Privacy rule may be customer-service issue
As access managers breathe a sigh of relief at the lifting of the written-consent requirement in the final Health Insurance Portability and Accountability Act (HIPAA) privacy rule, many are beginning to focus on the changes they will need to make in response to the law.
After serving for two years on a systemwide HIPAA steering committee and sitting on a couple of related subcommittees, it’s a relief finally to have solid information to work with, says Barbara Wegner, CHAM, regional director of access services for the Providence Health System in Portland, OR.
What has remained in the final rule is a requirement that hospitals, pharmacies, health plans, and other covered entities must obtain an individual’s specific authorization before sending the person marketing materials. Notices informing patients of wellness programs at the hospital would be included, as would putting patients’ names on a mailing list used by hospital foundations to ask for donations, she adds. "We have a group working on how to get a specific authorization."
There are several other privacy issues hospitals will need to address, Wegner says, including a couple that directly affect access personnel:
• The release of information to a patient’s faith community.
Providence already has a procedure for handling requests from members of the clergy who wish to visit patients, she explains. "Patients are asked specifically either at preadmission or at the time of service if they have a religious preference. We collect that information, and then ask if the person would like a visit from a [member of the clergy] of that faith."
If the person answers affirmatively, his or her name prints out on a list, Wegner adds. If the patient says no, the name won’t be there. That’s already in place, so we won’t need to tweak that."
• Inclusion of a patient’s name in the hospital directory.
The handling of this privacy issue likely is to cause some problems, she predicts.
At present, the names of all patients are included in the hospital directory, Wegner notes, although in the case of mentally ill patients, no information is released at all.
Once the privacy rule goes into effect, she says, patients will be asked as they come into the hospital if it’s OK to include their name in the directory. If not, the name will not appear on the list.
"The tricky part is that patients themselves will call and talk to friends, relatives, or neighbors on the phone, and then maybe not remember that they had said they didn’t want to be in the directory," Wegner says. "The person could call the patient back and be told there is no one by that name in the directory."
The result could be an awkward conversation in which the caller points out that he or she just talked to the patient an hour ago, she adds. Similarly, she continues, an individual visiting one patient on a floor might recall that a neighbor also is in the hospital and ask the nurse for that person’s room number.
"This might put the hospital between a rock and a hard place," Wegner suggests, "with the perception that the hospital is not being helpful."
The hospital also would need permission to give out the name of an outpatient who is in for a short procedure, or a person being treated in the emergency department, she points out. That could be a problem if, for example, someone calls to arrange to pick up the patient, and is told the person’s name isn’t on the hospital list, she adds.
The access services department is putting together a committee to look at how the requirement will be implemented, Wegner says. In addition, there will be an enhancement to the health care system’s computer system, which is a McKesson product. "We haven’t seen how that will work. We’re waiting to see how that will help us from the technology point of view."
Beginning in January, she says, all access personnel will be trained on the use and disclosure of the facility directory.
The process of informing patients about the use and disclosure of their medical information will begin during the preadmission telephone call, Wegner notes. Also at that time, patients will be asked if they wish to have their names released to the clergy or included in the facility directory, she says.
For emergency and other unscheduled patients, Wegner adds, "we’ll just have to do the best we can. If we can’t do it when patients are admitted, we’ll follow up when their condition permits."
[Editor’s note: Barbara Wegner can be reached at (503) 215-7525 or by e-mail at [email protected].]
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