As federal legislation to combat opioid abuse moved forward this week, several healthcare organizations are pressing federal legislators to amend the privacy laws of 42 CFR Part 2 to enable providers to access a patient’s entire medical record in order to better coordinate care.
This past week, the U.S. House of Representatives advanced a group of bills aimed at combatting opioid abuse, including H.R. 5046, the Comprehensive Opioid Abuse Reduction Act of 2016, and H.R. 4063, a bill aimed at improving the use by the Secretary of Veterans Affairs of opioids in treating veterans.
H.R. 5046 would allow the Justice Department to issue grants to assist state governments with developing, implementing or expanding a prescription drug monitoring programs (PDMPs). These programs enable states to collect and analyze data related to the prescribing of controlled substances through a centralized database and includes the tracking of dispensation of controlled substances and providing interoperability and data sharing with other states.
That legislation and other measures will be packaged together for negotiations with the Senate, which passed its own plan, S. 524, in March.
The American Hopistal Association (AHA) praised the House for approving seven AHA-supported bills as part of its legislative package to address the opioid epidemic, such as H.R. 4641, which would establish an interagency task force to review, modify and update best practices for pain management and pain medication prescribing.
Now, as the legislation moves forward, the AHA and other healthcare organizations want legislators to address limitations with accessing substance use records.
In a letter to House leaders, the AHA, along with 19 other healthcare organizations, including the American Psychiatric Association, Association for Ambulatory Behavioral Healthcare, Health IT Now, National Alliance on Mental Health and Premier Healthcare Alliance called on legislators to address privacy laws of Part 2, noting that “without access to a patient’s entire medical record, including addiction records, providers and organizations are limited in their ability to coordinate care for those patients.”
The privacy laws in Part 2 limit the use and disclosure of patients’ substance use records from certain substance use treatment programs without patients’ express consent. “Obtaining multiple consents from the patient is challenging and creates barriers to whole-person, integrated approaches to care, with are part of our current health care framework,” the letter states. “Part 2 regulations may lead to a doctor treating a patient and writing prescriptions for opioid pain medication for that individual without knowing the person has a substance use disorder. Separation of substance use from the rest of the medicine creates several problems and hinders patients from receiving safe, effective, high quality substance use treatment and whole-person care.”
The organizations note that while the Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a notice of proposed rulemaking which takes some steps to modernize Part 2, “it does not go far enough.” The organizations call for legislation action in order to modify Part 2 and “bring substance use records into the 21st Century.” And, the organizations also assert that Part 2 requirements should be aligned with Health Insurance Portability and Accountability Act (HIPAA) regulations.
“Without access to a complete record, providers cannot properly treat the whole person and may, unknowingly, endanger a person’s recovery and his or her life. For example, a medical doctor in primary care may not know that he or she is prescribing pain medication to someone with a history of addiction. Harmonization of Part 2 with HIPAA would also increase care coordination and integration among treating providers and other entities in communities across the nation,” the organizations wrote.
And, the organizations note that Part 2 reform is particularly important as Congress works to expand access to Medication-Assisted Treatment (MAT). Today, there are three FDA-approved treatments for opioid addiction and three for alcohol dependence, according to the organization’s letter. “With approximately two million individuals currently receiving these addiction treatment medications, there is a significant risk for drug interactions.”