Quality of care and patient privacy rights collide in EHR adoption

Modern Healthcare has reported that a work group assembled by the Office of the National Coordinator for Health Information Technology's Health IT Policy Committee expects to release recommendations in June regarding how to include behavioral health providers in the industry wide implementation of electronic health records without compromising patient data protected under the Health Insurance Portability and Accountability Act. 

Balancing privacy rights with quality of care
HIPAA has been a sticking point in the push for meaningful use and EHR adoption. The law was passed for the purpose of protecting the privacy of patients who seek treatment for behavioral health issues such as drug and alcohol abuse, as well as mental health ailments. The intent of the law is, in part, to help people seek treatment by guaranteeing their privacy so that they will not be burdened by the social stigma of seeking treatment. 

Implementing EHRs across the board in the health industry is an initiative aimed at achieving better care through sharing information among health care providers electronically. Under HIPAA, doctors must have the consent of patients when they wish to share information related to behavioral health issues. Once the patient's data has been shared with one doctor, that doctor must seek permission from the patient to share it with another, and so on for each doctor who wants access.  

The report by the work group, known as Tiger Team, notes that current technology would allow a doctor to "tag" a document that contains sensitive information, such as behavioral health data. Unless the doctor is granted permission by the patient, the tagged information would be stored in a separate file not to be shared with other health care providers. 

"It works, very well, I think, for the behavioral health entities that before couldn't share data," Tiger Team chairwoman Deven McGraw said to Modern Healthcare. "They get the ability to electronically send this data with the restriction communicated on it per the rules that apply directly to them and they've been able to help facilitate the coordination of care for a patient they have treated."

Chief privacy officer of the ONC Joy Pritts pointed out that there is effective technology available that simply is not being used. Pritts noted that software exists that allows doctors to "tag" data within a document. By doing this, a doctor could share a document while redacting information about the patient's treatment for drugs or alcohol. 

Mental health bills presented in Congress
As the Tiger Team continues its work, two bills have been presented to Congress regarding the expansion of mental health care, one of which has caused consternation among mental health advocates who believe it negates the intent of HIPAA. 

USA Today reported that Rep. Tim Murphy, R-Penn., is sponsoring the Helping Families in Mental Health Crisis Act. The bill calls for certain parts of HIPAA to be reinterpreted so as to allow greater access to information by a patient's family. Murphy, who is also a child psychologist, took issue with parents being left in the dark about the care of patients 14 and older. The bill would also pave the way for mental hospitals to be reimbursed for short-term care, or acute treatment, by Medicaid. Hospitals with 16 beds or more are not eligible for Medicaid reimbursements under the current law, a rule that Murphy said leaves mental health patients in danger of ending up in jail or worse. 

The bill has drawn the ire of the National Disability Leadership Alliance, which has said that the law would be an unreasonable encroachment on the privacy rights of behavioral health patients. 

"This bill includes provisions that would silence our voices, reduce our choices, compromise our rights and destroy programs that protect our rights and safety," the NDLA wrote in a statement. "It would increase the use of involuntary commitment by the criminal justice system, coerced psychiatric treatment, and hospitalization, heralding a return to the failed policies of the past."