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How effective are patient confidentiality rules in today's system?

August 24, 2014
by Julie Miller
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Patient confidentiality is one of the most polarizing issues in the substance abuse field. However, in today's atmosphere of integrated care, professionals must reconsider the need for such protection in light of the opportunity to use data to prevent adverse health events, according to Joseph Parks, MD, distinguished professor of science for the Missouri Institute of Mental Health at the University of Missouri. 
 
During the Behavioral Healthcare Leadership Summit, Parks said the 42 CFR Part 2 law that prevents behavioral health providers from sharing patient information also puts them at a distinct disadvantage. While other provider specialties are able to leverage data for patient care, behavioral health isn't part of the comprehensive patient picture.
 
"Patients don't get the extra care and attention," he said. "They don't get that extra question from a provider when behavior changes. It isn't on the chart that they had substance abuse treatment, and in many cases, the data doesn't end up in programs for care management. The care we provide is invisible and that disadvantages the people with substance use, and they don't get the same care."
 
As long as behavioral health is treated separately from other medical specialties, it will never be equal, he said.
 
Alternative policy
 
While Parks advocates for repeal of 42 CFR Part 2, he also laid out his alternative recommendations, such as making the law consistent with HIPAA while keeping the provision that patient data cannot be used for criminal investigation. He noted that HIPAA was updated as recently as last year to reflect today's medical environment, while 42 CFR dates back to 1972 and hasn't been updated since 1983.
 
Parks said that segment consent has been proposed, but it's not a workable solution because technology systems haven't been designed to handle the process in a practical way. Even with a granular level of information control that allows patients to choose how and when their data is shared, the solution would also place an administrative burden on providers to sift the data on a patient-by-patient basis.
 
The 42 CFR Part 2 law has advocates who have good reason to want to protect and lock down patient data, but Parks said CEOs need to consider all their liabilities when it comes to data, including the legal, financial and clinical concerns. In his own practice, he tells his patients that he might share their information with other providers for the sake of improved care. 
 
Park said the other downside to locking down patient data is that it contributes to a negative image of substance-abuse treatment programs among other providers.
 
"All your successes are hidden," he said. "[Other providers] only see your patients when they relapse and they come back."
 
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