Decoding New York State’s Prescription Monitoring Program

In the first case, a BNE official clarified that a psychiatrist is mandated to contact the PCP and inform him or her of the potential harm that amphetamine salts are causing the patient and to coordinate his care accordingly. Even without the patient’s consent, such contact is not a HIPAA violation and is a necessary action for compliance with the I-STOP laws (6).

In the second case, the psychiatrist is justified in deciding to decline to admit the patient to the clinic because at that stage, the physician and patient had not yet reached an agreement for establishing an ongoing patient-physician relationship. Also, the clinic would be justified in checking the PMP even though the patient did not provide permission to speak to the prior psychiatrist and even though she was not an established clinic patient. Realistically, the psychiatrist could have developed a therapeutic alliance by providing clinical care on the basis of the available information—while declining to write a stimulant prescription until the patient’s history could be confirmed from the previous psychiatrist.

The I-STOP laws permit physicians to contact other prescribers whose names are found in the PMP, even if the patient does not explicitly permit such collaboration or decline to authorize such contact (7). Interstate agreements allow physicians to share information about controlled substances through their PMPs and make more informed decisions about mutual patients’ care. For example, NYS has interstate agreements with Connecticut, Indiana, Massachusetts, New Jersey, Rhode Island, Vermont, and Virginia that permit exchange of this information (8). Furthermore, the U.S. Office of Civil Rights establishes that the covered entity or a business associate of a covered entity is permitted to obtain protected health information without patient consent or authorization for a subset of health care operation activities, which include supporting fraud and abuse detection (9). NYS law also permits physicians to check the PMP even if they are not prescribing controlled substances to a patient (7).

Specifications of HIPAA permit information sharing in all states under certain circumstances, even though it is contrary to the rule, according to 45 CFR §160.203(a). Disclosure is permitted under HIPAA if it is necessary to prevent fraud and abuse related to the provision of or payment for health care, is for the purposes of serving a compelling need related to public health, or has as its principal purpose in the regulation of the manufacture, registration, distribution, and dispensing of any controlled substance.

Physicians often cite “HIPAA violation” as the reason they are reluctant to contact another physician or prescriber to discuss a patient if they do not have the patient’s explicit permission to do so. The key implication for administrators is to train physicians to use PMPs and share information appropriately in medical practice. Clinical information sharing without patient authorization is permitted under HIPAA, and those in the position of shaping training and making recommendations should be explicit in explaining the circumstances under which these disclosures are acceptable.

Coordination of care improves clinical outcomes, patient satisfaction, and engagement in one’s own treatment, and it curbs the extent of diversion. It could ultimately result in reduction of relapses, coprescribing of controlled substances such as opioids and benzodiazepines, and ultimately, lethal overdoses.