Hospital uses aliases to protect patient identity
Policy assures accuracy in master patient index
What’s in a name? Potential embarrassment for celebrities, employees, or anyone else whose treatment at a hospital is made public against their wishes.
Events at Miami’s Jackson Memorial Hospital last July offered a much-publicized example of a breach of patient confidentiality when it was discovered that hospital employees were peeking at the electronic medical records of Italian fashion designer Gianni Versace, admitted there after being fatally shot outside his Miami Beach villa.
Most hospitals admit celebrities of Versace’s renown only rarely, but it’s not uncommon to encounter local VIPs or hospital employees who wish to conceal their identities during a stay in the hospital. A simple, workable alias policy, therefore, should be part of any health information management policy book.
Identities protected
Health information managers at the University of Texas Medical Branch (UTMB) at Galveston have instituted a confidentiality policy that protects the identities of patients who want their hospital stay kept under wraps while ensuring quality patient care. At UTMB the confidentiality policy allows patients to use fictitious names which camouflage their real identity throughout their hospital stays.
The policy makes use of the hospital’s electronic master patient index, which allows staff to set up a fictitious name for a patient, then later go back and substitute the patient’s primary name after discharge. So, when a prominent person, an employee, or a patient who wishes to have his or her identity kept secret checks in, the hospital assigns a fictitious name to the patient. (See the hospital’s policy, below.)
"In circumstances requiring the confidentiality of a patient’s identity [for security or public relations purposes], a patient may register under a fictitious name. In this case, the real identity is temporarily replaced with a fictitious name," the UTMB name change policy states.
The policy, which has been in effect for several years, "was triggered by having several patients that for various reasons needed to have their identities protected," says Diana Barr, RRA, associate director of the health information department. These have included local VIPs, someone in a government witness protection program, employees, and a gang member. "Any patient who feels the need to be seen under a fictitious name," she says, can make use of the hospital’s policy.
When a patient is admitted and asks for his or her identity to be concealed, the medical center’s master patient index is searched to see if that patient has previously been admitted either as an inpatient or an outpatient. If the patient has never been admitted before, a new medical record number is assigned to the patient and the chosen fictitious name is affixed to the record at that time.
If the patient already has a medical record number, the real primary name in the master patient index is changed to an alias, and the fictitious name is added to the master patient index as a primary name during the hospital stay.
Note that a distinction is made between an alias such as a maiden name or a nickname and a fictitious name, which bears no relation to the real name. So Jane Johnson’s medical record may list Jane Carson her maiden name as an alias name, which remains part of her medical record. A fictitious name, however, would only be affixed if requested to hide her identity and only during the hospital stay. When the patient is discharged, the master patient index is adjusted to show the real identity, and the fictitious name is then listed as an alias in the master patient record, Barr explains.
Under the UTMB policy, only hospital staff who have a need to view a record bearing a fictitious name should do so. So, for example, "if under normal circumstances someone in billing would have access to that [confidential] record, they would continue to have access if the role calls for it," Barr explains.
Inappropriate access not tolerated
If employees used that access inappropriately, "then that would be dealt with because of their using their authority to access this information for reasons not related to the job," Barr continues. A system of computerized audit trails shows who accesses medical records, so inappropriate access would raise a red flag.
At UTMB, a celebrity record is not flagged with any special marking, says Jim Braden, MBA, director of health information management. "It’s just treated as a standard record for good reason. We don’t want to attract attention to it," he says.
For that reason, in choosing fictitious names to use, names such as John Doe or Jane Smith are avoided, Braden says. "That would draw attention to it. They come up with whatever name they want to use; something that wouldn’t draw attention."
The UTMB alias policy requires additional time to update the medical record after discharge, Barr says. "Having to go back in and make the change at the time of discharge, creating an alias with the fictitious name the medical records need to be adjusted to show the real identity," contribute to extra hours spent enforcing the policy, she says.
Policy result of cooperation
A team of health information, risk management, admitting, outpatient, and information systems department staff at the medical center consulted with other HIM departments and legal counsel to develop the policy, Barr says. That in turn was submitted for review by the hospital policy and procedure committee, which counts members from various departments including legal, hospital admitting, and physicians.
"We view this as part and parcel of an overall strategy of ensuring the accuracy and integrity of our master patient index, and we view the master patient index as an extremely important strategic tactic," adds Carl Hula, associate director of the UTMB health information management department.
James H. Braden, MBA, Director, Health Information Management, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX 77555-0782. Telephone: (409) 772-1918.
Diana Barr, RRA, Associate Director, Health Information Management, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX 77555-0782. Telephone: (409) 772-9573.
Carl Hula, Associate Director, Health Information Management, The University of Texas Medical Branch at Galveston, 301 University Blvd., Galveston, TX 77555-0782. Telephone: (409) 747-0699.
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