HIPAA in "semi private" areas

[psu_213, BSN, RN]

We have an area of our ED where the treatment "rooms" are only separated by a curtain. If this was a violation of HIPAA, I'm sure the DOH (or some other regulatory agency would step in). The issue is people in the next room and at the nurses station can hear the discussion in the room (which would include, pt name, birthday, and the pt's full discussion with the doctor(s) and nurse(s) about their problem). In this area I had a patient who was somewhat notorious in our community and someone else who was an inlaw with a famous (deceased) person. In both cases they didn't have much privacy, nor does any other patient in this area. My question at the end of all this--if a patient requests a more private area/refuses to disclose information about their CC, do they have the right to be moved to a more private area (especially if they start spouting HIPAA violation)?

While I was thinking about that, I was also thinking about "semi private" rooms. In my schooling I was never taught that "semi" is a synonym for "not at all." In those cases, doctors and nurses interview one pt in the room when the other person can clearly hear. I know that, generally, insurance will not pay for a private room unless the private room is medically necessary. What if someone wants a private room because they are genuinely concerned that their privacy is at stake in a double room?

Not trying to create trouble here, just curious as to how this works out.

[Noimanurse]

There is the idea of "reasonable" that comes in to play. Many ER's have curtains separating certain rooms, especially with trauma rooms. Its just the way it is. As for semi-private rooms, again, there is a curtain, sometimes that is just the way it is and its all that is available. Again, my opinion, but if the patient is "so high and mighty" in society, maybe they could take the time to schedule a doctor's appt. I'm all for privacy, but I'll run naked through the grade school if it meant saving my leg or my child's life.

My thinking is that if its a big enough emergency to be in the emergency room, then you should be simply thinking of stabilizing/helping the patient's health and thats what the patient should be concerned with, as well. If its all you have to work with, then you do you best. For instance, if there were a wreck on the highway, would you keep from removing the clothes of a person to save a life or limb just to maintain privacy? NO, you do the best you can with what you have.

Recently we had one of our own children in a major ER, he was on a ventilator, the room was divided by a curtain, on the other side was some one complaining of an upset stomach. We didn't once think of HIPPA, we were just glad he got the care he needed, eventually woke up, and started breathing on his own. Most people that throw "hippa" in your face don't have a clue what it really means.

[psc205]

Not a lawyer, so don't take this as gospel...

It could probably be argued that any info in the ED or semi-private rooms would fall under HIPAA's incidental use & disclosure provision. A pt in their room should have been made aware of their pt rights when admitted. If they choose to answer questions without asking for additional privacy measures it would seem they are consenting to their info being shared in that setting, at that time. In both of your examples I would think that as long as the provider was taking reasonable steps to provide what privacy they could and they keep the discussions to information pertinent to that pt's care they should be fine.

[wooh, BSN, RN]

^Incidental for the win.

If two people are in the hallway standing next to each other, you cannot tell one of them "Your diagnosis is hangnail." If they are in a room separated by a curtain, you can tell that person anything.

It's the law, it doesn't have to make sense. :)

[psu_213, BSN, RN]

If two people are in the hallway standing next to each other, you cannot tell one of them "Your diagnosis is hangnail."

Speaking of that, we have times when it is busy when pt's are evaluated, treated, some (sometimes) discharge from the hallways. Personally, I would have trouble being treated for certain conditions while in the hallway, but it does not seem to matter when personal information we say tell someone about their care while other people in the hallway might be listening.

[nerdtonurse?, BSN, RN]

The key with HIPAA is "deliberate." I've never heard of anyone getting into trouble in an ER with curtains, or semi private room, as long as efforts are made at providing reasonable privacy -- you don't yell, "Mr. Smith, you have AIDS!" when your patient is in a semi-private area.

What trips the HIPAA trigger most of the time is when you a) deliberately access records you have no need to see, such as those of a celeb, b) you deliberately store or dispose of HIPAA information in a non-protected way -- you don't use a shredder or a document company, you just toss PHI into regular trash, you sell old PCs without deleting the contents, you broadcast PHI via WiFi and don't secure the transmission and it can be picked up on laptops by a hacker. FYI, if you use a company like Iron Mountain, you're protected. If you use uncle Joe's truck to take the PHI to an incinerator, and the truck's in a wreck and PHI goes everywhere, you're libel because you deliberately chose not to use a secure shredder company, c) you deliberately discuss a patient in a non-patient care setting (elevator, cafeteria, Wal-Mart) in such a way that the patient can be identified.

I've yet to see anyone get into serious trouble for accidental or incidental disclosures. Most of the time, you have to do something pretty stupid to get into trouble.

[kool-aide, RN]

This question regarding semi-private rooms was asked to a hospital administrator at my facility and the answer was that it would not be a HIPAA violation because it's understood that you may be overheard in a semiprivate room with another pt present. Take reasonable precautions to be as discrete as possible (pulling curtain, using low voices, etc) and you should be fine.

[Esme12, ASN, BSN, RN]

This question regarding semi-private rooms was asked to a hospital administrator at my facility and the answer was that it would not be a HIPAA violation because it's understood that you may be overheard in a semiprivate room with another pt present. Take reasonable precautions to be as discrete as possible (pulling curtain, using low voices, etc) and you should be fine.

Like someone else said it would fall under incidental uses and disclosures

"Incidental Use and Disclosure -- The final Rule acknowledges that uses or disclosures that are incidental to an otherwise permitted use or disclosure may occur. Such incidental uses or disclosures are not considered a violation of the Rule provided that the covered entity has met the reasonable safeguards and minimum necessary requirements. For example, if these requirements are met, doctors' offices may use waiting room sign-in sheets, hospitals may keep patient charts at bedside, doctors can talk to patients in semi-private rooms, and doctors can confer at nurse's stations without fear of violating the rule if overheard by a passerby."

(http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalu&d.pdf)

[sharkdiver]

OK, just to put a slight twist on this....suppose the patient clearly states that they want privacy for any discussions with their provider(s) regarding their care and are not comfortable discussing at bedside or other semi-private area where information may be overheard by others.

[Rob72, ASN, RN]

OK, just to put a slight twist on this....suppose the patient clearly states that they want privacy for any discussions with their provider(s) regarding their care and are not comfortable discussing at bedside or other semi-private area where information may be overheard by others.

Then "reasonable accomodation" must be made. Again, don't be confused by HIPAA, folks, it has nothing to do with patient privacy, and everything to do with limiting the liability of the institutions. If privacy were the real issue, semi-private rooms would not be legal. Look at the ADA rulings- even a facility built specifically for a support group of 1 legged Marfan's sufferers on crutches would have to have WC access, and 3' wide bathroom doors.