Can Patient Discovery be practical for 42 CFR Part II Programs?

Does patient consent for a substance abuse provider to disclose their identity to another provider on a Health Information Exchange (HIE) also authorize subsequent disclosures to other providers on that HIE within 200 Miles?


I recently re-read the 42 Code of Federal Regulations (CFR) Part II for the purposes of building a Health Information Exchange (HIE) rules engine.  I found a section of this regulation that has particular relevance to a maintenance treatment program HIE seeking to conduct a "Patient Discovery".

Section 2.34 and the Central Registry exception for maintenance treatment programs

A substance abuse program that has received patient consent to disclose their identity to the central registry and thereby any/all programs associated with that central registry provided that the following conditions are met.

1. Geography: The programs are within 200 miles of each other
   (programs in different states must also be within 125 miles of the central repository)
2. Purpose: The purpose of the request and disclosure is to avoid patient enrollment in more than one maintenance treatment program (such as a narcotic dispensing program to treat morphine-like drugs)
3. Event:
• Patient Acceptance into treatment
• Type/Dosage of Drug changed
• Treatment of patient is interrupted, resumed, or terminated
4. Patient consent: For HIE Repository to disclose identity    
5. Patient Information limited to:
• Patient Identifying Information
• Medication 
• "Relevant Dates"

Bottom Line:  Traditional "Patient Discovery" of substance abuse patients can be practical on HIEs with a 200 mile radius of providers.

References: 

1. 42 CFR Part II
   http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=4f93368c488542a669b772d864725e9d&rgn=div5&view=text&node=42:1.0.1.1.2&idno=42
2. Data Segmentation for Privacy Use Cases
   http://wiki.siframework.org/Data+Segmentation+for+Privacy+Use+Cases
3. SAMHSA FAQ - 42CFR Part II and Health Information Exchange
   http://www.samhsa.gov/healthprivacy/docs/EHR-FAQs.pdf
4. Individual Choice Models
   http://healthit.hhs.gov/portal/server.pt/document/911197/choicemodelfinal032610_pdf
5. Patient Discovery
   http://healthit.hhs.gov/portal/server.pt/document/955287/nhin_patient_discovery_production_specification_v2_0_pdf