Urgent HIPPA News!

[Cutie]

Hi all,

My name is Kimberly Tate and i thought that i would pass on a interesting hipaa article that was forwarded to me.I am not a nurse but work in cancer cell research.I know that this is national nurse appreciation week and i thought that i would share this with you all.Given the challenges you all face everyday i've included a great hipaa resource which i hope will help all of you!

By Judith Graham

Tribune staff reporter

Published April 13, 2004

DENVER -- When a close friend was released from a hospital here recently, Barry Fey brought him to his high-rise apartment to recuperate. Within a week the friend was dead, after jumping off a balcony and plunging onto a rooftop 16 floors below.

That's when Fey learned something doctors hadn't told him: His friend had been admitted to the hospital after trying to take his own life. The hospital withheld the information because of federal medical privacy regulations enacted a year ago this week under the Health Insurance Portability and Accountability Act.

"They discharge a suicidal person into my care . . . and they don't tell me to monitor him?" Fey asks with incredulity. "They don't tell me he could be dangerous? I ask and I ask [what's wrong with him], but they don't tell me anything because of this crazy privacy thing?"

Although few cases are as extreme as this, the act known as HIPAA has spawned a host of unintended consequences over the last year as doctors, hospitals and public health officials have struggled to understand its complicated rules.

Misunderstandings are common, in some cases leading physicians to refrain from sharing vital information about patients and compromising care. And people are adjusting to new, sometimes inconvenient regimens, such as doctors who now insist patients come to their offices to receive test results, rather than providing them over the phone.

HIPAA is the first comprehensive federal law to create protections for Americans' medical records and to impose substantial civil and criminal sanctions when they are violated. Most consumers learn of the law at doctors' offices, when they are handed forms informing them of their privacy rights.

Experts consider HIPAA's safeguards necessary. They cite examples of past privacy violations the law is now preventing, from pharmacies that supplied patient information to drug companies for marketing purposes, to employers that went into sensitive medical information without workers' permission, to patient records that were posted on the Internet.

`Vast improvement'

"HIPAA is a vast improvement" over the patchwork of state laws that existed previously, said Janlori Goldman, director of the Health Privacy Project, a non-profit organization in Washington, D.C.

Most people strongly believe their medical records should be kept private, she and others say.

But implementing the law--which required training hundreds of thousands of medical workers--hasn't been easy, and large gaps persist between what HIPAA requires in principle and how medical providers interpret the law.

Physicians are being excessively cautious out of fear they'll be slapped with fines, said Dr. William Kobler, president of the Illinois State Medical Society.

Consider cases described by doctors, hospitals, clinics and other medical experts in more than two dozen interviews:

A Phoenix emergency room doctor received a call about a young man brought in after a car accident. A brother from New York wanted to know how the patient was doing. The doctor would only say the patient was stable. "This happened recently, and it happens all the time. Do I think it's reasonable? No," said Dr. Todd Taylor, a Phoenix physician and vice speaker of the American College of Emergency Physicians.

`Judgment call'

"It's a judgment call how much information you give out, and families do get very upset with us," said Judith Miller, chief privacy officer for Advocate Health Care, Chicago's largest hospital system.

A doctor treating a patient in his 80s, who recently went to a hospital emergency room with severe chest pain, could not get information about his patient. The doctor wanted to find out if the man had had a heart attack so she could determine what follow-up care was appropriate. But the hospital refused to give the information, citing HIPAA.

"We had to make the best decisions we could about what was right for the patient, based on incomplete information," said Dr. Bree Johnston, a geriatrician at a San Francisco Department of Veterans Affairs hospital.

A patient with heart problems was transferred to Carle Foundation Hospital's emergency room from another hospital. When a Carle physician who planned to do heart surgery called to learn what earlier lab results were, the other hospital's staff wouldn't tell him. "We were left to do whatever we could on our own," said Carol Znaniecki, government program compliance specialist for Carle, based in Urbana.

A recent survey by the Council of State and Territorial Epidemiologists indicated that more than one-third of public health officers were experiencing "major obstruction" in getting information about publicly reportable diseases because of HIPAA, according to a March 5 letter to federal officials from the National Committee on Vital and Health Statistics.

In fact, these cases don't reflect the letter or the intent of the law, said Rick Campanelli, director of the Office of Civil Rights for the Department of Health and Human Services.

HIPAA explicitly permits communication between doctors, nurses, hospitals and other medical personnel concerning medical treatment, even without signed authorization by a patient, he said. Also, doctors, nurses and hospital or clinic staff can disclose limited information about a patient to family and friends if they are convinced this is in the best interest of a patient, Campanelli said. And reporting medical information to public health agencies is specifically allowed.

Providers catching on

"Some providers are confused about the rule or deciding to take a more restrictive stand than the rule requires as a matter of [their] convenience," said Campanelli. "But we are seeing more and more that providers are getting [what this rule really requires]."

His office received 5,300 HIPAA-related complaints over the last year. There are no plans to rewrite the law; if anything, what's really needed is expanded outreach and education activities, with a special focus on public health reporting, according to the National Committee on Vital and Health Statistics' March 5 letter.

Still, the health-care industry continues to grapple with HIPAA.

In New York City, hospitals are trying to figure out how to raise funds for cancer or heart programs without aiming fundraising appeals at patients who have had these conditions, said Susan Stuard, director of regulatory affairs for the Greater New York Hospital Association. Under HIPAA, fundraisers can't get access to clinical information about hospital patients unless they have the patients' authorization.

In Rockford, the Crusader Clinic now asks patients to come in to get lab results rather than phoning them. "How do you know who you're really talking to when you make a call?" said Dr. Bechara Chouckir, the clinic's medical director, acknowledging this procedure is an inconvenience. "At least if they come in, we know who we're dealing with."

Advocate changes

At Advocate Health Care hospital system, adaptation to HIPAA's new requirements have included keeping patient sign-in sheets behind a counter where they can't easily be seen. When charts are put in a holder outside an examination room, they're now turned so the patient's name doesn't show. Computers require new sign-ons after three minutes if they aren't being used, so that if a doctor or nurse walks away to do something else, sensitive information can't be readily accessed, said Miller, the privacy officer.

In Denver, Exempla St. Joseph Hospital had a hard call to make when it released Charlie Blumberg into Barry Fey's care a month ago. Blumberg, 66, a retired bookie, did not tell Fey about his suicidal inclinations, nor did he authorize anyone else to do so, it appears.

Exempla St. Joseph won't comment on the case. "Because of HIPAA, we weren't allowed to share information with Barry Fey or to talk about this," said hospital spokeswoman Ashley Robinson. "If this patient had said I want this information shared with my family and friends, we would have been happy to do so."

Copyright © 2004, Chicago Tribune

I've heard that this hipaa resource is quickly being adopted by nurses and staffing organizations from around the country.They even pay nurses for referrals!!! http://www.yourhipaacert.com

[oramar]

I have been saying that all they need to do is add an addendum to the law that says this, "Any health care worker that gives info to patient, family or friend out of concern for patient, family or friend's mental or physical safety will not be considered to be in violation of the law. That would just about cover all situations. That way if I find a hysterical family in the hall looking for MOM I won't have to stop and worry about HIPPA.

[elkpark]

But, oramar, your addendum would basically invalidate the entire law; anytime we release information, the argument could be made that it was out of concern for someone's physical or mental safety, so ...

[LT Dave]

Very informative, thanks. I think this new rule a nonsence! HIPPA and the JACCO crowed should all be sent to the bottom of the sea.

[mitchsmom]

I'll go totally against the grain and say that I think perhaps HIPAA was most applicable in this suicidal guy's type of situation. His case sadly turned out bad, but many people in his situation would NOT want their reason for being hospitalized released. I think it's silly to imply the guy died because of HIPAA and I don't think telling the friend of his condition would have saved him anyway. That's not to say that I think HIPAA is perfect but I just think that wasn't the greatest example to use.

Thanks for the article though :)

[BittyBabyGrower, MSN, RN]

I'd certainly want to know if someone coming to live with me was suicidal.

[mitchsmom]

I'd certainly want to know if someone coming to live with me was suicidal.

I know what you're saying but I think it is the guy's responsibility to tell you or yours to ask. I would want my friend to tell me what his condition was so I'd be sure I could care for him properly (whether it be a heart condition, psych condition, or whatever).

[elkpark]

Ditto, mitchsmom. It is the responsibility of the friend taking him home and the patient to work this out (e.g., for the patient to sign a ROI for the friend to be informed) to the friends' comfort level, not the hospital's responsibility to tell anyone else behind the patient's back.

Would you consider taking someone into your home from hospital without knowing what the acute problems/dx and current status/care needs were? I sure wouldn't ...

Plus, as a career psych nurse, I must point out that, unless the hospital REALLY screwed up, the patient was evaluated and officially considered to be stable/safe and not an acute suicidal risk when he was discharged. No reputable psych unit would knowingly "discharge a suicidal person" into the care of a friend in the community. However, sometimes people act impulsively on a strong impulse to harm or kill themselves after discharge even though they appeared, by every standard and reasonable assessment technique, to be doing better and contracting for safety. Of course, there are also people who are v. determined, and just fake it in the hospital in order to be able to get out and kill themselves, and hospital staff can't always spot or prevent that. Part of the challenge of working psych ...

[Havin' A Party!, ASN, RN]

But... anytime we release information, the argument could be made that it was out of concern for someone's physical or mental safety...

Yup. Agree.

[Havin' A Party!, ASN, RN]

Ditto, mitchsmom. It is the responsibility of the friend taking him home and the patient to work this out...

Again. Agree.

[oramar]

But, oramar, your addendum would basically invalidate the entire law; anytime we release information, the argument could be made that it was out of concern for someone's physical or mental safety, so ...

The law is aimed at institutions and how they manage information not individual healthcare persons. Right now it is intimidating individual nurses and doctors and making them reluctant to do what is humane.

[elkpark]

The problem is that one person's "humane" is another person's "massive invasion of privacy." It's not that I don't sympathize with what you're saying, but ... :)