Interpretation and integration of the federal substance use privacy protection rule in integrated health systems: A qualitative analysis
Interpretation and integration of the federal substance use privacy protection rule in integrated health systems: A qualitative analysis
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DOI：
10.1016/j.jsat.2018.11.005
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发表时间：
2019-02-01
影响因子：
3.9
通讯作者：
Bart, Gavin
中科院分区：
文献类型：
--
作者：
Campbell, Aimee N. C.;McCarty, Dennis;Bart, Gavin
背景：联邦法规（《联邦法规法典》第42编第2部分）为寻求物质使用障碍治疗的人员提供特殊的隐私保护。初级医疗服务提供者、医院和医疗保健机构一直在努力平衡医疗护理的最佳实践与对《联邦法规法典》第42编第2部分的遵守，但很少有正式研究探讨这一问题。本研究的目的是探究在与卫生系统数据隐私实践、政策和信息技术架构相关的《联邦法规法典》第42编第2部分法规的解释和实施方面的机构差异。
方法：这是一项横断面定性研究，采用目的抽样法对来自美国国家药物滥用研究所（NIDA）国家药物滥用治疗临床试验网络（CTN）三个研究节点的15个综合医疗保健机构的隐私/法务专员（n = 17）和信息技术专家（n = 10）进行访谈。经过培训的工作人员完成了一项简短的调查，并对每位参与者进行了数字记录的半结构化定性访谈。访谈内容被转录并在Atlas.ti软件中编码。框架分析用于识别和整理选定编码中的关键主题。
结果：参与者对平衡患者安全与《联邦法规法典》第42编第2部分的隐私保护表示担忧。尽管描述了关于在卫生系统之外信息发布的类似保护标准，但使用了许多变通方法来管理机构内部的沟通和护理协调。为了使《联邦法规法典》第42编第2部分的限制与电子健康记录相一致，卫生系统使用了敏感记录标注、“打破玻璃”技术、对提供者基于角色的有限访问以及临时解决方案（例如，提供者消息传递）。
结论：在当代综合医疗保健系统中，尽管有《联邦法规法典》第42编第2部分的规定，但与物质相关的电子健康记录（例如，患者就诊历史、用药记录）通常在内部可获取，无需明确的共享同意。《联邦法规法典》第42编第2部分的近期修订未解决综合医疗保健环境中的信息共享需求。
Background: Federal regulations (42 CFR Part 2) provide special privacy protections for persons seeking treatment for substance use disorders. Primary care providers, hospitals, and health care organizations have struggled to balance best practices for medical care with adherence to 42 CFR Part 2, but little formal research has examined this issue. The aim of this study was to explore institutional variability in the interpretation and implementation of 42 CFR Part 2 regulations related to health systems data privacy practices, policies, and information technology architecture.Methods: This was a cross-sectional qualitative study using purposive sampling to conduct interviews with privacy/legal officers (n = 17) and information technology specialists (n = 10) from 15 integrated healthcare organizations affiliated with three research nodes of the National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN). Trained staff completed a short survey and digitally recorded semi-structured qualitative interview with each participant. Interviews were transcribed and coded within Atlas.ti. Framework analysis was used to identify and organize key themes across selected codes.Results: Participants voiced concern over balancing patient safety with 42 CFR Part 2 privacy protections. Although similar standards of protection regarding release of information outside of the health system was described, numerous workarounds were used to manage infra-institutional communication and care coordination. To align 42 CFR Part 2 restrictions with electronic health records, health systems used sensitive note designation, "break the glass" technology, limited role-based access for providers, and ad hoc solutions (e.g., provider messaging).Conclusions: In contemporary integrated care systems, substance-related EHR records (e.g., patient visit history, medication logs) are often accessible internally without specific consent for sharing despite the intent of 42 CFR Part 2. Recent amendments to 42 CFR Part 2 have not addressed information sharing needs within integrated care settings.