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More than 70 commanders and their enlisted counterparts attended a town hall meeting on Jan. 18 to learn about the rules governing the release of a Soldier's protected health information, or PHI.

"Providers and command teams should have a working knowledge of releasable PHI in order to reduce any risk of Soldiers receiving any treatment without compromising personal privacy" said 1st Lt. Michelle Labrie, chief of patient administration at Kimbrough Ambulatory Care Center and organizer of the event. "All commanders have the right to a Soldier's health information when it could affect the mission or the Soldier's fitness for duty."

Kimbrough sponsored the 90-minute event at McGill Training Center. A previous town hall on the topic was held Jan 10.

Subject matter experts from Kimbrough and installation programs that provide clinical assessments of Soldiers gave a slide presentation to explain how they can work with commanders to ensure that Soldiers meet their mission goals while maintaining their privacy when receiving medical treatment. Health information is protected under the Health Insurance Portability & Accountability Act (1996) Privacy Rule military exception and Department of Defense regulations.

Col. Leon E. Moores, commander of the Fort Meade U.S. Army Medical Department Activity and commander of Kimbrough, welcomed the audience.

"When you've got something that you want to know about one of your folks and we know it, we have a strong responsibility to protect the information," Moores said. "What we're trying to do is make sure that you understand what our limits are, that we understand what your needs are, so that we can provide you what information you need within the limits of the law to allow you to do your job."

Georgine Pahlow, Kimbrough's HIPAA officer, said the purpose of the HIPAA Privacy Rule is to ensure that an individual's health information is properly protected, while also allowing the flow of health information needed to provide health care and balancing the important uses of information and patient privacy.

Overall, medical conditions that do not affect a Soldier's fitness for duty/mission or are not necessary to assure the proper execution of the military mission are not provided to a commander.

For example, a unit commander will not be notified if a Soldier is prescribed birth control medication or if the service member makes a self-referral for mental health treatment.

"Privacy and confidentiality are important," Pahlow said.

However, she said HIPAA does allow for the disclosure of PHI for certain purposes such as treatment, payments and organization.

The military exception to HIPAA states that a Soldier's PHI can be disclosed to a commander to determine the Soldier's fitness for duty and the Soldier's fitness to perform any particular mission. A Soldier's PHI can also be disclosed to report casualties in any military operation or to carry out any other applicable military regulations.

Dr. Mark Fisher, chief of psychological services in the Behavioral Health Department at Kimbrough, said that in compliance with the law, his staff will only notify a commander if the Soldier poses a threat to himself or others, or if there is a serious risk of harm to a specific military operational mission. If a commander has questions about a Soldier's ability to perform his duties, Fisher said a command-directed mental-status evaluation should be ordered. The disclosure of the PHI is limited to answering the commander's questions regarding the Soldier's ability to perform mission objectives, said Fisher.

Dr. Marcia Lang, clinical supervisor of the Army Substance Abuse Program at Fort Meade, said ASAP is a command-directed program. Soldiers referred to the program must have a Department of the Army-8003 form completed by their commander or first sergeant that gives the ASAP permission to conduct a clinical assessment.

After the assessment is completed, the Soldier meets with a counselor and the commander to discuss the results and whether enrollment in the program is necessary. Lang said that although the commander is involved in planning the Soldier's treatment, the disclosure of the PHI is limited only to alcohol- and substance-abuse related issues.

During the town hall, Shuron Baldwin, nurse case manager of Kimbrough's Medical Management Center, spoke about the center's work. Dr. Sacha Gutierrez, Medical Evaluation Board provider at Kimbrough, discussed the importance of E-profiles. TD Watlington, Kimbrough's Chief of the Physical Evaluation Board liaison officer, spoke about the Integrated Disability Evaluation System.

Among those who attended was Col. Brian P. Moore, chief of staff of U.S. Army Cyber Command.

"The most valuable lesson I took from the training is the need to communicate," he said. "The command team, the Solider, and doctor or health professional must talk. It is the only way we will guarantee our Soldiers are able to keep their commitment to the nation, themselves and sustain a ready, fit and trained force."