Wednesday, June 4, 2008

AG's office announces online drug database

I thought this program - and today's announcement of it by Attorney General Jerry Brown - raises a whole slew of privacy concerns that need to be addressed. Thankfully I got to make these concerns known to KQED today too, so listen for the California Report's coverage at 9 minutes after the hour, each hour, tomorrow morning.

The new database, to be funded privately, and in fact, it was Kaiser itself that funded the feasibility study of the program, would "allow doctors and pharmacists to immediately access a database of more than 86 million drug prescriptions. All prescriptions filled for schedule II, III and IV drugs – including powerful painkillers like morphine, hydro-codone and codeine – would be instantly available."

Its being sold as a way of cracking down on drug abusers, meaning law enforcement will also have access to your records...but they haven't said how this access would be approved or denied.
Before I comment more, here's some clips from the San Diego Union Tribune:

...his office plans to place the state's prescription-tracking database on a secure Web site that health-care providers can log onto to obtain the information instantly. The move is intended to make it tougher for patients to go from doctor to doctor and fill multiple prescriptions.


Under Brown's proposal, the Troy and Alana Pack Foundation would fund the database's implementation costs, with the state Department of Justice absorbing maintenance costs.


Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights, a consumer advocacy group based in Santa Monica, warned that in establishing such a database efforts would need to be made to ensure patient information isn't released to identity thieves or unwanted marketers. “Nationally, the push to put records online has evolved faster than the concern to make them private,” said Flanagan.

The San Jose Mercury News sheds some more light on the issue:

It will cost about $3 million to develop and operate the program for three years, according to a 2007 feasibility study paid for in part by Kaiser Permanente. Funds have not yet been identified, but supporters are hopeful health care providers and insurers will foot the bill. Nationally, prescription drug fraud costs insurers as much as $72 billion a year, according to a 2007 study by the Coalition Against Insurance Fraud.


Kathy Ellis of the Department of Justice said details about law enforcement access to California's system have yet to be worked out. Access likely will be granted on a case-by-case basis to prevent "fishing" in the system, she said. "They'd have to identify what their need is. I don't see a patrol officer having a direct need for that information."

It is important that enforcers not rely on numbers when looking at suspected abuse cases, said Sherry Green, executive director of the National Alliance for Model State Drug Laws.

"Even if something looks outside the traditional range, that doesn't in and of itself mean that something's wrong," said Green. "Prescription monitoring officials can't make those kinds of health determinations — all they can do is make a recommendation that something needs to be scrutinized more."

In Maine, civil libertarians fought the development of drug-monitoring. An online system, launched in 2006 in response to the state's OxyContin epidemic, has "an arm's-reach relationship with law enforcement," said program director Daniel Eccher. Investigators can't access records without a subpoena.

I guess the obvious point is that if such a program is to be implemented we must ask ourselves whether the possible pitfalls of allowing our private prescription records to be so easily accessed outweighs the claimed benefits of "stopping drug abusers"?

By the least, any such database must include the strongest of safeguards to ensure a patient's private information is protected from identity thieves, overzealous law enforcement, or unwanted marketers.

Some suggestions might include: Legislation that puts into law, a stringent, ironclad privacy policy for this database and its maintenance.

For instance, there should be an electronic audit trail examined regularly ANYONE who has accessed your file and consumer's should have access to these (as in their) medical records and to that electronic audit trail so they knew who's been snooping around.

I also am skeptical anytime the "war on drugs" is used to rationalize the increasing deterioration of our right to privacy. Since this whole program was pushed by the insurance industry (and who paid for the feasibility study), and is going to be funded by private sources, we should wonder whether industry profits and government power is the real end goal here?

Similarly, if we really wanted to reduce drug dependency perhaps we should focus on fully funding our schools, offering first class drug counseling and rehabilitation services, and stopping the advertising of prescription drugs on television every night?

It goes without saying too, that government could also abuse this system. We're opening a Pandora's Box to say the least...and since this kind of data sharing and storage is a likely fact of life in our future, then we better be vigilant in protecting our privacy from those who might seek to benefit from it at our expense.


Pop said...

Some 30 states have such a database. The two states that I am a authorized user on ( Indiana & Kentucky) the time it takes to input all the required data.. is very time consuming... Since I work/live in a area where patients/docs live/practice in both... I must access both databases to confirm suspicions of an abusive patient. Taking 10-15 minutes to generate a report on one patient... not counting the time to "analyze" the report.. To the best of my knowledge no pharmacy software package provides a "cut/paste" of patient data to the controlled substance database.. Some major Pharmacy chains PROHIBIT their Pharmacist from having access to the internet.. so the Pharmacist is left to developing conclusions about a patient's abuse without all the facts. I have worked in Pharmacies where NO ONE has bothered to sign up as a authorized user to access the database.. In Indiana ... the database (INSPECT) has been collecting data since the early 90's and until 2006 .. it was only accessible by law enforcement.

IMO.. this is just another FEEL GOOD LAW... it makes everyone feel better - because it was passed - but beneficial results will be virtually nil...

Steve Ariens, PD

ZJK said...

Thanks for the post. Now, let me apologize to everyone. Due to issues with my account, for the past year and a half I was not aware of all the comments that were being submitted (just discovered them on June 5, 2009)!! I went back and approved some, but others were so long ago it just didn't make much sense. At any rate, thank you, and I will be aware of comments in the future so comment away...Zack