Testimony by Susan Winckler for the March 31, 2005 NCVHS Subcommittee on Privacy and Confidentiality Hearings

Statement of the American Pharmacists Association

Before National Committee on Vital and Health Statistics

Subcommittee on Privacy & Confidentiality

Hearings on Privacy and Health Information Technology

March 31, 2005

Presented by Susan C. Winckler, RPh, JD

Members of the Subcommittee, thank you for inviting the American Pharmacists Association (APhA) to appear before you this morning. APhA welcomes the opportunity to present the views of the nation’s pharmacists on two important issues and their intersection: privacy and health information technology. I am Susan C. Winckler, a pharmacist and an attorney, and Vice President, Policy & Communications and Staff Counsel for APhA. APhA’s more than 52,000 members include pharmacist practitioners, pharmaceutical scientists, student pharmacists, pharmacy technicians, and others interested in advancing the profession. Our members practice in virtually every health care setting where medications are used: community pharmacies, hospitals, long term care facilities, hospices, and many other environments.

Pharmacists are committed to protecting the privacy of individually identifiable health information, with specific responsibility for the patient health information gathered and used as an essential component of medication dispensing and medication therapy management. Pharmacists maintain and use individually identifiable information in patient records as an integral part of daily patient care and as important components of efforts to enhance quality and improve the safety of medication. The profession is concerned with protecting the privacy of the information they create, collect, and manage. My comments today will address the three core issues for your consideration: access, contribution, and integration. Each of these issues is important to assure that health information technology supports and improves patient care while protecting the privacy of patient’s information. In addition to this discussion, I have provided an excerpt of APhA policy relevant to today’s discussion as an attachment to this statement.

Access
Pharmacist’s ability to access information as we expand health information technology is essential. As the medication expert on the health care team, our ability to care for patients would be improved with additional access to relevant patient information, such as the results of blood cholesterol tests to assess the effect of cholesterol-lowering interventions or medication blood levels for therapies which require close monitoring. Access to information within an electronic health record or shared using health information technology is essential to all health care professionals, including pharmacists.

Necessary access is not, however, unlimited. We recognize that some information may not be relevant to the pharmacist’s work, as well as the potential for situations where patients request limits on which providers may access what information. Such limits, when they do not compromise the pharmacist’s responsibilities under the relevant state laws to assess the appropriateness of medication therapy and accurately dispense medication, should be respected.

Our support for access to information distinguishes that information which is necessary for patient care and that information necessary for payment of health care claims. While payors certainly require access to some information to document provision of services and protect against fraud and abuse, payor access to information should be limited to a subset of the information necessary to provide patient care. Unfortunately, the implementation of the Health Insurance Portability and Accountability Act requirements around the ‘minimum necessary’ issue do not appear to have resolved some of these questions about the scope of information available to payors.

And with any discussion of health information technology, patient information must be protected from unauthorized access from those outside of the health care community.

Contribution
Pharmacist’s ability to contribute to the patient’s health record is also important. In addition to providing core information regarding the use of medications, pharmacists are increasingly involved in helping patient’s assess the progress of their therapy. Documenting this information in the health care record provides essential information to improving medication use, and is valuable to other health care professionals working with that patient. In some situations, knowing why a patient stopped using a certain medication may be just as important as knowing that another patient continues to take a prescribed therapy. Such information exchange—in an environment that continues to protect patient privacy--is only possible with appropriately structured health information technology

Integration
Achieving a health information technology future that supports health care professional’s and patient’s ability to both access and contribute to relevant health information is impossible without integrating the many existing disparate systems. Whether the challenges emerge from differences created as patients move from a hospital to a long term care facility or return to the community environment, a fundamental barrier to efficient, effective health information technology is the lack of standardization of information technology systems across health care providers. A well-constructed system in a hospital is useless to the community pharmacist if the structure and architecture of the system operates on different standards. As health information technology evolves, we must consider and address all of the environments where health care is delivered—including community health centers, community pharmacies, etc. Integration of all of these units is essential, and can help in efforts to protect access to this information as well.

And integration must extend beyond the integration of existing systems, or taking existing paper processes and translating them to an electronic format. If we merely move the existing health care communication system from paper to an electronic environment, we will have missed an opportunity to truly improve health care operations. Consider the prescription. The paper prescription of today looks much the same as it did 100 years ago—providing the patient name, drug name, quantity and directions. Moving this information electronically certainly addresses some potential for error and can introduce efficiencies, but it’s also likely that our need for information has increased in the last 100 years. Isn’t it time for prescriptions to contain more information—such as the intended use of the therapy—to help prescribers, pharmacists, and patients improve the likelihood that the medication will do what is intended, and nothing it shouldn’t? The “intended use” is not the diagnosis per se—it is the intended outcome for a designated medication, such as a medication prescribed ‘for pain’. Including such information helps the pharmacist tailor their communications with the patient, and the patient better manage their medications. As we look to the future of health information technology, we must consider potential improvements along with the transition of existing practices.

In conclusion, thank you for the opportunity to provide comments on this important issue. APhA appreciates the Subcommittee’s attention to this important debate. We offer our assistance to the Subcommittee as you continue your valuable work. Thank you.

Relevant Policy

1998 Access and Contribution to Health Records

APhA urges the integration of pharmacy-based patient data into patient health records to facilitate the delivery of integrated care.
APhA recognizes pharmacists’ need for patient health care data and information and supports their access and contribution to patient health records.
APhA supports public policies that protect the patient’s privacy, yet preserve access to personal health data for research where the patient has consented to such research or where the patient’s identity is protected.
APhA encourages interdisciplinary discussion regarding accountability and oversight for appropriate use of health information.

(JAPhA 38(4): 417. July/August 1998)

1996 Confidentiality of Patient Data

APhA supports the establishment of uniform national privacy protection standards for personally identifiable health information. These standards should:

include provisions for patients to access and request modification of their health information, and disclosure of who will have access to the information;
establish broad privacy protections for the individual patient without compromising patient care or creating an excessive administrative burden for health care providers; and
make a distinction between the clinical information required for communication among health care professionals, and the administrative or financial information required by others (e.g., claims processors and payers).

(JAPhA. NS36(6):396. June 1996)