[ Wednesday, August 27, 2003 ]


Deaing with patient requests for restrictions.

Also presenting at the speech I did yesterday were Mary Ann Swann and Jeff Pounds of Baylor College of Medicine in Houston. Among the many helpful tips they could provide were some ways to deal with medical records when you're trying to comply with HIPAA. For example, as you know, you are required to account for any disclosures of PHI other than for treatment, payment, operations, or pursuant to patient authorization. How do you do that? Do you keep a single log of all disclosures that aren't TPO or authorized? Do you note in the patient's file when an accountable disclosure is made? One way to approach this is to "sticker" the particular patient's file whenever such a disclosure is made. Print up colorful stickers that can be put on the file if an accountable disclosure is made; make sure the sticker has blanks for all of the information that you need to track for an accounting (date of disclosure, recipient, purpose, etc.).

Another thing that Mary Ann and Jeff recommended was a sticker system for patients who request restrictions on the use of their information. First, keep in mind that you do not have to comply with a patient's request for restrictions on the use of his or her PHI. However, if you do agree to a restriction, you are bound by it. How do you know if you are doing what you promised? One way is to make sure that you put a colorful sticker on the file of any patient to whom you have promised to restrict disclosures. The sticker should have a space on it where you can list what the specific restriction is. This way, once a file is pulled and a disclosure is about to be made, you can easily see if there's a restriction that would prevent the disclosure.

Of course, you don't have to agree to any restrictions on disclosures. This may seem like an attractive option: if a patient wants a restriction, tell them no, and if they don't like it, they can go somewhere else. Be careful before you decide to go this route. First, it's bad patient care. Secondly, angry patients are much more likely to file a lawsuit or file a complaint with HHS for a HIPAA violation (unless they are a new patient, even if they go elsewhere, you will probably keep a copy of their records, so will be required to maintain them in a HIPAA-compliant fashion). If the patient stays, they will be generally unhappy; if they leave, they may still have it out for you and may file a complaint for the slightest reason. So, you can deny all requests for restrictions, but be careful how you do it.

UPDATE: Mary Ann forwarded me the format for the stickers to put on the files,along with instructions for what kind of stock to use (Avery Standard Label stock, #8253, which prints 10 labels per page). If you want it, e-mail me at jdrummond-at-jw.com and I'll e-mail you a copy.

Jeff [11:02 AM]

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