Privacy and Confidentiality Issues in e-Prescribing

Testimony Presented to the National Committee on Vital and Health Statistics
Subcommittee on Privacy and Confidentiality

Mark A. Rothstein, J.D., Chair
NCVHS Subcommittee on Privacy and Confidentiality

Thursday, November 18, 2003
Department of Health and Human Services
Hubert Humphrey Building
Washington , DC

Submitted by,
Laura Van Tosh, Consultant
1533 West Falkland Lane, #336
Silver Spring , MD  20910
(301) 585-9455

Good morning.  My name is Laura Van Tosh and I am a mental health consumer advocate and a policy consultant specializing in public sector mental health and consumer issues.  I appreciate the opportunity to present my perspective on privacy and confidentiality issues in e-prescribing.

I am pleased the Subcommittee is hosting this hearing to learn how this cutting-edge technology will impact upon all consumers, especially persons with mental illness and those with substance abuse issues.  Today I will focus my comments on e-prescribing for people with mental illness.

Efficiency in the healthcare marketplace is welcomed among consumers.  Enabling consumers to easily access medications through the use of e-prescribing provides the field with an opportunity to support and sustain consumers in the community.  Consumers who are unable to access medications in a timely fashion can be at risk for relapse or interruptions in care.

Increased efficiency can raise concerns as well.  With the fast-paced technology characteristic of e-prescribing, the Subcommittee and other quality assurance and patient protection groups must ensure that privacy is protected and that strategies to monitor the technology are discussed, implemented, and overseen.  Consumers need to know that protections are in place and that such oversight is conducted by external organizations that do not have financial interest in the technology.  We cannot cut corners in the name of efficiency or technology when it comes to privacy protections.

For example, what provisions are in place to ensure that the systems are free from hackers and viruses?  Is a rapid-response built into these systems?

How will consumers know – for certain – that their personal information will be protected?  The Subcommittee’s work appears inadequate in this regard and I encourage the Subcommittee to actively seek out consumer perspectives about ways to market e-prescribing so consumers have confidence in the new technology and how it is used.  In addition, the new system for e-prescribing should include the use of patient identifiers, other than name, that is only accessible to pharmacists and prescribing physicians. Can consumers opt-out of the technology if it is not working for them?

E-prescribing has been noted as a tool to help prevent medical errors.  With the advent of atypical psychiatric medications, consumers are now experiencing newer and perhaps unexpected types of side effects.  The prevention of these adverse effects through e-prescribing and its associated technology would be a welcome change for consumers.

We need to ensure that physicians receive proper training to prevent medical errors.  While the patient-physician relationship cannot be computerized, the Subcommittee needs to increase its understanding and sensitivity to the clinical information exchanged between these parties.  Will e-prescribing impact on patient-physician rapport?  How will e-prescribing impact on the role mental health consumers have to be active participants in their own treatment?  This may not be a direct concern of the Subcommittee but e-prescribing will surely influence these issues.

As noted in the Committee letter to Secretary Thompson (dated 9/2/04), the Committee stressed the need for industry flexibility so that innovation can occur.  How this flexibility is applied should be clarified and specific so that consumer concerns are taken into account and balanced with other needs.  Electronic technology should support all partners, especially the end-user.

Consumers have a lot at stake.  For many, medication information is extremely private.  Consumers such as myself, have been users of medications for decades and we expect that this information be held discreetly and not shared without consent.  Particularly for consumers who take psychotropic medications, any inappropriate disclosure could destroy careers or even lives.  Illegal disclosure of medication information must be avoided at all cost and these concerns should be placed high on the agenda of the Subcommittee.  Unfortunately, we live in an era when psychiatric histories are used to destroy people’s lives and perpetuate unfounded stigma.  People should not lose their jobs at the expense of faster technology.

One way to dispel stigma is to involve consumers in policy and educational processes.  I encourage the Subcommittee to recommend that the industry implement patient education programs to inform and receive regular input from consumers on e-prescribing technology.  In mental health, we are fortunate to have statewide organizations across the country.  The end-users of e-prescribing ought to be a key stakeholder group that continues to advise this Subcommittee.

Thank you.