Dr. Melissa Harris-Perry: Late last year, state lawmakers in Oklahoma passed SB 1369. It's called the Oklahoma Healthcare Transparency Initiative Act.
The legislation requires all healthcare providers to enter patient records into an online database. It's set to go into effect on July 1st, and the measure specifically requires providers to "submit health and dental claims data, unique identifiers, and geographic and demographic information for covered individuals to the Oklahoma Healthcare Transparency Initiative."
Sounds either pretty technical or maybe really great but in advance of implementation, many mental health providers in Oklahoma are raising concerns about patient privacy and confidentiality. With us now is Sabrina DeQuasie, therapist in Oklahoma. Sabrina, thanks so much for being here.
Sabrina DeQuasie: Thank you so much for having me, Melissa.
Dr. Melissa Harris-Perry: When I just read that legislation, when I looked through it, I thought, "Oh, well, isn't this what we want?" Digitized patient records that allow us to ensure that we get comprehensive care across different providers. Why is it a problem?
Sabrina DeQuasie: You would think that this would be a really great idea. However, we are concerned that mental health records are being included in this database, and we're not sure exactly what data is going to be required of us. That's a question that hasn't been answered. The entity that is in charge of making all of this happen, the Oklahoma Healthcare Authority, really hasn't had any kind of authority over any type of private practice mental health providers ever.
None of us were looking and seeing what they were up to. We didn't find out about this mandate until roughly 14 days before the final vote. It really took us all by surprise, and we didn't have a chance to even look and see are our clients being protected here? There's so many questions that seem to say that they're not.
Dr. Melissa Harris-Perry: Tell me more about that. What kinds of information are you concerned about having to turn over to this digital database?
Sabrina DeQuasie: We are concerned that we might be being asked to turn over actual therapy notes. We've gotten information back and forth saying, "No, that's not the kind of information that we want." Then others saying, "Oh no, we just want diagnosis and date of treatment." The thing is that even so much from my perspective as a mental healthcare provider, even so much as saying, "This person is my client and this is their diagnosis," can be a violation of their privacy.
In particular, when you think about some of the reasons people might come to therapy perhaps for abuse or for substance use disorder, this kind of information is highly sensitive and we really want to protect that for our clients.
Dr. Melissa Harris-Perry: Make sure even in casual interactions, like if you see a client in a restaurant or in an elevator, you're not meant to say, "Oh, hi, John, nice to see you. Are you coming to your session on Thursday?" Is that right?
Sabrina DeQuasie: Oh, yes, absolutely. Even if your doctor were to call me and I know it's your doctor and your doctor says, "Hey, I need this information on John," well, if I haven't gotten permission from John, I can't even say to the doctor that this person is my patient or client at all. I have to say, "I can't confirm or deny, have them to reach out to me if you think that they might be my client."
Dr. Melissa Harris-Perry: We're going to take a very quick pause right here, but we're going to dig in more on this and what these potential violations of privacy could mean. More about the Oklahoma Healthcare Transparency Initiative Act in just a moment.
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We're talking now with Sabrina DeQuasie. She's a therapist at The Virtue Center in Oklahoma. We're talking about threats to patient privacy, which might be embedded in the new initiative in the state. Sabrina, it's my understanding that you and other therapists met on Friday with this oversight body, the OHCA, the Oklahoma Health Care Authority. What happened at that meeting?
Sabrina DeQuasie: We had a representative from Oklahoma Providers for Privacy who was able to be there. I personally was not able to be there. What happened at that meeting is we had several mental health groups who had come together to speak with OHCA. OHCA had called this emergency meeting, I suppose, to reassure us. During this meeting, they changed some of their stances on things, but I feel like they weren't being completely forthright or answering questions completely.
They seemed to be saying that they were looking at our complaints about the opt-out and opt-in situation. They tried to smooth us over quite a bit about the [00:05:08] exorbitant cost of getting into this. They said that if we sign up for this program, we're signing an agreement with the state-designated entity. We're not signing an agreement with the state. It seems to me that they're saying that there's a third party who's going to be responsible for these medical records rather than even the state itself. We're being required to sign an agreement with this. They seemed very confident that they can make us do this based on the wording of the law that says that all providers must comply.
Dr. Melissa Harris-Perry: As far as you can tell right now, you won't have an opt-out option?
Sabrina DeQuasie: Right now, the way that it is set up is that you have to opt out per provider. It's not clear on whether or not that even means your information won't be gathered. The way the wording seems to say is that you can opt out of your information being viewed, but you can't opt out of your information being recorded. That's one of the things that has us very concerned in regards to privacy.
It's our position that clients should have to opt in. They should have to seek this out and say, "My information needs to be in this system because my information is important to my overall medical care." Anyone else who might not need their medical care to be wrapped up in their mental healthcare, they wouldn't have to do anything at all. That's our position.
Dr. Melissa Harris-Perry: Is this-- particularly if it's a requirement or an opt-out rather than an opt-in, does that constitute a violation of the federal law of HIPAA?
Sabrina DeQuasie: According to OKSHINE, they are in compliance with HIPAA and with the other restrictive law that we look at, which is 42 CFR Part 2. We're not disputing that. We have seen that there are federal guidelines for HIPAA and for 42 CFR in regards to health information exchanges. What we are saying is that because you have to opt out, when you opt out, you have to identify who your provider is. That's the part that we are saying is a violation of your privacy. Because I'm only a mental healthcare provider so if you say I'm opting out for Sabrina DeQuasie, it becomes very clear that you're opting out for your mental health and that is the violation of your privacy that we are saying is not correct.
Dr. Melissa Harris-Perry: Sabrina, I just have to ask, in terms of trying to understand what the goals of this legislation are, is this connected to abortion services? Is the desire to see all medical care, a capacity for the state-appointed entity to be able to see when there might be either prescriptions or follow-up care that might have been regarding termination of a pregnancy?
Sabrina DeQuasie: Yes, absolutely. We have speculation amongst our colleagues that a part of the reason why they're wanting this information is to do just exactly what you said, to track this kind of information. I also found out this morning that the school systems here are trying to create rules that say that teachers have to identify children who are suddenly using different pronouns or who are exploring their gender identity.
That also seems to confirm to us that this law is intended to invade people's privacy in regards to what you just said, in regards to our bodily autonomy and our abortion rights and things of that nature. This makes us very afraid that people are going to give information inadvertently that could cause them a lot of problems down the road.
Dr. Melissa Harris-Perry: Sabrina DeQuasie, therapist in Oklahoma, Sabrina, thanks so much for being here.
Sabrina DeQuasie: Thank you.
Dr. Melissa Harris-Perry: Just a note that we did reach out to the Oklahoma Healthcare Authority, Oklahoma's Medicaid Agency. They said, "The rule proposal is the first step." You can read the full statement up on our website.
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