Recent advances in computer technology are redefining the way pharmacists do business. And in response to the changes, faculty at the University of Connecticut School of Pharmacy are making sure students are well versed in the latest laws and ethical standards of the industry.

Two areas of immediate concern involve electronic prescribing and data mining.

Electronic prescribing is a procedure being adopted by a growing number of health care providers in place of the more traditional hand-written prescriptions patients bring to their pharmacist. The federal government is encouraging the use of electronic prescriptions by offering health care professionals financial incentives to use the technology. Eligible physicians who fail to adopt electronic prescribing will face financial penalties beginning in 2012.

Advocates say sending prescriptions electronically over the Internet helps eliminate pharmacist errors (it’s a widely held perception that doctors don’t always have the best handwriting); facilitates insurance reviews; and makes it easier for health care professionals to share important medical data.

But the immediacy and efficiency that comes with the technology brings with it new professional and ethical concerns.

Placing an individual’s personal health care information into an electronic database increases the risks that the information may be accessed, shared, or used by someone inappropriately, says Robert L. McCarthy, dean of the School of Pharmacy, who has written several research papers on pharmacy ethics and patient privacy.

“Technology is great in that it can do a lot of very positive things,” says McCarthy, who has a Ph.D. in law, policy, and society from Northeastern University in addition to his master’s degree in hospital pharmacy. “Technology can help improve drug safety, make things easier for patients, and encourage physicians, pharmacists, and other healthcare professionals to work together. But we have to make sure there are proper safeguards.”

McCarthy co-teaches a class in pharmacy law and ethics at the Storrs campus with Professor Gerald Gianutsos, who has a JD in law in addition to his pharmacy Ph.D.

Pharmacy students also are instructed in the latest business practices, privacy and confidentiality rules, health policies, and pharmacy communications.

“We’re trying as much as we can to prepare them for this reality,” McCarthy says. “The biggest challenge is that it is constantly evolving. Sometimes, we’ll tell them one thing today and it will change tomorrow. It’s a very dynamic time.”

Decades ago, local pharmacists kept their patient’s records on paper and the only people who had access to those records were individuals who worked in that pharmacy. Today, McCarthy says, a broad range of individuals have access to people’s medication information including pharmacists, pharmacy technicians, insurers, managed care companies, and even marketing firms.

While patients are now routinely asked to sign forms approving the sharing of their medical information as part of the federal Health Insurance Portability and Accountability Act or HIPAA, controlling the release of electronic data is especially difficult.

Some examples of ethical concerns and violations that McCarthy has used in his class include:

• A pharmacy technician on the east coast looking up a famous celebrity’s medication history on the west coast by accessing a large national retail pharmacy’s database.
• An employer or health care provider denying someone a job or insurance because they learn the individual is taking medication for a chronic illness or disease that may increase insurance premiums and other costs.
• A husband seeking his wife’s medication records or a son seeking the medication history of his ailing father. While pharmacists routinely shared such information with family members in the past, they must be more wary today, as the information may be misused. The husband may be interested in obtaining his wife’s history of using psychotropic drugs to bolster his case in a child custody battle. The son, in the second case, may want his father’s medical information to try to show he is incompetent so the son can access his funds for his own personal use.

McCarthy says he also is concerned that physicians and pharmacists wary of violating HIPAA’s stringent confidentiality rules may be discouraged from sharing information with each other or their peers to the detriment of patients who may benefit from the exchange.

“We’ve put a lot of burden on health care professionals with HIPAA,” McCarthy says. “But we need to be careful we don’t get carried away. We’ve got to balance ethical and legal concerns with ensuring quality patient care. I think people would say our number one responsibility is taking care of patients.”

Another ethical concern that has arisen as a result of personal medication information being stored electronically is data mining. Data mining is the process whereby third-party companies collect data about practitioners’ prescribing habits from pharmacy organizations (primarily large chain-store companies) so they can analyze the records to improve drug marketing. Large pharmaceutical manufacturers for instance, are very interested in knowing whether a doctor sees mainly patients with diabetes or heart disease, so they can target him or her with specific lines of medicine, research news, etc., to improve sales.

Patient identifying information is supposed to be scrubbed from the content before it is shared. But the practice has raised concerns about possible violations of the prescribers’ privacy rights, commercial conduct, and even free speech.

“I can see where people would have concerns whether their names are used or not,” McCarthy says. “If information about me is being used without my permission, that’s certainly cause for concern.”

Data mining is big business. According to a Jan. 20, 2011 article in the U.S. Pharmacist, approximately 51,000 pharmacies in the United States are wired to facilitate data mining, resulting in revenues to “data miners” in excess of $2 billion annually. The same article said that the pharmaceutical industry spends more than $30 billion annually promoting medications, providing drug samples, placing ads in medical journals, and conducting direct-to-consumer advertising. Approximately $7 billion of that total involves direct marketing to physicians, the article noted.

Laws restricting data mining involving prescription information have been upheld in Maine and New Hampshire. But the U.S. Court of Appeals for the Second Circuit in New York recently struck down a similar law in Vermont as an unconstitutional regulation of commercial speech. The U.S. Supreme Court has agreed to hear Vermont’s appeal of that ruling, which is pending and is being watched closely by the pharmaceutical industry.

Other states also are grappling with the issue. Last fall, six independent pharmacies in Texas sued CVS Caremark claiming the merger between CVS Corp. and Caremark Rx created an unfair competitive environment that hurt rival pharmacies. The suit also claimed CVS Caremark violated the privacy rights of its consumers by using data collected through its pharmacy benefit management arm to identify physicians’ prescribing practices and patient buying practices in order to market drugs favored by CVS Caremark to doctors and patients.

CVS Caremark has denied the claims, saying the lawsuit mischaracterizes the company’s business practices.

McCarthy is among those watching the developments closely, so he can pass the latest policy decisions on to his students.

“The idea is to make sure that the ethics keep up with the technology,” he says. “Certainly we have ethical concerns we’ve never had before, and we need to make sure we attend to those concerns and not violate in any way our responsibilities to the patient.”