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HIV Reporting: Oregons NametoCode System for County Health Departments

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Strengthen medical privacy laws ... Medical Information ... and ethical mandates to maintain privacy of medical and personnel information. ... – PowerPoint PPT presentation

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Title: HIV Reporting: Oregons NametoCode System for County Health Departments


1
HIV Reporting Oregons Name-to-Code System for
County Health Departments
  • HST Program
  • Oregon Health Division
  • Department of Human Services

2
Why expand HIV reporting?
  • Systematically obtain information about the
    entire population of HIV-positive persons, in
    order to
  • Better understand all stages of the HIV epidemic
  • Plan and coordinate care and prevention services
  • Facilitate access to care and prevention services

3
Implementation Objectives
  • Assure the availability of anonymous testing
  • Assure a confidential and secure data system
  • Strengthen medical privacy laws
  • Assure that all components of the reporting
    system (labs, county health departments and
    clinicians) are trained
  • reporting requirements (all)
  • confidentiality laws and assurances (all)
  • medical care guidelines (clinicians)
  • Increase access to HIV testing

4
Oregon Name to Code HIV Case Reporting
  • The decision to expand reporting followed a three
    year process and four public hearings
  • A community Advisory Group provides oversight in
    implementation
  • Implementation date is Oct 1, 2001
  • 34 states report HIV by name and retain the name
  • Two other states have name-to-code systems, which
    convert the name to a unique code
  • Washington
  • Maine

5
New HIV Case Reporting
  • Oregon Administrative Rules 333-019-0223
  • (1) Reporting of AIDS
  • (a) Each case or suspected case of AIDS shall be
    reported to the local health department, or to
    the Division if specified by the local health
    department within one week from the time of
    identification
  • (2) Reporting of HIV.
  • (a) Each case or suspected case of HIV infection
    shall be reported to the Division within one day
    from the time of identification

6
New HIV Case Reporting Investigation of Cases
  • (b) Investigation of HIV Cases.
  • (A) Investigations of HIV cases shall be
    conducted to the extent that resources permit.
    The local health department, or the Division at
    the request of the local health department, will
    assure that each identified case is referred to
    prevention and care services, encouraged to
    contact his or her sexual partners and
    needle-sharing partners of their potential
    exposure, and inform partners of the availability
    of counseling and HIV testing services

7
New HIV Case Reporting Investigation of Cases,
cont.
  • b) Investigation of HIV Cases (cont).
  • (B) After completion of the case investigation,
    but in no instance more than 90 days after
    receipt of a report, the Division shall create an
    encrypted unique alphanumeric code for each case
    from the patient's name or the necessary letters
    of the name and other information contained on
    the case report. This code shall be substituted
    for the patient's name on all case-related
    reporting information retained by the Division
    and local health departments. The patient's name
    shall not be retained by either the state or
    local health department except as authorized by
    the patient for the purposes of providing
    HIV-related services to the patient.

8
Consent for HIV Testing
  • Providers must assure that the person being
    tested for HIV has given informed consent (either
    verbal or written). This should include the
    requirement for reporting of HIV positive results
    by name to OHD.
  • Informed consent is documented by a state form
    that must accompany the HIV lab slip and test
    sample.
  • In addition, a model written consent form is
    available from the Health Division. (This form is
    optional.)

9
Anonymous Testing
10
Definitions
  • Anonymous Testing
  • No name is collected. If the test result is
    positive, the patient is NOT asked for his/her
    name. The result is reported anonymously. This
    option is available at all publicly funded HIV
    counseling and testing sites.
  • Confidential Testing
  • The person is tested using his/her name. This
    is kept in a secure location which protects
    confidentiality. A positive test is reportable by
    name.

11
Anonymous HIV Testing Will be Available at
Public-Funded Sites
  • Anonymous HIV testing will continue to be
    available at local health departments.
  • All persons testing at public HIV testing sites
    must be informed of the anonymous test option.
  • A persons name is not reported if the anonymous
    test is positive.

12
OHD/County HD Assurances Anonymous Testing
  • HIV PREVENTION COUNSELING, TESTING AND REFERRAL
    SERVICES
  • 3. HIV counseling, testing, and referral services
    will be voluntary and be available in both
    confidential and anonymous formats in each
    county. Every client will be informed of the
    anonymous HIV testing option.

CLHO Approved Feb, 2001
13
Confidentiality
14
Assurances Confidentiality of Data and Medical
Information
  • 1. The county health department and/or its
    sub-contractor(s), may not keep/retain
    information regarding an individuals
    HIV-positive status on file without the existence
    of an established client with service provider
    relationship. This relationship, at a minimum, is
    defined as the provider having engaged in an
    interview or dialog with the client that results
    in a specific client record being developed
    relative to prospective services available to the
    client.

CLHO Approved Feb, 2001
15
Assurances Confidentiality of Data and Medical
Information (cont.)
  • 2. All material related to the program which
    contains client names or other identifying
    information must be maintained in a locked and
    secure area/cabinet which allows access only to
    authorized personnel. Counties must assure that
    all personal computers and data programs that
    contain client information have restricted
    access.

CLHO Approved Feb, 2001
16
Assurances Confidentiality of Data and Medical
Information (cont.)
  • 3. Breaches of confidentiality are serious and
    require immediate action. Therefore, all known
    and alleged breaches of confidentiality will be
    evaluated by county supervisory or administrative
    staff, and the process and resolution documented.
    All confirmed breaches of confidentiality will
    result in appropriate sanctions as directed by
    county policy and procedure and all applicable
    Oregon Administrative Rules (OAR) and Statutes
    (ORS). The nature of confirmed breaches of
    confidentiality will be reported to the Oregon
    Health Division within 14 days from the date of
    evaluation by the county.

CLHO Approved Feb, 2001
17
Assurances Confidentiality of Data and Medical
Information (cont.)
  • 4. All county health departments will have a
    written policy and procedure regarding a breach
    of confidentiality. Such policy will detail the
    consequence to the employee (paid or volunteer)
    for a verified breach of confidentiality.

CLHO Approved Feb, 2001
18
Assurances Confidentiality of Data and Medical
Information (cont.)
  • 5. All county health departments will maintain
    documentation of an annual review of county,
    state, and federal requirements regarding the
    confidentiality of client-level information.
    Employees who, in the course of performing their
    job, have access to client-level information will
    have an annual confidentiality review and by
    his/her signature acknowledge understanding of
    the information.

CLHO Approved Feb, 2001
19
Assurances Confidentiality of Data and Medical
Information (cont.)
  • SUBCONTRACT AGENCIES
  • Local county health departments will assure that
    authorized subcontracting agencies will follow
    all relevant assurances for subcontracted
    services.

CLHO Approved Feb, 2001
20
Assurances Confidentiality of Data and Medical
Information (cont.)
  • HIV PREVENTION COUNSELING, TESTING AND REFERRAL
    SERVICES
  • 12. The identity of any individual served by the
    program will not be released to anyone without
    the written consent of the individual, except
    when otherwise required by county, state, or
    federal statute or regulation. A written copy of
    the confidential HIV test results can be released
    to the individual tested only by request of the
    client, after the client or an authorized
    representative has signed an appropriate release.

CLHO Approved Feb, 2001
21
Confidentiality of HIV Medical Information
  • ORS 433.045 prohibits the release of HIV related
    medical information without the specific
    authorization of the patient.
  • This release is not covered by the general
    release of information signed by all patients
    when they enter care.

22
The Reporting Process
23
OHD Data and Evaluation Section
Receive AIDS and HIV reports (with names)
  • Check registry for previous report
  • If new case, obtain case report from provider
  • Complete follow-up of case
  • Facilitate referrals to care and prevention
  • If AIDS case previously reported as HIV,
  • convert to AIDS case (by name)
  • If new HIV (non-AIDS), convert name to UI
  • delete name

Information match with UI only
24
Practical Steps in Response to Report from a
Private Lab or Clinician to the County Health
Department
  • Thank clinician for the call.
  • Take name and number of clinician and notify
    OHDs HST Program.
  • Tell clinician that HST will contact them to
    obtain the case report.
  • Inform clinician of the HIV case management
    services available at the county.
  • Remind clinician of the HIV prevention needs of
    persons living with HIV.

25
Practical Steps to Assure Confidentiality
  • Orientation for all new personnel regarding
    confidentiality policies and procedures.
  • Periodic (at least annual) training for all staff
    and volunteers regarding legal and ethical
    mandates to maintain privacy of medical and
    personnel information.
  • Swift and objective evaluation of any potential
    breaches of confidentiality.
  • Clear consequences related to a confirmed breach
    of confidentiality.

26
Partner Notification and Referral
  • All newly diagnosed persons should be encouraged
    to notify sexual and needle sharing partners.
  • This can be accomplished in three ways
  • The client commits to notifying all sexual or
    needle sharing partner.
  • Notification can be done by the clinician or
    his/her designated staff at the request of the
    client.
  • Disease Intervention Specialists, public health
    professionals trained to do contact notification
    and referral for testing, are available to assist
    in notifying partners. This can be arranged
    through OHD or the local county health department.

27
Oregon HIV Reporting Name-to-Code
System QUESTIONS
28
Scenario A1
  • A person tests anonymously through a local health
    department (LHD) and returns to the LHD for
    post-test counseling and test results.
  • Process
  • If the HIV antibody test is positive, the
    counselor provides referrals to care services
    during post-test counseling.
  • The test result is entered into the anonymous
    testing database.
  • The clients name is never entered on a document
  • The client should be informed that his case must
    be reported by the provider when he/she enters
    care, but the name will be converted to a UI as
    soon as the case report is completed.

29
Scenario C1
  • A confidential HIV test is submitted by a local
    health department (LHD) counseling and testing
    service (CTS) site to the Oregon Public Health
    Lab (OPHL). The test is positive.
  • Process
  • OPHL calls the HIV Data Analysis Section to tell
    them there is a positive HIV test from a specific
    LHD.
  • OPHL will provide the HIV Data Analysis Section
    with the lab ID number, date of test, and other
    demographic and risk history information for the
    client. OPHL will not have the clients name on
    the lab slip or specimen.
  • Someone from the HIV Data Analysis Section will
    call the reporting person or a specified contact
    person at the LHD to get the HIV persons name
    to complete the case report and will determine if
    the patient is using or has been referred to case
    management or care services.

30
Scenario C1 (continued)
  • If the LHD has not been able to contact the HIV
    person to inform him/her of the result, OHD and
    the LHD will develop a plan to locate the person
    for post-test counseling and referral to care.
  • After the HIV Data and Evaluation Section knows
    that the HIV person has been referred to care,
    the name of person will be changed to an unique
    identifier (UI) and will be deleted from the
    database.
  • Even if follow-up remains incomplete after 90
    days, the name of the HIV person is changed to a
    UI and deleted from the database.

31
Scenario L1
  • A private laboratory calls the LHD to report an
    HIV test result.
  • Process
  • The LHD thanks the lab for calling, takes the
    number of the contact person, and notifies OHDs
    Data and Evaluation Section.
  • OHD contacts the lab to get the clients name and
    provider information.

32
Scenario L1 (continued)
  • OHD contacts the provider and completes the case
    report and follow-up.
  • After follow-up is complete the name of the HIV
    person is converted to a unique identifier (UI)
    deleted from the database.
  • Even if follow-up remains incomplete after 90
    days, the name of the HIV person is changed to a
    UI and deleted from the database.

33
Scenario P1
  • A clinician calls the LHD to report an HIV
    person.
  • Process
  • The LHD thanks the provider for calling and tells
    the clinician that the HIV Data and Evaluation
    Section will call to take the case report.
  • Take the clinicians name and phone number and
    notify OHD to take the report.

34
Scenario P1 (continued)
  • OHD contacts the clinician and completes the case
    report and follow-up.
  • If the clinician has not been able to contact the
    HIV person to inform him/her of the result, OHD
    and the clinician may agree that public health
    will attempt to notify him/her. In this case,
    OHD will contact the LHD to determine the best
    way to contact the person.

35
Scenario P1 (continued)
  • After follow-up is complete the name of the HIV
    person is converted to a unique identifier (UI)
    deleted from the database.
  • Even if follow-up remains incomplete after 90
    days, the name of the HIV person is changed to a
    UI and deleted from the database.
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