Aaah, but Matt, the full definition of "treatment" at sec. 164.501 of the Privacy Rule is as follows:
"Treatment means the provision, coordination, or management of health care and related services by one or more health care providers, INCLUDING THE COORDINATION OR MANAGEMENT OF HEALTH CARE BY A HEALTH CARE PROVIDER WITH A THIRD PARTY; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another." (emphasis added) What the emphasized phrase means is the question. I don't see all that much in the Privacy Rule Preamble discussing what "treatment" means in the first place, much less what this "coordination or management...with a third party" means. Is the "third party" language mere surplusage, or does it refer to non-providers? (FWIW, IMO it is the latter). There are a few references to AMA ethical materials in the Preamble, and a few other sections (see for example the Privacy Rule preamble at pages 82625 to 82626), where DHHS says that it intends the term "treatment" itself to be defined very broadly, albeit limited to "treatment's" performance by only physicians and medical providers (and not, for example, by health plans), and also, limited to treatment of an individual. In other words: WHO DOES IT? "Treatment" must be performed by a provider. WHO IS IT DONE TO? "Treatment" must also concern the medical care provided to an individual, and not to a community. But once the above limitations are imposed, all bets are off. In terms of ... WHAT IS IT? "Treatment" can be just about any type of health care and... WHO ELSE CAN THE PROVIDER PERFORM IT WITH? I think the Rule says that, as long as the above qualifications are met, a physician or provider can perform "treatment" with anybody else (a "third party"). So, noting the reference to "coordination or management of health care by a health care provider with a third party", I am wondering, can that "third party" be read as broadly as to include the community at large? I wonder if the physicians or medical providers on the list can give examples or otherwise expand upon, in their experience, what this coordination with a third party might entail? For example, if a physician believed that enlisting the community's help in identifying a comatose patient was essential for performing treatment on that patient, would that be the physician's "coordination or management of health care ... with a third party"? Thanks again, John John C. Cody, Esq. NYS Central HIPAA Coordination Project NYS Office for Technology http://www.oft.state.ny.us/hipaa/index.htm [The opinions expressed herein are my own and do not necessarily reflect the policies, practices or opinions of my employer or anyone else. Nothing herein constitutes legal advice - if you need legal advice, please consult your own attorney.] -----Original Message----- From: Matthew Rosenblum [mailto:[EMAIL PROTECTED] Sent: Sunday, November 02, 2003 12:48 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: is this practice O.K.? John, Clearly, HIPAA allows a health care provider to disclose PHI to any other health care provider for the purposes of "treatment", and the HIPAA-definition includes "consultation between health care providers [i.e., physicians and pharmacists] relating to a patient". As most pharmacists are CEs, they would be mandated to comply with the HIPAA rules. The general scenario to which you refer (below) is not so clearly defined by HIPAA: the photo of a comatose patient disclosed to the general public through mass media in order to "identify" the individual might (or might not) apply to a "treatment" or "public health" emergency. For example, if the need-to-identify is intertwined with a "public health" emergency, possibly HIPAA would allow the disclosure of the photo by the provider to a public health authority. But in that case, it would be public health authority (and not the provider) that makes the photo available to the media. I hope that this helps. Your questions are always welcome. Matt Matthew Rosenblum Chief Operations Officer Privacy, Quality Management & Regulatory Affairs http://www.CPIdirections.com CPI Directions, Inc. 10 West 15th Street, Suite 1922 New York, NY 10011 (212) 675-6367 [EMAIL PROTECTED] CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute it. Please notify the sender by E-Mail at the address shown and delete the original message. Thank you. AVISO DEL CONFIDENCIALIDAD: Este email es solamente para el uso del individuo o la entidad a la cual se dirige y puede contener información privilegiada, confidencial y exenta de acceso bajo la ley aplicable. Si usted ha recibido esta comunicación por error, por favor no lo distribuya. Favor notificar al remitente del E-Mail a la dirección mostrada y elimine el mensaje original. Gracias. -----Original Message----- From: Cody, John (OFT) [mailto:[EMAIL PROTECTED] Sent: Sunday, November 02, 2003 11:18 AM To: WEDI SNIP Privacy Workgroup List Subject: RE: is this practice O.K.? Matt: That is an interesting perspective, and one which I have wondered about myself. But I wonder how far the concept can be stretched under the HIPAA Privacy Rule. For example, one of the listserves a few months ago (I think it was a different one than this one) was discussing the situation where an unidentified comatose patient is brought to the hospital and the hospital believes the only way to identify the patient is through a photo disclosed to the mass media. The discussion took various twists and turns, but one thing which I privately pondered at the time was whether there is such a thing as "community" treatment. Under the principle you embrace below, would the hospital's media disclosure also constitute "treatment"? If not, why not? Is the distinction that in Dr. Fairley's example, the disclosure is to other providers, while in the hospital's scenario, the disclosure is made to a wider audience than providers? Where in the HIPAA Privacy Rule is that distinction defined? Thanks for your thoughts, John John C. Cody, Esq. NYS Central HIPAA Coordination Project NYS Office for Technology http://www.oft.state.ny.us/hipaa/index.htm [The opinions expressed herein are my own and do not necessarily reflect the policies, practices or opinions of my employer or anyone else. Nothing herein constitutes legal advice - if you need legal advice, please consult your own attorney.] -----Original Message----- From: Matthew Rosenblum [mailto:[EMAIL PROTECTED] Sent: Friday, October 31, 2003 5:12 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: is this practice O.K.? Dear Dr. Fairley, What a great question! We believe that HIPAA allows this practice and in doing so, provides patient with privacy protections. For nearly 2000 years physicians, nurses, and pharmacists (chemists) have comprised the "treatment" triad. And especially when treating substance abuse and addiction, it does take a community to provide a safe and therapeutic environment: whenever we remove a member of the treatment community from the process, errors and mistakes may increase and disease resolution may decrease. Within this context, the scenario that you describe (below) fits well within the bounds of sharing PHI for treatment purposes, and the involved providers will be beholden to the related HIPAA rules. I hope that this helps. Your questions are always welcome. Matt Matthew Rosenblum Chief Operations Officer Privacy, Quality Management & Regulatory Affairs http://www.CPIdirections.com CPI Directions, Inc. 10 West 15th Street, Suite 1922 New York, NY 10011 (212) 675-6367 [EMAIL PROTECTED] CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute it. Please notify the sender by E-Mail at the address shown and delete the original message. Thank you. AVISO DEL CONFIDENCIALIDAD: Este email es solamente para el uso del individuo o la entidad a la cual se dirige y puede contener información privilegiada, confidencial y exenta de acceso bajo la ley aplicable. Si usted ha recibido esta comunicación por error, por favor no lo distribuya. Favor notificar al remitente del E-Mail a la dirección mostrada y elimine el mensaje original. Gracias. -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Friday, October 31, 2003 3:54 PM To: WEDI SNIP Privacy Workgroup List Subject: is this practice O.K.? The practice that I am going to describe is quite common in our community but I am not sure it is acceptable. I wanted the opinion of the experts on this list. Occassionally, we run into a problem with a patient who seems to be doctor hopping and getting multiple prescriptions for narcotics. In order for the patient's principle physician to keep a close watch on the patient's use of narcotics and to avoid abuse/misuse of narcotics, the physician makes a deal with the patient. The deal is "ALL prescriptions for narcotics must be funneled through one doctor-the primary care physician." The patient usually agrees but then (and here is where I am not sure if we are infringing on privacy)we can send an "Alert" to all the area pharmacies to alert them that this deal occurred and if the patient shows up at one of the area pharmacies with a narcotic prescription from someone other than the primary care physician, the patient is told that they have an order that they can not fill the prescription unless it comes from the designated doctor. Is this practice acceptable? Do we need the patient's consent to notify all heighborhood pharmacies? Is verbal consent acceptable? Can the information be sent to the pharmacies without the patient's specific consent (that is, the patient consented to the arrangement that one doctor fills all narcotic prescriptions but the patient did not consent to the information being sent to all area pharmacies? ) Thank you Rich Fairley, M.D. --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. 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