Privacy is a topic that is heavily debated in society today with a large influence from the promotion of electronic advancements. Electronic medical records, Internet health information communication, and telemedicine are just a few of the areas that have been innovative in the health care system that also produce large privacy concerns. Currently there are enhanced health privacy laws to protect against discrimination, such as HIV/AIDS and mental health disorders, however there remains multiple grey areas of debate on whether privacy needs to be help to such a high degree (Pritts, 2013). The Health Insurance Portability and Accountability Act (HIPPA) was designed to help with the health privacy while at the same time promoting electronic medical records and the expansion of electronic health information (Pritts, 2013). There has been continued debate of uniform health care information across the nation but due to differing state-by-state populations and each state’s public health goals there has been a push for a more state based compared to national system. This has prevented the overall expansion of an all-encompassing system. In regards to opioids, the electronic database that produces results for the prescription-monitoring program is an area of possible concern for privacy and contents so the program has been left up to a state-by-state system in order to better address each state’s issues. Also, with most medical systems there are now electronic medical records where patients are tracked and over time can be “red flagged” for opioid overuse and ineffective pain management called the “chronic pain program”.
I was able to interview the medical director of the emergency room (ER) at Banner Good Samaritan Medical Cetner, Dr. Monesh Bhow MD, and he was able to provide insight into the issues that are encountered with pain programs and monitoring opioid use and overuse. He stated that, “Pain is a sensitive subject and it is often a factor in the satisfaction scores of patients. While we need to help manage their pain we also are there to help them get their pain addressed on a chronic level and limit the amount of opioid abuse.” The balance for managing a patient’s pain in the ER is tough balance but it has been through the chronic pain program that the ER has been able to know who needs help with pain and who needs to be given other tools to help. Dr. Bhow also states that the prescription-monitoring program has been instrumental in the management of people seeking pain meds and allowing those patients to be given some of the tools necessary for their treatment. He stated also that the system is not perfect and people without health insurance or the ability to follow up are often left without the resources needed to manage their pain. When it comes to privacy, Dr. Bhow reported that patients often feel upset and show mistrust with a provider who pull up a detailed report of the patient’s multiple narcotic prescriptions recently all filled however it is a necessary part of giving appropriate care. Dr. Bhow also thinks that monitoring someone’s pain medication use is a part of treatment that without the provider cannot preform his/her job effectively.
It is apparent from the interview with Dr. Bhow, who influences the chonric pain policy in the ER, that while privacy is advocated from a patient it can be linked to negative effects such as the provider not knowing how much opioids the patient is currently on. Promoting policy to effectively manage acute pain while also providing the best long term evidenced based management for chronic pain is difficult to balance however it is with the help of promoting electronic based medical records and systems that has helped contribute better overall management.
References
Bhow, M. (2014, March 15). Interview by T Watkins [Personal Interview]. Opioid interview.
Pritts, J. (2007). Federal efforts to impose uniformity on state health information privacy laws . Health Law & Policy, 1(20),
Opioids: Giving More Pain Than Taking Away 
Tyler your post this week reminded me of an article I just read about the underuse of buprenorphine in the treatment of opioid dependence and abuse and its role in the management of patients with a history of chronic opioid use. The article demonstrated that despite receiving additional training and passing a test qualifying them to prescribe buprenorphine, most office-based physicians report a continued feeling of uneasiness regarding prescription and management of the drug (Brooks, 2014). The inadequacy of intervention in the primary care setting results in the presentation of many patients that use opioids chronically to the ER—where you and your colleagues are faced with the difficult task of finding a balance between managing pain and a chronic condition.
One of the failures cited by physicians that are reluctant to prescribe buprenorphine is the lack of mental health support services—a necessary component of chronic pain management (Brooks, 2014).
Chronic pain and opioid dependence present a significant challenge, especially in the context of this week’s topic of data privacy and patient protection. The condition is stigmatized in and of itself, but adding addiction treatment as well as mental health services to a patient’s health record significantly increases risk associated with inadvertent disclosure of personal health information. Do you know of any specific safeguards in place that protect these vulnerable patients, either at the level of documentation or in the case of inappropriate access to information?
Thanks for your post!
Reference
Brooks, M. (2014 Mar 13). Buprenorphine prescribing ‘disappointingly low’. Retrieved from http://www.medscape.com/viewarticle/821902
Hi Tyler,
I recently had an in-service with a pain clinic organization connecting as a site for referral and to share information regarding what services entailed. They had stated that a majority of patients seen at the facility do have chronic pain and are not narcotic seekers, in which the prescription-monitoring program is not necessary. It is very easy for them to determine who has seeking tendencies and only then do they need to utilize such tools. Surprisingly, most of the time, the patients who complain about invasion of privacy are the ones who also attempt to look up personal information regarding the providers to see if they are newly graduated and are more easily persuaded to prescribe, which is also information shared amongst the community of drug seekers. The one’s who complain usually don’t have a valid argument and do a lot more than violate personal information. As you have stated, the tool is necessary in order to regulate limitations on a treatment that is high risk for abuse, which is necessary for optimal care. If not already implemented, perhaps initiatives should be developed that require individuals to sign a document before narcotics are dispensed stating that medication use will be shared amongst providers to prevent exploitation and to eliminate complaints regarding privacy, which may not only assist in deterring seekers, but will also assist providers in mitigating the difficult situation.
Thank you for your insightful post.
Maesa
Chronic pain and opioids discussion can create many questions, comments, opinions and discriminations. It is a double edged sword. You want to treat the patients chronic pain effectively so they can hopefully live a productive and comfortable life, but you also want to prevent the overuse/abuse of the medications they are using for their pain. Prescription monitoring sites and data are one of the many tools providers have at keeping tabs on their patients habits. Does it cause a breech in their privacy? Maybe, however, if a patient is doing something illegal, under your name and DEA license, you need to know. These sites also help keep track of patients who shop around, like Maesa previously stated, for doctors who may be easily pursuaded to fill narcotic prescriptions. Patients who abuse their pain medications can come up with very ingenious and insightful ways of getting them. Like, WRedford previously said, it is often difficult to manage these patients in a primary care setting. I think it is important to know what your resources as a provider are also, like referring to a pain management specialist. Great topic Tyler!
Excellent discussion among everyone here thus far. Maesa is correct that those who create the most “noise” are often the problem makers. And while patients do have a right to privacy, prescribers are held accountable for what they prescribe. There are numerous lawsuits for overdoses in which the family sues any prescriber that contributed to the patient’s access to controlled substances. I don’t see controlled substance monitoring going away. But perhaps we should make patients more aware of it, instead of just “barging in a room” with a list of previously filled RXs – what do you think?