Patient Privacy Crucial in SUD Fight, Academy Tells HHS

AAFP Policy Reflected in Proposed SAMHSA Regulation

October 30, 2019 12:39 pm News Staff

As family physicians balance treatment of patients enduring chronic pain against the challenges of managing those with substance use disorder, privacy must be paramount, the Academy told federal regulators this month.

[doctor patient confidentiality sign]

"The confidential relationship between physicians and patients is essential for the free flow of information necessary for sound medical care," the Academy said in an Oct. 21 letter(3 page PDF) to Elinore McCance-Katz, M.D., Ph.D., HHS assistant secretary for mental health and substance use, who leads the Substance Abuse and Mental Health Services Administration.

But differing state regulations, along with varying operational standards and capabilities, add difficulty to data sharing between physicians and other health care professionals, introducing burdens to ensuring that vital confidentiality.

The Academy applauded a proposed rule from SAMHSA for acknowledging that truth and upholding key protections of Americans' medical information.

The letter -- signed by Board Chair John Cullen, M.D., of Valdez, Alaska -- was a response to the proposed rule, titled "Confidentiality of Substance Use Disorder Patient Records,"(www.govinfo.gov) which was published in the Aug. 26 Federal Register.

The proposed rule, according to SAMHSA,(www.hhs.gov) is meant to encourage care coordination among health care professionals, update the definition of what constitutes a record and its applicability for participants in federally assisted SUD treatment (Part 2 programs)(www.samhsa.gov) and remove legal hurdles that might discourage care for SUD patients by non-Part 2 health care professionals.

The agency added, however, that certain EHR tools affected by the rule need further development and should not yet be required as standards.

"The AAFP agrees with technical standards to support practices to enable and manage the complex requirements around the privacy and security of these types of data," the Academy wrote. "The AAFP looks forward to maturation of these standards to dramatically reduce the burden on physicians and practices to manage the complex requirements to ensure appropriate confidentiality."

The proposed rule does not alter the basic framework for confidentiality protection of SUD patient records created by federally funded treatment programs. Rather, SAMHSA would continue to prohibit law enforcement use of SUD patient records in criminal prosecution against the patient -- an approach in keeping with the Academy's position.

"The AAFP therefore supports this proposed rule, as it properly protects patient privacy concerns, improves the intent of the law and makes it less burdensome," the letter said.

If finalized, the regulation would also continue to restrict the disclosure of SUD 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.

The Academy expressed support for this approach while urging continued vigilance in safeguarding patient privacy. The letter called on regulators to review the AAFP's policy on patient/physician confidentiality, which says, "The right to privacy is personal and fundamental."

"Only in a setting of trust can a patient share the private feelings and personal history that enable the physician to comprehend fully, to diagnose logically and to treat properly," the Academy wrote in the letter.

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