By Ceci Connolly
Washington Post Staff Writer
Saturday, July 7, 2001; Page A06
The Bush administration issued detailed guidelines yesterday for protecting the confidentiality of medical records, attempting to dispel what many described as the most serious misconceptions about the first federal patient privacy rules.
Contrary to some early interpretations of the rules, hospital rooms need not be soundproofed, doctors may discuss a case with a nurse or lab technician and pharmacists are free to hand over prescriptions to a patient's relative, according to the guidelines from the Department of Health and Human Services.
But the administration postponed action on some of the most contentious matters surrounding patient records, most notably the question of whether parents should have guaranteed access to a child's health records. Under the federal regulations, parents may be told if a minor seeks services such as substance abuse counseling or birth control. The only exceptions to that rule are if the child is at risk or if a state law grants confidentiality.
In yesterday's guidance, Health and Human Services Secretary Tommy G. Thompson reiterated his plans to reassess that policy, raising concern among some medical professionals and privacy advocates that he intends to allow access to minors' records.
"That is a really worrisome thing," said Debra Ness, executive vice president of the National Partnership on Parents and Families. "Anyone who has teenagers knows that in certain sensitive areas -- such as mental health or contraception or screening for STDs [sexually transmitted diseases] -- the assurance of confidentiality is critical to their willingness to get those services."
An official at the Planned Parenthood Federation of America said that about two dozen states allow minors to receive contraceptive services without parental consent, but about 30 states require consent for an abortion.
Initiated during the Clinton administration, the federal standards give patients more control over their medical records, in many instances requiring health care providers to get written consent before releasing any information. By 2003, Americans will have the right to scrutinize -- and amend -- their own medical files and keep much of that information from financial institutions or employers.
"We consider this to be a very important consumer right," said Joy Pritts, senior counsel at the Health Privacy Project at Georgetown University. "If everybody else is looking at your health information and making life-altering decisions based on that, you should have the right to see it too."
Nothing in yesterday's guidelines alters the safeguards approved last December, but in offering the lengthy interpretation the Bush administration soothed health care industry officials who complained that the regulations were unnecessarily burdensome and costly. The Blue Cross Blue Shield Association, which fought much of the privacy effort, estimated at one time that it would cost the industry more than $40 billion over five years to implement the rules.
Yesterday, however, the insurance association was satisfied with Thompson's effort. After a quick reading of the 60-page document, Blue Cross Blue Shield Association President Scott P. Serota issued a statement praising the "positive steps" the federal agency had taken "regarding the most onerous restrictions on consumers as well as providers and health plans."
Spokespersons for the American Hospital Association and the American Association of Health Plans said they were encouraged by Thompson's straightforward guidance but needed more time to dissect the details.
Consumer groups that have largely been at odds with the industry echoed Serota's guarded optimism.
"This is a very calming document that cuts down on the hyperbole," said Pritts, whose organization has lobbied hard for aggressive privacy protections. "We see this as a potential sign the administration really is committed to privacy."
For patients, Pritts said the impact of the federal rules will depend largely on where one lives.
"If you live in a state like California that has a lot of privacy protections, your life is not going to change much," she said. "But if you live in a state like Alabama you will be better off with implementation of these regulations."
Still, the debate over medical records is far from over. In the guidelines, HHS listed several areas in which it plans to pursue changes.
During a news conference in May, Thompson said he would leave "major changes" regarding minors' records and confidentiality restrictions on researchers until next year.
In addition to revising regulations affecting minors' records, the department intends to make it easier for doctors to phone in a prescription, refer patients to specialists, post sign-up sheets or call out a patient's name in the waiting room.
Although the guidance covered many consumer-related issues, Pritts expressed concern that HHS did not signal any intention to tighten marketing restrictions. Under the regulations, doctors and pharmacists would be permitted to send marketing materials to patients on behalf of another business, such as a pharmaceutical manufacturer. However, providers would be forced to disclose that they are being paid for that work and that patients can put a stop to such solicitation, an HHS policy analyst said.
© 2001 The Washington Post Company See "Spotlight on Medical Privacy Guidelines"; http://www.hhs.gov/ocr/hipaa.
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