Minutes of July 8, 1998 Meeting

 A meeting of the Law Revision Commission Committee on Confidentiality of Medical Records was held commencing at 4:00 p.m. on Wednesday, July 8, 1998 in Hearing Room 1A in the Legislative Office Building in Hartford, Connecticut. Those attending were: Commission members Committee Chairman Joseph J. Selinger, Jr., Mary Anne O’Neill, and Joel I. Rudikoff; advisors Larry Berliner, Elizabeth M. Burns, Regina Dacier, Doreen Del Bianco for Gail Sturgess, Brenda Farrell, Mary H. Hess, Peter Kane, Jennifer Jackson, Stephen Lewis, Richard J. Lynch, David W. Parke, Jeanne Milstein for Commissioner Kristine Ragaglia, Marybeth Reinhardt, Stephen Ristau, Robert Scalettar, Jeannette C. Schreiber, and Patricia Shea; Commission staff David Hemond and David Biklen; and Uniform State Laws Commissioner K. King Burnett. Also noted as attending were Fritz Conway, Matthew Hallisey, Dennis LaGanza, Donald L. Roll, and Bonnie Stewart.

Mr. Selinger called the meeting to order.

The minutes of the June 10 meeting, with the corrections as of 7/6/98, were approved.

K. King Burnett, chairman of the committee that drafted the Uniform Health-Care Information Act, presented background for the Uniform Act. That presentation provided information concerning the National Conference of Commissioners on Uniform State Laws, the impetus for the Uniform Act, the current and proposed federal provisions, and the status in other states.

Mr. Burnett then walked the Committee through a review of the Act itself, providing background on matters taken into consideration in drafting of the Act and, at various points, comparing the Uniform Act provisions to recommendations made by Secretary Donna Shalala of the United States Department of Health and Human Services (HHS).

Among points made by Mr. Burnett:

Importance of the definition section in determining the scope of the Act. For example, the definition of "health-care provider" excludes pharmacists. Mr. Burnett suggested consideration of whether pharmacists should be included, citing the HHS recommendations. The Act also excludes "medical devices". HHS does not. "Audit" includes an assessment or evaluation of a health-care provider in numerous circumstances.

Use of the term "agent" in section 2-101 pulls into the Act numerous non-health-care providers who may obtain access to medical information through a provider.

The rules concerning authorizations, which require identification of the nature of the information to be disclosed and the person to whom it is disclosed and which are limited in time, provide limitation on abuse of blanket waivers. However, note that authorization to third-party health-care payors are not time-limited. HHS would require that patients receive a copy of the authorization. The Act does not.

Section 2-104 is the key provision setting out exceptions to the requirement for patient authorization prior to disclosure. Mr. Burnett reviewed each exception and the rationale for making that exception. He noted that certain provisions, such as that concerning law enforcement, sweep in existing state law.

Section 2-105 details obligations of the provider in cases involving compulsory process. Mr. Burnett reviewed underlying considerations.

Under section 3-101, concerns were discussed as to the required response time for allowing examination and providing record copies. It was noted that the health-care provider is not required to create a new record or reformulate an existing record to facilitate examination.

Under section 3-102, criteria for denial of access were discussed.

Under sections 4-101 and 4-102, correction and amendment criteria were reviewed.

Under section 5-101, the requirement for notice of information practices was discussed. It was noted that the HHS recommendations would go further and include a statement of intended uses.

Under section 7-101, the Act’s skeletal security language was discussed. Mr. Burnett provided the rationale for such a limited statement but also noted that additional provisions might be appropriate including, possibly, authorizing the setting of minimum security standards by regulation. It was suggested that consideration be given to including application of the section to "agents" or others who might have obtained possession of information subject to confidentiality requirements.

Under sections 8-101 through 8-103, the Act’s remedial provisions were discussed.

Mr. Burnett discussed his experiences with seeking adoption of the Act – now enacted in two states – and expressed concern over whether health-care providers will actively support the confidentiality protections offered by the Act. Other discussions concerned the change in political dynamics, the impact of an individual identifier, and the movement to provide protections on the federal level.

The next meeting was set for August 12, 1998 at 4:00 p.m. in Hearing Room 1A in the Legislative Office Building in Hartford, Connecticut.

Mr. Selinger said that he hoped to have a proposed plan for developing a draft for the Committee to consider at the August 12 meeting.

The meeting adjourned at 6:10 p.m.

Respectfully submitted,

 /S/ 

David L. Hemond
Reporter/Drafter

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