1. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics Confidentiality in Medical Practice Chapter 10

2. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Confidentiality Physicians are expected to maintain all confidences concerning their patients Modern medicine and technology make patient privacy issues a paramount concern Confidentiality preserves the patient's dignity

3. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 10.1 Computer Screen Hidden from Patient View

4. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 10.2 Copy of an Approval Form for Release of Medical Information

5. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Health Insurance Portability and Accountability Act (HIPAA) Signed into law in 1996 Regulates the privacy of patient health information Five major categories covered under HIPAA – Insurance portability – Administrative simplification – Medical savings and tax deductions – Group health plan provisions – Revenue offset provisions

6. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Privacy Rule Applies to protected health information (PHI) Limits disclosures to only the minimum information necessary to carry out the medical treatment Patient must grant written consent or permission to disclose their PHI for treatment, payment, and other health care operations

7. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 10.3 Physician Explaining HIPAA Document

8. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Who Is Affected? Public health authorities Health care clearinghouses Self-insured employers Private insurers Information systems vendors Various service organizations Universities

9. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Denial of the Request for Privacy Some health care institutions, such as nursing homes, may have to deny access to a patient’s medical information in order to protect the patient

10. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. State’s Preemption Some states have stricter privacy standards than those of HIPAA The state’s laws would then take precedence over the Federal HIPAA regulation

11. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Unique Identifiers for Health Care Providers Standard identifiers are used to reduce confusion and errors Employer Identifier Standard – Published 2002 – Uses employer’s tax ID number or Employer Identification Number (EIN)

12. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Can Public Health Information (PHI) Be De-identified? To “de-identify” patient information, remove – Patient’s name – Address, including e-mail – Telephone and fax numbers – All dates, including birth (except year), admission, discharge, and death

13. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Can Public Health Information (PHI) Be De-identified? (continued) To “de-identify” patient information, remove – Social security number – Medical records numbers – Health care insurance numbers – License numbers – Facial photos – Other identifying numbers or characteristics

14. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Obligations to Patient Under HIPAA Obtain consent and authorization for any disclosure of medical information Permit patient access to medical information Provide only the minimum necessary standard

15. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 10.4 Only the Minimum of Information That Is Needed Can Be Sent to Another Provider

16. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Penalties for Noncompliance with HIPAA Civil penalties Federal criminal liability with sanctions (fines) and time in prison Risk of class action suit and public relations damage Health Integrity and Protection Data Bank (HIPDB): national data bank collects reports and disclosure of actions taken

17. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patients’ Rights Under the Privacy Standards Copy of privacy notice Access to medical records Limit how health care information is shared Accounting of who information is given to

18. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patients’ Rights Under the Privacy Standards (continued) Ask to be contacted in special way Examine health information provider’s copy Complain to “covered entity” if violation of privacy is suspected

19. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Special Rules Relating to Research Researcher must obtain – Patient authorization that complies with HIPAA – Waiver of authorization from a privacy board or Institutional Review Board Waiver must include extensive documentation as required by HIPAA

20. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Problems Relating to HIPAA’S Privacy Rules Some health care providers now refuse to provide medical records to anyone except the patient Compliance with HIPAA slows police investigations and impedes prosecution of crimes

21. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Misconceptions About HIPAA Does not prevent physicians or hospitals from sharing patient information to treat Does not prevent disclosure to clergy Allows hospitals and physicians to share information with spouse or anyone patient has identified as involved in their care

22. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Misconceptions About HIPAA (continued) Does not apply to most police or fire departments (may release information about accident victims) Does limit information EMTs may disclose

23. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Recommendations Appoint and train privacy officer Conduct internal assessment of existing policies Enter agreements with all nonemployee service providers Adapt procedures for handling patient requests

24. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Recommendations (continued) Implement notice of privacy practices Revise employee manuals regarding HIPAA standards Train all employees on policies and procedures Retain signed authorizations, copies, etc. (six years) Implement and enforce sanctions for violations Establish complaint process for noncompliance

25. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ethical Concerns with Information Technology (Informatics) Wireless local area networks (WLANs): communication system used to access patient records from central databases Medical informatics: application of communication and information to medical practice, research, and education Telemedicine: use of communication and information technologies to provide health care services to people at a distance