Drug Testing - DOT Fed. Adv. Committee on E Transmission of Drug Testing Info. (2003))

September 15, 2003

DOT Electronic Transmission and Storage of
Drug Testing Information
Federal Advisory Committee
Docket Clerk, Attn: Docket No. OST-02-12148
Department of Transportation
400 7th Street, SW
Washington, DC 20590

Re: Electronic Transmission and Storage of Drug Testing Information Federal Advisory Committee Meeting

The American Association of Occupational Health Nurses, Inc. (AAOHN) is pleased to submit our comments on the electronic transmission and storage of drug testing information.

General Comments

Recognizing that electronic transmission could erode the privacy of health information, Congress incorporated into the Health Insurance Portability and Accountability Act (HIPAA) provisions that mandated the adoption of privacy protection for individually identifiable personal health information (PHI). Therefore, HIPAA requires privacy and security standards to protect electronic transmitted and maintained PHI. Since the public continues to express concern about privacy protection, and with HIPAA fully in effect, employers face increased liability in fulfilling legal responsibilities related to the administrative requirements of confidentiality. As licensed health care providers, occupational and environmental health nurses (OHNs) are privy to and responsible for confidentiality of the employee?s personal and work related health information, including drug test results.

Just as confidentiality is essential to building trust and honesty between the employee and the health care provider, confidentiality and security are crucial to the effectiveness of any drug-testing program. Since the U.S. Department of Transportation (DOT) drug testing program has multiple types of screening (pre-employment, random, post accident, reasonable suspicion, return to work) and methods of reporting, AAOHN advocates for administrative, technical, physical, ethical and legal safeguards that protect the privacy and security of health information collected at the worksite.

AAOHN agrees with DOT that increased use of electronic reporting is both beneficial and inevitable, but can pose risks. Therefore, the association recommends the development and implementation of universal security standards and safeguards for electronic transmission and storage in order to protect the integrity and confidentiality of PHI, including drug-testing information. Having this capability in place will expedite the reporting requirements of the drug-testing program and aid in the paper reduction process.

Specific Comments

To avoid becoming a covered entity under HIPAA, some companies will continue using hard copy transmission and storage of drug testing and PHI vs. electronic transmission and storage. Additionally, computer downtime will necessitate the need for hard copies. Therefore, AAOHN stresses the need for privacy and security safeguards for hard copies as well as electronic transmission and storage.
Personal information (i.e., address, social security records, academic records) is available in many forms via the Internet. Any additional electronic placement of employee PHI presents an opportunity for unauthorized or indiscriminate access and places the company and the health care provider at risk for breach of confidentiality. Therefore, AAOHN recommends having administrative, technical and physical security safeguards in place, such as:

Internal administrative safeguards, i.e., written policies, designated security coordinators.
Work station design, i.e. monitor placement, screen guards & savers.
Access controls, i.e., terminal, user and content codes, encryption, de-identification, email faxing.
Tracking the disclosure and transmission of PHI, i.e., audit logs
Changes in access codes or passwords, i.e., scheduled changes or immediately upon user termination, etc.

A possible problem with implementing new systems is that not all companies have interconnecting electronic information systems. This creates situations such as inability to open email attachments. Thus, there is a need to adopt universal privacy and security safeguards for electronic and hard copy transmission.

AAOHN appreciates the opportunity to provide input on this issue. As always, we will continue to promote safe and healthful work environments. We would welcome the opportunity to elaborate on the points outlined in this document. Please feel free to contact us at 919-966-0979 for clarification or additional information.

Sincerely,

Susan A. Randolph, MSN, RN, COHN-S, FAAOHN
President

cc: AAOHN Board of Directors
Ann R. Cox, AAOHN Executive Director