Jun 2004 Table of Contents

BALANCING ACT

Hipaaposterous



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Sometimes a look at the lighter side can help cure what ails you.

Fam Pract Manag. 2004 Jun;11(6):68.

Medicine is a serious business, but sometimes the only way to cope with the headaches of our profession is to laugh. Case in point: the Health Insurance Portability and Accountability Act (HIPAA). As a physician, I’m all for keeping patient information confidential, but some of this HIPAA stuff goes too far. It is beyond me why the government had to get involved in a basic tenet of the doctor-patient relationship and make everything so complicated.

While I recognize that physicians need to engage in continuous learning, I never thought I’d have to learn a completely new set of acronyms and policies unrelated to medicine: “covered entity,” “protected health information” (PHI to the “in” crowd), “business associate,” “transaction and code sets” and “privacy officer.” (That last one sounds like the title of a city official whose job is to oversee public restrooms). In plain English, what does it all mean?

It’s a bird, it’s a plane, it’s HIPAA!

I work at a college health center providing medical care to students and their families. As per HIPAA regulations, every patient receives a copy of the privacy notice as he or she checks in. Since college students have enough to read, they usually just accept the privacy notice and either leave it behind to litter the lobby or cause a commotion by making it into a paper airplane and flinging it. To save the reception staff from flying missiles, I’m going to put copies of my new book, Origami for HIPAA Privacy Notices, in the waiting room. Just imagine all the little folded paper things we could make for Christmas presents.

You have the right to remain silent!

This PHI has me concerned too. Last spring I spent a half-hour talking with a student who complained that her nurse practitioner had released details of her condition to campus housing without her permission. After calming her down, I walked her to the door of my office where she stood outside and blurted in a strident voice, “Now I’m going to the pharmacy to get my Vicodin refilled,” oblivious to all the students mingling in the hallway just waiting to hear her PHI. Horrified, I wanted to clap my hand over her lips and whisper, “Shhh, don’t you know you are disclosing protected health information?” and usher her out the back door. Luckily, the HIPAA police were at lunch.

Get smart

I don’t understand the transaction and code sets either. Code sets are something I vaguely remember from childhood, when my brothers and I played secret agents like Maxwell Smart on our favorite show, “Get Smart.” (That’s something the HIPAA officials should do – get smart, I mean.) Our transactions were made from our walkie-talkies as we scuttled around the house, trying to avoid being seen by the enemy spy, a role unwittingly played by our mother. I think the code sets were found on the back of cereal boxes, to go with the magic decoder rings found inside. I recently called the Office of Civil Rights, which oversees HIPAA, but as yet, they have no plans to make a magic decoder ring for HIPAA.

Undercover

I know that HIPAA has gone too far when I take it home with me. Last night, when my husband finally fell into bed at midnight and yanked at the blankets, I rolled over, tugged the quilt back around my shoulders and mumbled, “Leave me alone. Can’t you see I’m a covered entity?”

Dr. Elwyn is a family physician at the student health center at Colorado State University in Fort Collins.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.

Copyright © 2004 by the American Academy of Family Physicians.
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