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Stimulus brings HIT, privacy into sharp relief

BY Jim Frederick

WASHINGTON The Obama administration’s $787 billion plan to reboot a dangerously ailing economy is now law, unleashing billions of tax dollars to ease the state Medicaid funding crisis and spur the rapid adoption of health information technology, along with programs designed to ease tax burdens and bring millions of Americans back into the workforce. Pharmacy advocates approve of many aspects of the stimulus package, but remain deeply concerned over more stringent patient privacy protections that made it into the bill.

The bill allocates $18.83 billion for healthcare projects and the acceleration of HIT, including $1.68 billion to maintain, expand and make permanent an Office of the National Coordinator for Health Information Technology. Add in the $300 million slotted for regional HIT coordination efforts and $20 million for other integration activities, and the tab for national health IT coordination and support comes to $2 billion, including incentive payments to physicians for rapid adoption of electronic prescribing.

The stimulus bill also includes $2 billion in funding for prevention and wellness programs within the Department of Health and Human Services — programs that could trickle down to the pharmacy level.

Officially known as the American Recovery and Reinvestment Act of 2009, the massive spending package is drawing guarded praise from pharmacy leaders, particularly for its allocation of $86.6 billion to cash-strapped state Medicaid programs and its support of HIT. “The Medicaid funds in this bill will help states to ensure that low-income patients maintain access to vital health care, such as medications and pharmacy services,” noted Steven Anderson, president and CEO of the National Association of Chain Drug Stores. “In addition, the final report contains important tax relief that will assist NACDS members and other businesses. The legislation also provides $2 billion in grants and loans for the advancement of interoperable health information technology.”

However, Anderson and other pharmacy leaders cautioned, the final bill calls for patient-privacy provisions that go beyond current HIPAA restrictions — provisions that could tangle pharmacists and other health providers in a web of needless restrictions and hamper both patient relationships and the needed flow of protected patient data among health providers. “The final report contains the most significant changes ever to the HIPAA privacy rules, which affect the entire healthcare delivery system,” Anderson warned.

Other experts concur. “The federal stimulus package … has been widely discussed for its provisions relating to the promotion of [HIT]. What has been less widely reported, however, is that the bill’s Health Information Technology for Economic and Clinical Health Act also contains provisions that would significantly expand the reach of the Health Information Portability and Accountability Act of 1996,” noted a report from the legal firm of Waller Lansden Dortch & Davis. “These provisions will have significant impact on the policies and procedures used by healthcare providers, health plans and their business associates that create or receive Protected Health Information,” the report admonishes.

Indeed, the bill calls for heightened enforcement and increased penalties to health providers who fail to comply with HIPAA regulations, as well as new security standards among businesses that deal in PHI. It also requires “the notification of patients of any unauthorized access, acquisition or disclosure of their ‘Unsecured PHI’ that compromises … the patient’s privacy and security,” noted Waller Lansden.

With the uncertainty surrounding health reform, HIT and patient privacy, the leaders of NACDS, the National Community Pharmacists Association, the American Pharmacists Association and other groups, laid out a set of “Pharmacy Principles for Health Care Reform” at a press conference Feb. 12.  Among those principles, said coalition leaders, is “assuring patient access to needed medications and pharmacy services,” and “promoting pharmacy and HIT interoperability, so that all health providers, including pharmacies, are linked via electronic data and decision-making platforms to improve patient care.”

Said Anderson, “The promise of HIT will not be realized if electronic silos replace paper silos, and unless we … commit financial resources. We need to make sure that financial resources will not be wasted if we have systems that don’t talk to each other or provide the right kind of information.”

Among the principles urged by the pharmacy coalition:• Pharmacists should have electronic access to such patient health information as diagnosis and laboratory values.• Federal and state grants to healthcare providers should support the growth of interoperable healthcare systems.• Guidelines should be established to protect patient information, while assuring that these protections also allow information flow among healthcare providers to enhance treatment decisions.

John Coster, NCPA’s newly named SVP government affairs, spoke for independent pharmacists when he asserted, “Pharmacies go to great lengths to protect the privacy of patients’ prescription information. We believe that the current HIPAA regulations strike the right balance in protecting patients’ information, while giving providers the information they need to provide care. However, we recognize policymakers’ concerns that new and innovative medical records technologies are also subject to HIPAA, so we look forward to working … to assure that any new protections also strike the right balance between patients’ rights and healthcare providers’ responsibilities to their patients,” Coster told Drug Store News.

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Obama may overturn Bush’s ‘conscience’ rules

BY Alaric DeArment

NEW YORK The Obama Administration may overturn the Bush Administration’s “conscience” rules that allow healthcare workers to invoke religious beliefs to deny certain services such as birth control, according to published reports.

The Los Angeles Times reported that Barack Obama may roll back the provisions, which allow pharmacists to refuse to prescribe birth control pills on account of personal religious beliefs. 

Seven states have also filed lawsuits to challenge the rule, the newspaper reported.

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Clear up patient medication guidelines, independent pharmacy group urges FDA

BY Jim Frederick

ALEXANDRIA, Va. The National Community Pharmacists Association wants the government to give patients a clearer, more concise set of guidelines on how to take their medications, the effects those drugs have and the risks and benefits they carry.

The independent pharmacy organization yesterday urged the Food and Drug Administration’s Risk Communication Advisory Committee to push for a change in the current system of overlapping instructions that go to patients along with their prescriptions. In testimony before the committee, NCPA asked the agency to develop criteria for a guidance that would describe “a single, patient-friendly, written prescription information sheet to eventually replace the multiple written documents that patients can currently receive from their pharmacists with a particular prescription.

Under current practices, those documents can include  Medication Guides, Patient Package Inserts [PPIs] and Consumer Medication Information [CMI]. Too often, said NCPA’s director of public policy, Tony Lee, patients discard the CMI and never read it — sometimes even throwing it away before they leave the pharmacy.

“While we recognize that the FDA has worked hard to try and improve these medication documents, the problem needs to be addressed in a fundamentally different way that combines useful written information with the personal relationships between the pharmacists and patients,” Lee told the FDA advisory panel.

“It is time for a comprehensive solution to this written prescription information issue,” added John Coster, NCPA’s senior VP of government affairs. “Any FDA effort to make CMI more useful for the patient should be accompanied by a broader assessment of the usefulness and purpose of the other information leaflets that pharmacist may be required to provide. We look forward to working with the agency and patient groups to meet this goal.”

Last summer, NCPA joined other pharmacy provider groups to file a “One Document” citizens’ petition with the FDA. The Risk Advisory Committee was convened specifically to address how to make CMI leaflets more useful for the patient, the group noted.

“These leaflets are voluntarily provided by the pharmacist, but the information contained in these leaflets often duplicates information in other written leaflets,” NCPA stated.

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