Protected health information available to commanders, when needed

| October 28, 2010 | 0 Comments

Jerry Harben
U.S. Army Medical Command Public Affairs

SAN ANTONIO — Soldiers might wonder if their commanders will be told when they seek help from the troop medical clinic for a medical condition. 

Such concerns may lead Soldiers to avoid medical care, perhaps until a condition becomes a serious health hazard.

However, commanders need to know if Soldiers can’t perform their duties or have conditions that might present a hazard to themselves or others in the unit.

Army leaders are trying to resolve these competing needs by clarifying and emphasizing requirements and procedures for informing commanders about Soldiers’ protected health information, or PHI. 

“Commanders play a critical role in the health and well-being of their Soldiers, and therefore, require sufficient information to make informed decisions about fitness and duty limitations,” said Gen. Peter Chiarelli, Army vice chief of staff, in a message distributed in May.

“We must balance the Soldier’s right to the privacy of his/her protected health information with mission requirements and the commander’s right to know,” Chiarelli continued. “It would be counterproductive for Soldiers to perceive increased stigma, or not seek medical care, because of the inappropriate release of PHI.”

As a general rule, PHI can’t be released without the patient’s authorization. But privacy laws and regulations recognize that military missions sometimes requires commanders to know information that otherwise is protected.

Commanders have unrestricted access to some medical information, including the following:

•Department of Defense drug testing results;

•Medical readiness and fitness for deployment, like immunization status, profile, flight status, etc.;

•Medical line-of-duty investigation determinations;

•Changes in duty status due to medical conditions, like appointments and hospitalization;

•Army weight control program documentation;

•Medical conditions or treatments that are duty limiting — providers will notify commanders about medication side effects that affect duty performance, but are not required to identify the medication or diagnosis; and

•Any perceived threat to life or health, such as violent or suicidal behavior.

Commanders won’t be notified of conditions that don’t affect Soldiers’ abilities to perform duties, such as self-referrals for behavioral health services or prescriptions for birth control.

Warrior Transition Units are a special case, where commanders have access to PHI without authorizations. Using PHI in a WTU is considered treatment and care coordination.

Family members’ PHIs aren’t ordinarily provided to a commander. Family members’ PHIs can only be released to commanders when the family is enrolled in the Family Advocacy Program, or when they’re enrolled in the Exceptional Family Member Program, and their condition affects the Soldier’s fitness for duty.

Medical Command has prepared training packages for medical treatment facilities to use in ensuring medical providers and administrative personnel know the rules about communicating with commanders. Providers also must inform Soldiers when they will share information with the commander.

“What we want is to enhance communication between the providers and the commanders regarding the health of Soldiers,” said Tom Leonard, Patient Administration Division, headquarters, MEDCOM.

Specific procedures for transmitting PHI to commanders are listed in Office of the Surgeon General/MEDCOM Policy Memo 10-042, issued June 30.

Chiarelli also requires that medical treatment facilities inform commanders when Soldiers don’t show up for medical appointments. The average rate of no-shows among active duty Soldiers is 11 percent, according to Michael Griffin, senior managed care specialist, Tricare division, MEDCOM Headquarters.

“Each no-show appointment represents a lost opportunity to provide health care services to our population, and hampers our ability to meet access-to-care standards and beneficiary expectations,” Griffin said. 


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