While
we are working with clients on HIPAA compliance and risk assessment issues, including the OCR pilot request list for potential audits, we
see that some very common HIPAA questions arise for health care providers. There is a great deal of misunderstanding out there.
One of the reasons that staff often do not know the rules is that many small to medium-sized health care providers do not have HIPAA compliance manuals that make the rules clear. If the staff is not trained well, this can lead to patients not understanding the rules and making meritless complaints. Since most audits for HIPAA are initiated after patient complaints or disclosures by the providers, having a well-trained staff with a resource helps prevent meritless complaints.
Here are frequently misunderstood basic issues that get raised by staff. The HHS HIPAA website has lists of FAQ in different categories to assist providers. Here are ones relating to patient communications.
1. Question: Can
health care providers engage in confidential conversations with other providers
or with patients, even if there is a possibility that they could be overheard?
1. Answer: Yes.
The HIPAA Privacy Rule is not intended to prohibit providers from talking to
each other and to their patients. Provisions of this Rule requiring covered
entities to implement reasonable safeguards that reflect their particular
circumstances and exempting treatment disclosures from certain requirements are
intended to ensure that providers’ primary consideration is the appropriate
treatment of their patients.
The
Privacy Rule recognizes that oral communications often must occur freely and
quickly in treatment settings. Thus, covered entities are free to engage in
communications as required for quick, effective, and high quality health care.
The Privacy Rule also recognizes that overheard communications in these
settings may be unavoidable and allows for these incidental disclosures.
For example, the following practices are permissible under the Privacy Rule, if reasonable precautions are taken to minimize the chance of incidental disclosures to others who may be nearby:
a. Health care
staff may orally coordinate services at hospital nursing stations.
b. Nurses or
other health care professionals may discuss a patient’s condition over the
phone with the patient, a provider, or a family member.
( c. A health care
professional may discuss lab test results with a patient or other provider in a
joint treatment area.
d. A physician
may discuss a patients’ condition or treatment regimen in the patient’s
semi-private room.
e. Health care
professionals may discuss a patient’s condition during training rounds in an
academic or training institution.
f. A pharmacist may
discuss a prescription with a patient over the pharmacy counter, or with a
physician or the patient over the phone.
In
these circumstances, reasonable precautions could include using lowered voices
or talking apart from others when sharing protected health information.
However, in an emergency situation, in a loud emergency room, or where a
patient is hearing impaired, such precautions may not be practicable. Covered
entities are free to engage in communications as required for quick, effective,
and high quality health care.
2. Question: May
physician's offices or pharmacists leave messages for patients at their homes,
either on an answering machine or with a family member, to remind them of
appointments or to inform them that a prescription is ready? May providers continue
to mail appointment or prescription refill reminders to patients' homes?
2. Answer: Yes.
The HIPAA Privacy Rule permits health care providers to communicate with
patients regarding their health care. This includes communicating with patients
at their homes, whether through the mail or by phone or in some other manner.
In addition, the Rule does not prohibit covered entities from leaving messages
for patients on their answering machines.
However,
to reasonably safeguard the individual’s privacy, covered entities should take
care to limit the amount of information disclosed on the answering machine. For
example, a covered entity might want to consider leaving only its name and
number and other information necessary to confirm an appointment, or ask the
individual to call back.
A covered entity also may leave a message with a family member or other person who answers the phone when the patient is not home. The Privacy Rule permits covered entities to disclose limited information to family members, friends, or other persons regarding an individual’s care, even when the individual is not present. However, covered entities should use professional judgment to assure that such disclosures are in the best interest of the individual and limit the information disclosed. See 45 CFR 164.510(b)(3).
In situations where a patient has requested that the covered entity communicate with him in a confidential manner, such as by alternative means or at an alternative location, the covered entity must accommodate that request, if reasonable.
A covered entity also may leave a message with a family member or other person who answers the phone when the patient is not home. The Privacy Rule permits covered entities to disclose limited information to family members, friends, or other persons regarding an individual’s care, even when the individual is not present. However, covered entities should use professional judgment to assure that such disclosures are in the best interest of the individual and limit the information disclosed. See 45 CFR 164.510(b)(3).
In situations where a patient has requested that the covered entity communicate with him in a confidential manner, such as by alternative means or at an alternative location, the covered entity must accommodate that request, if reasonable.
For
example, the Department considers a request to receive mailings from the
covered entity in a closed envelope rather than by postcard to be a reasonable
request that should be accommodated. Similarly, a request to receive mail from
the covered entity at a post office box rather than at home, or to receive
calls at the office rather than at home are also considered to be reasonable
requests, absent extenuating circumstances. See 45
CFR 164.522(b).
3. Question:
May physician's offices use patient sign-in sheets or call out the names of
their patients in their waiting rooms?
3. Answer:
Yes. Covered entities, such as physician’s offices, may use patient sign-in
sheets or call out patient names in waiting rooms, so long as the information
disclosed is appropriately limited.
The
HIPAA Privacy Rule explicitly permits the incidental disclosures that may
result from this practice, for example, when other patients in a waiting room
hear the identity of the person whose name is called, or see other patient
names on a sign-in sheet. However, these incidental disclosures are permitted
only when the covered entity has implemented reasonable safeguards and the
minimum necessary standard, where appropriate. For example, the sign-in sheet
may not display medical information that is not necessary for the purpose of
signing in (e.g., the medical problem for which the patient is seeing the
physician). See 45
CFR 164.502(a)(1)(iii).
4. Question:
A clinic customarily places patient charts in the plastic box outside an exam
room. It does not want the record left unattended with the patient, and
physicians want the record close by for fast review right before they walk into
the exam room. Will the HIPAA Privacy Rule allow the clinic to continue this
practice?
4. Answer: Yes,
the Privacy Rule permits this practice as long as the clinic takes reasonable
and appropriate measures to protect the patient’s privacy.
The physician or
other health care professionals use the patient charts for treatment purposes.
Incidental disclosures to others that might occur as a result of the charts
being left in the box are permitted, if the minimum necessary and reasonable
safeguards requirements are met. As the purpose of leaving the chart in
the box is to provide the physician with access to the medical information relevant
to the examination, the minimum necessary requirement would be satisfied.
Examples of measures that could be reasonable and appropriate to safeguard the patient chart in such a situation would be limiting access to certain areas, ensuring that the area is supervised, escorting non-employees in the area, or placing the patient chart in the box with the front cover facing the wall rather than having protected health information about the patient visible to anyone who walks by. Each covered entity must evaluate what measures are reasonable and appropriate in its environment. Covered entities may tailor measures to their particular circumstances. See 45 CFR 164.530(c).
Attorney Commentary - Get Ready for Audits: Understanding the rules and training staff is just one part of HIPAA compliance. Auditors will want to see that your practice has a compliance program and relies on industry standards and guidance. It is also important in places like California to be disaster ready and show that there is contingency planning.
If there is an audit for HIPAA, it is like any other audit in that there are findings. It is time to get prepared and risk assessment is one of the most important parts of this. We have worked with numerous providers and outsource the technical and electronic data issues where needed and refer our clients to cost-effective providers while we handle the agreements, manuals, document review, and related legal issues.
Posted by Tracy Green, Esq.
Office: 213-233-2261
