HIT Think

How a policy change could better protect recovering drug addicts

In today’s world of increasingly connected healthcare data, CIOs and other healthcare IT professionals often see the unintended consequences when two public policies clash.

A case in point is 42 CFR Part 2 and the Health Insurance Portability and Accountability Act (HIPAA).

42 CFR Part 2 was designed to protect the privacy of patients undergoing treatment for substance use disorders. The thinking was that prohibiting unauthorized disclosures of patients’ records would allay confidentiality concerns, which some people struggling with addiction say prevents them from seeking help.

While well intended, this policy prevents clinicians from seeing a patient’s complete medical record, raising the possibility that a physician might prescribe opioids and inadvertently send the patient down the path of addiction again.

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The College of Healthcare Information Management Executives (CHIME) and the CHIME Opioid Task Force have been calling for the Substance Abuse and Mental Health Agency (SAMHSA)—the agency that oversees Part 2—to synchronize patient consent policies with HIPAA, which the Office for Civil Rights oversees. This would reduce the burdens imposed by these two different sets of rules and facilitate better treatment for patients, which could make the difference between life and death.

We recently have seen a great deal of interest by Congress, the White House and federal agencies to combat the opioid epidemic. Earlier this month, the administration announced they awarded another wave of funding to address the opioid epidemic. The funds come from both the Centers for Disease Control and Prevention and SAMHSA.

By the end of the year the Department of Health and Human Services (HHS) will have released more than $9 billion in grants to states and local communities. HHS notes that between 2017 to 2018, “provisional counts of drug overdose deaths dropped by 5 percent, and overdose deaths from opioids went down 2.8 percent from 2017 to 2018.”

We are encouraged that the decades-long upward trajectory in opioid-related deaths finally appears to be bending downward, but many challenges remain. In August, SAMHSA published a proposed rule on substance abuse information sharing that lacked the key change we supported.

According to the HHS fact sheet, “Part 2 will also continue to restrict the disclosure of SUD (substance use disorder) treatment records without patient consent, other than as statutorily authorized in the context of a bona fide medical emergency; or for the purpose of scientific research, audit, or program evaluation; or based on an appropriate court order for good cause.”

This does not mean we are giving up. We will continue to urge congressional leaders to give SAMHSA the authority they need to fully align Part 2 with HIPAA through the passage of the Overdose Prevention and Patient Safety Act (H.R. 2062) and the Protecting Jessica Grubb’s Legacy Act (S. 1012). As with our past efforts, we know that it often takes time and commitment to educate policymakers about health IT policies that affect patient care and safety.

Issues like this won’t correct themselves without health IT leaders taking an active role in the process. There is no time better than now, National Health IT Week, to start. Lives rest in the balance.

Liz Johnson and Bill Spooner are co-chairs of the CHIME Opioid Task Force’s Policy Subcommittee and serve on the CHIME Public Policy Steering Committee.

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