AMCP Approves Position Statement on Patient Confidentiality

In a unanimous vote, the AMCP Board of Directors has approved a position statement on the confidentiality of patient medical records and how they should be used and protected.

The statement said that AMCP "supports protection of patient confidentiality and endorses the responsible use of patient-identifiable medical and prescription drug information by authorized pharmacists, physicians, and other health care professionals."

The Academy has been discussing the issue of patient confidentiality in light of federal and state health care proposals that would limit the use of patient records in a medical setting. AMCP believes that proposed legislative or regulatory restrictions on the use of patient-identifiable information must be carefully considered so that they "will not hinder the effective administration of pharmacy benefits and impede patient protections in place today."

Health plans, providers, and pharmacy benefit managers have long recognized the importance of maintaining the confidentiality of patient-identifiable medical information. For this reason, health organizations use such information only when it is essential to assure accurate and efficient coordination of health care services. And, when patient-identifiable information is not necessary for the administration of a health benefit, health care organizations have developed methods to separate the identity of the patient from his or her medical information.

The position statement outlines several appropriate uses of patient-identifiable information: to protect patients against inappropriate medication use; to assess patients’ satisfaction; to assess quality of health care; and to administer pharmacy benefits. Disclosure of patient- identifiable information, aside from the purposes described above, should "only be permitted when the patient agrees to the disclosure," AMCP said.

The complete text of the position statement on patient confidentiality is available on AMCP’s Web site at www.amcp.org (legislative/position statements) or through Fax-On-Demand at 800/964-9648, #712.

Academy Decries Proposal to End Need for Pharmacists

A federal regulation that would eliminate the requirement for a pharmacist in most hospitals would "severely compromise the safe, accurate, and cost-effective provision of pharmaceuticals and pharmaceutical care services," AMCP said. In comments filed with the Health Care Financing Administration (HCFA), the Academy said HCFA’s proposal to eliminate the requirement for a pharmacist or a drug formulary system would "compromise patient care" and "should not be enacted."

The federal regulation, known officially as revisions to the "conditions of participation" that hospitals must follow to participate in Medicare and Medicaid programs, would eliminate the need to:

The new regulation also would require hospitals to have no more than a 2% drug error rate.

Eliminating the current standard that mandates a pharmacist’s presence is ill conceived, AMCP told HCFA. "This proposal shows a lack of understanding of the pharmacist’s contribution to the effective use of pharmaceuticals and the value added by the one health care professional who is specifically trained in drug therapy management."

AMCP also said that HCFA’s proposal conflicts with provisions of federal, state, and accrediting bodies that require pharmacists to review a patient’s medication record with each prescription filled to ensure that 1) the patient receives the appropriate drug in the correct dosage and dosage form, 2) each medication order is screened for potential allergies, drug-drug, and drug-food interactions, and 3) each medication order is evaluated for drug-disease interactions and potential side effects.

Pharmacists have more extensive training in pharmacology, kinetics, dosage estimates, drug interactions, available products, and drug therapy management than any other health professional. Considering the importance of pharmacists in reducing adverse drug reactions and medication errors, "AMCP questions the wisdom of transferring these pharmacist responsibilities to other health care professionals who have less training and education than pharmacists in drug therapy management."

AMCP said that it supports the elimination of medication errors and applauds efforts to reduce their occurrence. However, the Academy is concerned about setting a universal standard of a 2% error rate that may or may not be achievable, especially in light of the proposals to delete requirements for both pharmacists and formularies.

A more pragmatic approach is to require institutions to have policies geared toward preventing medication errors and monitoring inappropriate procedures, AMCP said.