CURRENT ISSUES

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DM programmes in jeopardy by US patient privacy law? New US legislation to protect patient confidentiality may have significant implications for disease management (DM) programmes, says Jane Anderson in a special report. Representatives from the managed-care and DM sectors have expressed concern that the new legislation could threaten DM programmes. Senior director for research at the American Pharmaceutical Association (APhA) Foundation in Washington, DC, Benjamin Bluml says that this legislation will create 'new barriers'. He adds that 'managed care will probably be very concerned about this and very resistant.' Access to patient data is very important for DM programmes. Without access to best available information, it is not possible to make the best decisions, he notes.

Difficult to outline exceptions The new legislation should include exceptions for DM programmes, suggests Peter Smith, CEO of Ralin Medical, the parent company for DM vendor Cardiac Solutions. However, he admits that it will be difficult to outline the exceptions. The difference between disguised pharmaceutical marketing initiatives and pure DM programmes cannot be easily recognised. Another suggestion for coping with the restrictions would be to use encrypted personal data, suggests Blum\. Such a model would also introduce further accountability to the system, he adds. Special report: DM at risk in privacy proposals. Disease Management News 4: 25 Jan 1999 800737613

Protect patient confidentiality The new federal proposals are expected to become established by August 1999. Most of the new proposals will place severe restrictions on the use of medical information by health plans, case managers and employers. The new proposals include: • a requirement for patient authorisation at each instance information is accessed • specification of the planned use of the information • use of data for the purpose specified only, unless otherwise authorised. The programme associate for health policy at the National Consumers League in Washington, DC, Brett Kay states that patient privacy needs to be protected and that patients need to know how their medical information is used. He expresses concerns about the use of pharmaceutical records, particularly for programmes that are 'marketing-driven.' Although he is supportive about the idea of DM programmes, he is concerned when pharmaceutical information or personally identifiable claims are used without permission by health plans or DM vendors to target specific patients.

Data used for patient benefit? The American Association of Health Plans, the leading managed-care industry group, notes that in DM health plans, patient-identifiable information is used for the benefit of the patient. For example, such information is necessary to identify patients with asthma or diabetes mellitus using claims from a patient popUlation. If consent to obtain such information becomes necessary, the DM industry will face significant difficulties.

PhannacoEconomics & OutcOmBS News 13 Feb 1999 No. 199

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