylvania’s Josh Shapiro.
Major advances in our health information systems help doctors and other healthcare professionals share medical information securely and often immediately. But clinicians and facilities treating someone with a substance use disorder can’t receive or share this information, except in limited circumstances, even with other doctors treating the patient. This isn’t just impractical, it’s dangerous.
If someone collapses in the street and is taken to the hospital, emergency room doctors can check medical records without waiting until the patient is awake to consent. They can find out if the patient has high blood pressure, is diabetic, or had a past heart attack— life-saving information. But if the same person has a history of drug addiction, by law, substance use disorder diagnosis or treatment records are not available to the attending ER doctor.
This creates a situation where doctors are forced to treat patients in an information vacuum. To share information, they need multiple patient consents, which can be hard and time-consuming to get. Without access to full medical histories, the current law inadvertently prevents doctors from providing the best possible care to those trapped in addiction.
Without knowing that someone is taking methadone or Vivitrol, two drugs that help treat opioid dependence, a doctor might unknowingly prescribe a drug that counteracts those medications. The law also ties the hands of health plans, like Independence, from working with doctors and others to coordinate care for our members suffering with substance use disorder. We can, and do, coordinate care for other chronic conditions. Why can’t we do the same for people coping with addiction?
We guard the privacy of our members’ health information fiercely. This isn’t about violating anyone’s privacy; it’s about saving lives. ●