As public health director for the city of Portland, I want to reassure our citizens and our community partner organizations that we take patient privacy and health very seriously and are fully aware of the rules and regulations required under the Health Information Portability and Accountability Act. We deeply regret that we did not do a better job of communicating with our former Ryan White HIV Positive Health Care Program patients about the survey we’re conducting with two University of Southern Maine researchers to review the transition of patient care to Greater Portland Health.

We want to make sure that the patients and greater community understand that there was no breach of protected health information under HIPAA, the federal medical privacy law. Despite this, we moved quickly to investigate the complaints we received, and we put additional safeguards in place to further ensure the privacy of patient information and the integrity of the survey.

Conducted by USM’s Muskie School of Public Service, the survey is an important best practice measure to evaluate the transition process, to assess whether patients were receiving the care they needed and whether they were satisfied with their new care providers, and to determine whether the city should be taking additional steps to better address patients’ care needs.

Although the survey was requested by and developed in cooperation with the India Street Health Center’s Patient Advisory Committee, in hindsight, we wish we had notified all patients in advance in case a patient did not want to be contacted to participate in the survey.

Under state and federal privacy laws, the city was not required to obtain patients’ written authorizations for the disclosure of their health information. A clear exception to Maine’s HIV confidentiality statute allows such information to be disclosed to researchers for research and program evaluation purposes. An exception to HIPAA allows such disclosures to a contractor that agrees in writing to protect the information.

USM’s researchers agreed in writing to protect such information in accordance with the law, and to not use or redisclose the city’s patients’ personal health information in any manner that would violate the law. Although the researchers’ original written assurance to protect such information did not include all of the language required in a HIPAA business associate agreement, the city and USM promptly corrected that technical deficiency by executing a fully HIPAA-compliant business associate agreement. The city also obtained the USM researchers’ written assurance that they had not used or redisclosed any such information in violation of HIPAA or Maine law before the business associate agreement deficiencies had been corrected.

Although the initial written assurance already included numerous safeguards and assurances that the city’s patients’ personal health information would be adequately protected from being compromised, the city and USM also put in place additional, more-express protections in the formal business associate agreement. That agreement carefully outlines in great detail all of the protections that must be afforded to patient information by USM’s researchers, and the researchers have provided written assurance to the city that they have, in fact, treated the information in precisely the way that the formal agreement dictates, both before and after it was signed by the parties.

We have learned important lessons from this experience and are implementing new and updated policies and procedures for ensuring that our health care entities and programs better communicate with patients regarding uses and disclosures of their patients’ personal health information for these types of research, program evaluation and business associate-related purposes going forward.

While the decision to transition the Ryan White HIV Positive Health Care Program grant to Greater Portland Health was not an easy one to make, it was done proactively so that we would not be in a position of having lost the grant with no plan in place.

Making this strategic decision afforded patients a longer transition timeline and allowed us the opportunity to fulfill the original vision of having a thriving federally qualified health care center in our city. This designation allows patients to access more comprehensive services for their health care, and it ensures the longevity of the grant and its services in our community.

We look forward to completing the survey and hope for a high level of patient participation so we can fully understand the impact of this transition of care. Once again, we take very seriously the privacy and health of all our patients and will protect such with all measures possible.

— Special to the Press Herald