New technology sparks confidentiality debate

NABP guidelines on the table

The debate over trying to balance patient confidentiality with legitimate needs for patient information has intensified as new technologies continue to streamline the use and availability of patient records.

Along with established uses by third-party payers or pharmacy benefit managers, new programs like patient reminder e-mails or the recent boom in Internet pharmacy have led organizations such as the National Associa tion of Boards of Pharmacy (NABP) to search for ways to separate legitimate need from the potential for marketing abuse by drug companies, for example.

"Some kind of balance needs to be struck between what is important for providers to share about a patient and what is information that does not need to be shared. . . . between what is used for clinical purposes and what is used for marketing purposes," said Rod Shafer, executive director of the Washington State Pharmacists Association, at a recent meeting of the National Wholesale Druggist’s Association.

Balancing administrative needs, privacy

As part of its policy statement on patient confidentiality, the Academy of Managed Care Pharmacy has stated, "AMCP believes that proposed legislative or regulatory restrictions pertaining to the use of patient-identifiable information must be carefully considered so that they will not hinder the effective admin istration of pharmacy benefits and impede patient protections."

Finding a way to do that has been frustrating on the federal level, as patient confidentiality bills coming out of Congress continually have died since 1995. More and more, it’s looking like refill reminders and similar compliance programs — despite documentation that they save the health care industry a lot of money — will have to be sacrificed to avoid cumbersome proposals such as written permission every time a pharmacist wants to review a patient’s file to formulate counseling options, interventions, or therapy modifications, says Janlori Goldman, a policy analyst with the Georgetown University Institute for Health Care Research & Policy.

"Anxiety about the lack of privacy has led people to engage in a series of privacy-protective behaviors," says Goldman. "They withhold information, give inaccurate information, and even ask doctors to put inaccurate diagnoses on claim forms."

During the last 12 months, bills have been introduced into nearly every state legislature concerning patient confidentiality. A Texas bill introduced this spring, for example, would make it illegal for pharmacists to use patient-identifiable information without written consent and would not allow the use of patient data for quality assurance programs.

Groups like AMCP have opposed this bill and others like it by stating that while they support patient rights, they fear that mandated written consent would rarely be granted. The lack of consent would thwart disease prevention programs and accreditation outcomes reporting, they say.

NABP has passed a set of guidelines it is offering to state boards and federal agencies for consideration. "By putting together guidelines, we’re giving state boards some direction in case they are confronted with this issue," says NABP executive director Carmen Catizone.

"We also wanted to send a clear message to any congressional committees about the position of the boards and what we liked and didn’t like about what we thought might protect confidentiality and what might be a threat," Catizone explains.

Pharmacists as gatekeepers

The guidelines as proposed attempt to set up safeguards against abuse while maintaining access for clinical reasons, and they attempt to set up pharmacists — historically among the most trusted professionals in opinion polls — as major gatekeepers. The guidelines call for the following actions:

• creating secure methods of accessing, transmitting, analyzing, storing, and deleting information;

• maintaining confidential information separately from information deemed nonconfidential;

• allowing access to confidential information only by pharmacists or technicians supervised by pharmacists;

• giving patients the opportunity to withdraw from a given program at any time with assurances that their medical information will remain secure;

• requiring pharmacists to maintain lists of participating patients and take responsibility for their accuracy as well as their safety.

[For more information on the guidelines, contact the National Association Boards of Pharmacy at 700 Busse Highway, Park Ridge, IL 60068. Telephone: (847) 698-6227.]