[ Monday, November 08, 2004 ]


Paperwork reduction: The American Hospital Association has sent a letter to Tommy Thompson requesting that HHS take action and implement standards to streamline the cumbersome process of providing an accounting of disclosures. As you know, patients have a right to know what their medical information is and how it has been used and disclosed. Patients should expect providers and others to use their medical information for treatment, payment, and healthcare operations, and should know that their information may be disclosed in manners that the patient has specifically authorized. But if their information is disclosed for other purposes, HIPAA requires that covered entities account for those disclosures. The trouble is that accounting for these disclosures can be awfully troublesome.

Fortunately, there are few requests for accountings of disclosures, and it is a very small fraction of total disclosures that are even subject to the accounting requirement. However, when a patient asks for an accounting, it can tie up a medical records department. Personally, I think HHS did a pretty good job balancing this. The accounting rule starts like the general HIPAA rule: a universal proclamation, followed by allowed exceptions. The general HIPAA rule is "Thou shall not disclose PHI," followed by exceptions: with permission; for treatment, payment and healthcare operations; as requried by law. The universal proclamation of the accounting rule is "Thou shall tell patients when and where you've disclosed their PHI," followed by exceptions: when disclosed for treatment, payment, and operations; when disclosed pursuant to an accounting; and certain other instances where informing the patient of the disclosure might cause more harm than good.

I understand the AHA's position, though. It sure wouldn't hurt if HHS provided some guidance, such as a baseline or minimal acceptable accounting program (sort of like HHS did with the model BAA).

Jeff [9:01 AM]

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