BY SHERI PORTER
Arlene Brown, M.D., of Ruidoso, N.M. recently referred a 19-year-old patient to a psychiatric hospital emergency room for court-ordered evaluation and hospitalization.
But when Brown, a member of the AAFP Board of Directors, called the hospital for routine follow-up on her patient, she was shocked by the anything-but-routine response. It stemmed from problems interpreting the privacy rule for the Health Insurance Portability and Accountability Act.
"I was told out and out that they could not release any information to me because of HIPAA," said Brown. "Even though I'm the attending physician, I was not allowed to be part of the information loop."
Eventually, Brown received a patient update from her patient's mother. "But I have yet to see anything from the psychiatrist," she said. "Obviously, it's a problem in terms of continuity of care. How am I supposed to do the follow-up when I'm not allowed to know what was done?"
The HIPAA privacy rule went into effect April 14. Overzealous interpretation of the regulations has been frustrating physicians ever since. Even people well-acquainted with HIPAA -- created to benefit patients by safeguarding their private health information -- have been surprised by the unintended ripples it has caused.
Consider this scenario in Brown's 11-bed hospital: Patients' names and room numbers are no longer listed on the board in the nursing station. Instead, physicians are given a list of occupied rooms.
"We have to go wandering up and down the hall looking in patient rooms to find our patients because we're not allowed to know what room they're in," said Brown. "It was a corporate decision -- and it's their interpretation of what HIPAA means."
Misinformation
Much of the problem, speculated Mary Elizabeth Roth, M.D., of Allentown, Pa., is misinformation. "The rule was changed after it was first promulgated," said Roth, "and some people are still stuck on what the original version said."
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Roth is dealing with the patient records of a retiring physician. All the patients must be contacted and their charts transferred to other physicians and hospitals, said Roth.
"I just spent half an hour trying to explain to someone in another hospital that it's not a violation of anything to send them the original patient chart," said Roth. The hospital, citing the HIPAA privacy rule, refused to accept the chart even though the patient had given written consent for the transfer.
Darlene Lawrence, M.D., of Washington, D.C., tangled with a misinformed health plan employee. Lawrence was trying to refer a pregnant patient to an obstetrician to schedule a Caesarean section. "I got so much flack from a staff person," said Lawrence. "She quoted HIPAA to me three different times on the phone. She said she couldn't give me an appointment for my patient because she couldn't break HIPAA."
Flustered families
Patients' nerves are fraying as well. "We have found it difficult and time-consuming to explain to patients and their families why we cannot communicate health information to spouses and children without patient consent," said FP Lindsay Phillips, M.D., of Rochester, N.Y.
A common example, she noted, is calling to change a patient's warfarin or levothyroxine doses. "The patient may have some dementia, be hard of hearing or difficult to reach," she said, explaining the patient's need for help in managing medications. Phillips hopes that once all patient charts have been updated with the proper consent documentation, the situation will improve, but she said that may take more than a year.
Kathryn Stewart, M.D., medical director for care management at Mount Sinai Hospital in Chicago, said her facility is also grappling with family communication issues.
"Patients' families are stopping physicians in the hallway and wanting to talk about what's going on with Dad," said Stewart. And the family doesn't simply want to know whether Dad's critical or stable. "The family wants to know what Dad's cardiac cath showed," said Stewart.
"I think our policy is going to state that those kinds of discussions must occur in the presence of the patient," she added.
Phone calls from family members -- routine in the past -- now create havoc because patient information cannot be given out over the phone "just because someone calls in and identifies themselves as a family member," said Stewart.
"Don't get crazy"
People are having problems because the HIPAA privacy rule is complex, said Leon Goldman, M.D., chief compliance and privacy officer at Beth Israel Deaconess Medical Center in Boston. "The rule allows for people to use their best clinical judgment in any given situation."
Despite extensive and ongoing staff training on the privacy rule at his facility, "we'll still make mistakes," said Goldman. "First ask what's good for the patients and make sure they're cared for. Then protect their information, but don't get crazy about it."
This is a confusing rule, said Goldman. "We've done our best to interpret it correctly, but even the best is not perfect."
To reach writer Sheri Porter, e-mail sporter@aafp.org.
FP Report is published by the
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Copyright © 2003 by
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