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D-ATM Questions and Answers for Patients

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What is D-ATM?
Why is D-ATM necessary?
Is D-ATM being implemented nationally?
Where does D-ATM get patient dosage and take-home information?
As a patient, will my name be stored in the D-ATM database?
Does this mean that my finger scan is being stored in D-ATM?
How long will my dosage and take-home information be stored in D-ATM?
If I need to be medicated in an emergency, how does the guest clinic obtain my dosage information from D-ATM?
Will my home clinic know if I am medicated at a guest clinic?
What else might I encounter at a guest clinic?
Can D-ATM be used only in the case of a major disaster or emergency?
I understand that I will have to sign the D-ATM Consent and Release Form if I want to participate in the D-ATM pilot project. Exactly what am I agreeing to?
If I refuse to sign the D-ATM Consent and Release Form to participate in the D-ATM project, will this affect my treatment at my home clinic?
How do I know that the information stored in D-ATM will not be shared with the police or some other government agency?
Suppose a computer hacker was able to get into the D-ATM system. What would happen?
If I participate in this pilot project, does this mean that I can get medicated at any clinic I want?

1. What is D-ATM?

D-ATM stands for Digital Access to Medication, an information system being developed for the Center for Substance Abuse Treatment. In the event of a service disruption, whether due to an emergency or other more routine occurrence, D-ATM will allow patients who are unable to reach their home OTP (methadone clinic) to be medicated more easily at another OTP.

2. Why is D-ATM necessary?

Any patient's medication is important, and for a patient in treatment for opioid dependence, receiving a safe, accurate dose in a timely manner is critical. Methadone patients have individualized doses and take-home schedules and normally must be enrolled in a particular clinic. When a patient cannot reach his/her home clinic, he/she must seek medication in a guest clinic. The guest clinic needs to know:

Is this individual really a patient?
What is the patient's current physician-prescribed dose of methadone?
When was the patient last medicated at his/her home clinic?
Was the patient given take-home medication at his/her last visit, and how many doses were given?

D-ATM will gather and store this information from the patient's home clinic and will make it available to the guest clinic. This will allow the patient to receive the proper dose of medication more efficiently and safely.

3. Is D-ATM being implemented nationally?

Not at this time. This is a pilot project being implemented in a limited number of programs across the United States, potentially including programs in the New York city metropolitan area including parts of New Jersey and Connecticut, Louisiana, California, North Carolina, and the Baltimore-Washington area. If funding becomes available, it is hoped that this pilot will provide the foundation for a nationwide expansion. Patients in pilot treatment programs will participate in D-ATM only if they choose.

4. Where does D-ATM get patient dosage and take-home information?

Every opioid treatment program has a clinical management system. In most programs, these systems are computerized. The clinical management system contains many data elements including the patient's dosage and take-home information. Clinics participating in the pilot project will program their computerized clinical management system to "talk" to the D-ATM central database and provide very limited data elements for storage in D-ATM.

5. As a patient, will my name be stored in the D-ATM database?

No. Patient names will not be stored in D-ATM. If a patient chooses to participate in this pilot project, he/she will sign the D-ATM Consent and Release Form and will have one or more fingers digitally scanned. These scans will be used to generate an identification number. The dosage and take-home information stored in the system will be linked to this identification number, not to the patient's name.

6. Does this mean that my finger scan is being stored in D-ATM?

No. Finger scans will not be stored in D-ATM. One or more fingers will be digitally scanned to generate a unique patient-specific identification number. This number—not a picture of the finger scan or the patient's name—will be stored in the database. Also, this information will be retrieved only in the event that the patient must seek treatment other than at their home clinic.

7. How long will my dosage and take-home information be stored in D-ATM?

If you participate in D-ATM, your dosage and take-home information will be stored only for 90 days. For example, information placed in the system on March 15th will be erased on approximately June 15th. If you continue to participate in the project, new data will continuously replace the old data, but at any point in time, no more than 90 days of dosage and take-home history will be stored. If a patient leaves treatment, all dosage and take-home information will be erased approximately 90 days later. Also, if a patient withdraws permission for his/her data to be stored in D-ATM, the data will be erased in 90 days.

8. If I need to be medicated in an emergency, how does the guest clinic obtain my dosage information from D-ATM?

In the event of an emergency in which you are unable to get to your home clinic, you would visit any available opioid treatment program. You would inform the guest clinic that you are a methadone patient, you would provide the name and location of your home clinic, and you would say why you are unable to go there for medication. Once you have done this, there are three ways that the guest clinic can obtain information from D-ATM:

If the guest clinic is participating in the D-ATM pilot project, the patient can have his/her finger scanned, and the guest clinic can obtain the necessary information through a secure D-ATM Web site.
If the guest clinic is unable to scan the patient's finger, the patient's secret personal identification number (PIN) can be entered along with the name of the patient's home clinic. The secure D-ATM Web site would then provide the guest clinic with the necessary information.
If the guest clinic cannot access the Internet, or if the system is unavailable, the guest clinic can still retrieve the dosage and take-home information by telephoning Central Support via a toll-free number and providing the patient's D-ATM ID or PIN and home clinic. The clinic will then be provided with the most recent dosage and take-home information for the patient.

In all of these examples, the patient must authorize the guest clinic to access his/her dosage and take-home information. None of this information is available to the guest clinic without the patient's permission.

9. Will my home clinic know if I am medicated at a guest clinic?

Yes. After a clinic medicates the patient, any other clinic that has a current medicine order for the patient will be notified. The notified clinic can then check its "Queue of Patient Visit Events Occurring at Other Clinics" through the secure D-ATM Web site. This queue shows dosing events and retrieval of patient dosing information performed by any clinic other than the patient's home clinic.

10. What else might I encounter at a guest clinic?

In addition to the D-ATM Consent and Release Form, guest clinics might require you to sign some form or authorization to treat, or an authorization to bill any available insurance. Also, guest clinics might require you to pay for being medicated. These practices will vary widely from State to State and from clinic to clinic. The D-ATM project has no authority over these internal clinic practices. The final decision of whether or not to treat a patient is always made by the individual clinic. D-ATM is simply a tool to allow the guest clinic to provide an appropriate medication dose.

11. Can D-ATM be used only in the case of a major disaster or emergency?

The terrorist attacks of September 11, 2001, provided the impetus to develop the D-ATM system. However, D-ATM's usefulness is not limited to such emergencies. Snowstorms, floods, tornados, hurricanes, earthquakes, power failures, and transit strikes can all severely impact a patient's ability to reach his/her home clinic and the clinic's ability to stay in operation. Even when there are no such large-scale events, there can be individual emergencies. For example, a business trip or vacation can be unexpectedly disrupted by travel problems. D-ATM could help a patient obtain necessary medication in any of these situations.

12. I understand that I will have to sign the D-ATM Consent and Release Form if I want to participate in the D-ATM pilot project. Exactly what am I agreeing to?

When you sign the D-ATM Consent and Release Form, you are agreeing to:

Allow your home clinic to store your dosage and take-home information in D-ATM
Allow D-ATM to release this information to a guest clinic when you, as the patient, authorize such a release
Allow the guest clinic to inform your home clinic and any other clinic with a current medicine order for you about the services and medication you received at the guest clinic

13. If I refuse to sign the D-ATM Consent and Release Form to participate in the
D-ATM project, will this affect my treatment at my home clinic?

No. This will have no effect on the treatment you receive from your home clinic. However, in the event of an emergency, you may find it easier to obtain medication at a guest clinic that is using D-ATM.

14. How do I know that the information stored in D-ATM will not be shared with the police or some other government agency?

The information stored in D-ATM can only be used in compliance with the D-ATM Consent and Release Form that you signed. The police or other government agencies will not be allowed access. Various Federal laws make it a crime to release patient information not specifically authorized. This means that treatment programs can only access a patient's records when properly authorized during an emergency or other situation resulting in service discontinuity, and only then, if the patient authorizes it. The methadone treatment field has an excellent record of maintaining patient confidentiality, and D-ATM will not compromise this record.

15. Suppose a computer hacker were able to get into the D-ATM system. What would happen?

It is very unlikely that this will happen. D-ATM will use state-of-the-art encryption and firewall technologies to make hacking extremely difficult. However, even if all these forms of security were breached, the database contains no patient names or other identifying information. The hacker would only see information about dosage and take-home schedules linked to identification numbers, but he/she would have no way of figuring out who the patients are.

16. If I participate in this pilot project, does this mean that I can get medicated at any clinic I want?

No. You are expected to continue to comply with all the rules of treatment for your home clinic. You should make an unplanned medication visit to another clinic only in special situations, such as:

A true emergency in which your home clinic can no longer operate
Your home clinic is temporarily out of service due to a temporary emergency, such as a power failure or severe weather
You cannot reach your home clinic because of a temporary emergency, such as a transportation strike or unplanned change in travel schedule