[ Friday, July 08, 2011 ]


Guest Blogger: As regular readers will be aware, I occasionally allow guest bloggers to post on HIPAABlog. Today, Pat Walling of Medical Coding Career Guide has a guest commentary on physical safeguards, and what might be necessary. Certainly reasonable precautions must be taken; however, in some instances, it may be necessary for patients to let providers know of problems, and for providers to seek solutions.

Pat's post follows:

Is Soundproofing Hospital/Clinical Rooms Required for HIPPA Compliance?

One of the requirements of the Health Insurance Portability and Accountability Act (HIPAA) is that there are “physical barriers that protect against uses and disclosures not permitted by the privacy rule.” This is generally enacted by pulling curtains and making sure that confidential information is disclosed to a patient when roommates are not present, but the mere image of a physical barrier without the sound muffling qualities to accompany it may not be enough. Health care professionals more often than not are aware of this issue, and take “bedside” reports and the like out of earshot or make sure to whisper. Reports made during changes of shift or in the process of medical coding are made on paper or in rooms away from patient ears. However, this ambiguity in the language of HIPAA can leave a loophole large enough to drive a medical equipment truck through, and may have the effect of leaving patients feeling as though they have no legal recourse when they feel their privacy has been violated.

Clinics often compensate by making sure to have patient consent to talk about their maladies in a certain place, and then chalk up any mishaps to incidental disclosure, because this inclusion does not require every risk be eliminated so long as they have implemented reasonable safeguards. However, patients may not always be aware of who else may be listening. For example, I myself went to my own family doctor recently, who was in a new building where the ventilation system was very open between rooms. After my vitals were taken and I was left waiting for my doctor to examine me, I heard the entire conversation in the next room over, even with my bad hearing, with an elderly female patient concerning the plan of care for her hemorrhoids. I knew her name, and even learned the name of her dog and her shopping habits. While clinics and hospitals may be aware of the issues, even beyond a pulled curtain patients do not expect private rooms to pose privacy issues. In a small community such as the one my clinic is in, the patient's name may be easily recognized, and if I were a lesser person her information may quickly have become town gossip. If that woman were potentially so embarrassed, there would be little recourse for her to gain compensation under incidental disclosure, and more patients in the future may face similar problems if the sound continued to carry so clearly through the ventilation.

Perhaps soundproofing is not entirely the answer though. While in many cases the burden of implementing effective privacy for everyone is impossible, such as in hallway beds, but in cases where soundproofing is difficult patients should be made aware of the issues at hand in revealing patient information. If private rooms are known to carry sound and cannot be renovated, then that should be explained as well, and a room should be made available that is sound-proof for such conversations if necessary. One way or another, the “physical barrier” may not really be enough to prevent violation of patient privacy.

Jeff [5:33 PM]

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