murrphy - privacy and public health · • early detection and intervention • vital records •...
TRANSCRIPT
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Privacy And Public HealthPrivacy And Public Health
Hearings on the Population Health Dimension National Health Information Infrastructure WorkgroupNational Committee on Vital And Health Statistics
April 22, 2003
Anne M. Murphy, JDChief Counsel and Chief Privacy Officer
Illinois Department of Public Health
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IntroductionIntroductionPublic health and privacy principlesare at a critical intersection
• Public health activities are increasingly prominent and increasingly essential
• Public health activities depend upon individual health data
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IntroductionIntroduction• Better technical capacity to access
health data
• Increased need for public health authorities to exchange data with other parties
• Heightened sensitivity to privacy of health information under federal and state law
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IntroductionIntroduction
Public health activities are increasingly prominent and increasingly essential
• Bioterrorism• West Nile virus• SARS
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IntroductionIntroductionPublic health activities depend uponhealth data• Communicable disease reporting
• Population health assessment- Epidemiological investigation - Registries- Research - Laboratories
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IntroductionIntroduction• Licensure and certification
• Early detection and intervention
• Vital records
• Preventing or controlling disease, injury or disability
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IntroductionIntroduction
Better technical capacity to access healthdata
• Syndromic surveillance
• Improved electronic linkages with providers and local health departments, CDC
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IntroductionIntroduction
Increased need for public health authoritiesto exchange data with other parties
• Third-party researchers
• Service providers
• Law enforcement
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IntroductionIntroduction
• Community-based organizations
• Other government agencies
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Introduction
Heightened sensitivity to privacy ofhealth information under federal andstate law
• HIPAA
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IntroductionIntroduction
• In Illinois, numerous state law protections as well- Communicable Disease Code
- HIV/AIDS, STD
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IntroductionIntroduction
- Mental health records
- Medical studies
- Registries
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IntroductionIntroduction
- Facilities licensure laws
- FOIA
- Vital records
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HIPAA ApproachHIPAA Approach
The Privacy Rule allows for continued government/public health access toindividual health information withoutauthorization or consent
• Required by law
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HIPAA ApproachHIPAA Approach
• Public health activities
• Health oversight
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HIPAA ApproachHIPAA Approach
• Avert a serious threat to health or safety
• Disaster relief
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HIPAA ApproachHIPAA Approach
Required by law• Communicable disease reporting
• Mandated lab testing
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HIPAA ApproachHIPAA Approach
• Mandated access for licensure/certification
• Vital records
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HIPAA ApproachHIPAA Approach
• Special requirements for mandated disclosures regarding victims of abuse, neglect or domestic violence; disclosures for judicial and administrative proceedings; and disclosures for law enforcement purposes
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HIPAA ApproachHIPAA Approach
Disclosures for public health activities to a“public health authority”• “Public health authority”: a government
agency, or a person or entity acting under grant of authority from or contract with such agency, authorized by law to collect or receive information for the purpose of controlling or preventing disease
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HIPAA ApproachHIPAA Approach
• Includes reporting of disease, injury, vital events; public health investigations and interventions
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HIPAA ApproachHIPAA Approach
For Health Oversight
• “Health oversight agency”: government agency, or third party acting under grant of authority or contract with such agency, authorized by law to oversee healthcare system
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HIPAA ApproachHIPAA Approach
• Includes audits; civil, criminal or administrative investigations, proceedings or actions; inspections; licensure or disciplinary actions
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HIPAA ApproachHIPAA Approach
HIPAA constraints on public healthactivities
• A function of activities
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HIPAA ApproachHIPAA Approach
• In Illinois, IDPH a “hybrid entity”
• Blood lead screening, ADAP programs are covered functions
• Adopting a “culture of privacy”, but HIPAA requirements legally mandated only for covered functions
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Key IssuesKey Issues
1. Possible reductions in reporting to public health authorities due to HIPAA misperceptions- Work aggressively to dispel
misperceptions (letters, meetings with community, education)
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Key IssuesKey Issues
- Reasonable reliance on a public official’s determination that the information requested is the minimum necessary
- Accounting requirements can be a general statement as to the nature of public health reporting
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Key IssuesKey Issues
2. Facilitate innovative but appropriate data relationships between public health authorities and third parties
- HIPAA maybe more flexible than some state laws
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Key IssuesKey Issues
- Research, early intervention, outreach, data processing
- Agency arrangements, contractual arrangements, with confidentiality protections; should be standardized to the extent possible (i.e., designation as a “public health authority”)
- Public health data’s value is in its use
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Key IssuesKey Issues
3. Should focus on reporting to law enforcement, bioterrorism-related investigative activities- Forensic epidemiology generating
attention- State laws may be inflexible- Need for continued state legislative
attention and dialogue
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Key IssuesKey Issues
4. Consider increased pressure for specific health information from the media and the public- For example, West Nile, SARS,
cancer statistics
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Key IssuesKey Issues
- Protection of public safety vs. protection of privacy
- FOIA laws should be examined- Litigators, organized labor- Public health system should strive
for consistency in level of detail