07/18/2018    Michael Brody, DPM

HIPAA and the Opioid Crisis (Joseph Borreggine, DPM

My opinion (disclaimer: I am not an attorney and
this is my opinion as a provider) is that
unless you have a valid medical reason to query
a registry about a patient, then the query could
be considered a HIPAA violation. I do not
believe it is reasonable to routinely query the
registry prior to meeting the patient. If after
meeting the patient you develop medical concerns
about the patients use of opioids and feel this
information needs to be taken into account then
it is valid to query the registry.

One example where you might want to check the
registry is if you are considering surgery on
the patient, and usually prescribe opioids as
part of the post-operative course, being aware
of previous use of opioids may be valuable in
developing the treatment plan. Knowing this in
advance may allow you to NOT include the
potential for the use of opioids in your
treatment plan. [If you tell the patient they
will get opioids, and then as a result of the
pre Rx query you decide not to provide the Rx
this could damage the doctor patient
relationship, if you know in advance you can
avoid the discussion of opioids as part of the
treatment plan and therefore better manage
patient expectations and patient adherence to
the treatment plan]

Many years, prior to the deployment of
registries I had a patient walk into my office
who talked about their pain and had a list of
providers who could not help them. They came
from a town that was a fair distance from my
office. Based upon the history provided, I
determined that I did not want to enter into a
doctor patient relationship with that patient.
If I am uneasy about a patient and have concerns
about them coming to me for opioids, I might
check the registry and use that as part of my
decision as to whether or not to accept that
individual as a patient.

I would always document your medical rationale
for querying the registry. As part of the
forms the patient signs when they register at
the office it might be a good idea for them to
give you permission to query public registries.
In fact I will now review my Notice of Privacy
Practices and make sure it includes a provision
for querying and reporting to registries.

I look forward to hearing other perspectives.

Michael Brody, DPM, Commack, NY

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