[ Monday, March 14, 2005 ]


Unintended Consequences: I grew up in a suburb of Houston, LaPorte, that was pretty much a small town; it had been there about as long as Houston had, so it had a fair amount of independence. And while some people commuted to work in Houston, they were the exception; most worked locally in the refineries or over at NASA, which is pretty far out of Houston proper. The mother of one of my friends growing up used to say, "I'm going into town; do you need anything?" when she was going not to Houston, but to the downtown area of LaPorte.

I now live in an area within the city of Dallas that also has a small-town feel: Lake Highlands. It's not nearly the close-knit community LaPorte was, but similar.

And LaPorte was nothing like small towns in the midwest, like Clearwater, Nebraska. In LaPorte, you were pretty sure that someone else in town knew your business. If you had an accident, got sick, or wound up in the hospital, a lot of folks in town would know it pretty soon after it happened. But in places like midwestern farming towns, admits and discharges from the local hospital were something that were put in the newspaper or broadcast over the local radio station. Of course, as this story points out, HIPAA has changed that. And of course, some townsfolk aren't too happy about it.

(As an aside, there's a local radio station in Madisonville, Texas (county seat of Madison County) that goes by the call letters KMVL. Many years ago, a hospital client of mine bought the county hospital, and when we closed the deal, we had to go before the county commissioners and get their final vote of approval and signatures on the documents. As usually was the case in Madisonville, KMVL carried the commissioners' court hearing live, and then rebroadcast it during the news later. It was a bit disconcerting speaking to the commissioners, explaining the deal to them, with a radio microphone in front of me, and is probably the only time I've ever been on the radio. It was really weird hearing myself on the radio later, when I caught the rebroadcast. But KMVL was the local station (its studios were on the courthouse square), and they took it as their mission to be the voice of the community -- as well as its bulletin board. They are still the place to go if you want high school sports news on the Madisonville Mustangs or the North Zulch Bulldogs.)

This is the balancing act between medical record privacy and the way people usually live their lives. Most people aren't all that concerned that a particular piece of PHI about them gets out; how many people would try to hide a broken arm that's in a cast? How many people would get truly upset if you said to them, "I hear you had the flu; feeling better?" Conversely, how many people would actually be glad that someone took interest in their health and how they were feeling? In the perfect HIPAA world, nobody would ever say, "I hope you're feeling better," because they'd never know you were sick in the first place.

Jeff [10:31 AM]

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