RE: Here is a good Privacy Issue that will cause problems

2003-01-17 Thread Bruce Bradigan
There was some good discussion of whether it was proper (legal) for the
pharmacist to notify the prescribers (probably not), but if he stole the RX
book, or someone suspected he stole the RX book, that was a (potential)
crime and should have been reported to the police.  I was thinking about
suggesting reporting it to the police in the first place.  They would have
(hopefully) done an investigation and developed a case before notifying
anybody, thus preventing the embarrassment to the wrong person (and
potential law suit).  

If the pharmacist reported it to the police and it turned out that nothing
illegal was done, I don't see what harm it would have done to the pharmacist
or to the person suspected of wrong doing.

Bruce Bradigan
Healthcare Consultant

 -Original Message-
 From: Rebekah Savoie [mailto:[EMAIL PROTECTED]] 
 Sent: Thursday, January 16, 2003 5:43 PM
 To: WEDI SNIP Privacy Workgroup List
 Subject: RE: Here is a good Privacy Issue that will cause problems
 
 
 Thank you for all your responses.  They were all great and 
 exactly what I expected - 
 
 Now I will tell you the rest of the story -
 
 A man stole some Rx books and forged the Rx's - but it gets 
 better - he used someone else's name and the pharmacy gave 
 this information to physicians when the person they thought 
 and named was seeking drugs, was actually not.  You can 
 imagine how mad this man was after the information got back 
 to his employer who was a friend of a physician that received 
 one of the general mail-out letters about him being a drug seeker.
 
 Makes you think, doesn't it?
 
 Rebekah Savoie
 Healthcare Consultant
 
 
  Christiansen, John (SEA) [EMAIL PROTECTED] 01/16/03
 02:55PM 
 Robert -
  
 I think I need to question one of your assumptions, and your 
 approach to this kind of problem. 
  
 #1 the assumption that:  the individual has lost the right 
 to privacy once they break the law is not correct, and is in 
 fact dangerously incorrect.
  
 HIPAA does not state that principle anywhere. It does list a 
 number of conditions under which PHI may be disclosed: for 
 TPO, under an authorization, and under the conditions listed 
 in 45 CFR 164.512 (uses and disclosures not for TPO for which 
 no authorization is required). If you read that regulation 
 you will see that subsection (a) does permit a disclosure 
 required by law, while subsection (f) sets out the specific 
 requirements for disclosures for law enforcement purposes. 
 (The other exceptions in this regulation don't appear likely 
 ever to apply to this kind of situation). If there is a law 
 on the books requiring disclosure of drug-seeking behavior, 
 exception (a) would apply; but I am not aware of any such 
 laws (doesn't mean there aren't any, I just don't know of any). 
  
 This is a very different approach to privacy from the 
 assumption that if you break the law you lose your privacy. 
 While the U.S. Constitution does not explicitly state a 
 privacy right (there are theories that it does so implicitly, 
 but that's another set of questions), HIPAA does create a 
 statutory/regulatory set of privacy obligations on the part 
 of CEs and entitlements on the part of individuals. I frankly 
 don't think that a pharmacist's judgment that he thinks 
 someone has broken the law by improperly seeking drugs (by 
 the way, *is* drug-seeking behavior a crime? or just a basis 
 for suspicion of a crime? or are we using an alert of this 
 kind to prevent health problems and over-prescription?) will 
 suffice to eliminate this entitlement (as a matter of law) or 
 relieve the pharmacist, as a CE, of his or her obligation to 
 respect these privacy entitlements by complying with the 
 regulations. (By the way, what if he's wrong? In addition to 
 breach of privacy there might well be a suit for libel available.)
  
 This is not to say something can't be done to communicate 
 about this kind of problem - we have discussed it quite a bit 
 and there have been a number of good postings on the subject 
 - but the way to approach a solution it is to start with the 
 regulations and read them carefully. (Also any applicable 
 business associate contracts; for example, in your example of 
 the PBM, has the PBM checked to make sure any BAC it has with 
 a CE that provided some of the PHI which describes the 
 prescriptions written permits that kind of disclosure? There 
 are some badly drafted documents out there, not all of which 
 might allow for everything you would like to assume they do.)
  
 The underlying point being that with HIPAA coming into effect 
 decisions like these have to be made in a more formal way, 
 with actual reference to regs and contracts and not in 
 reliance on what you assume should be the right result.
  
 John R. Christiansen 
 Preston | Gates | Ellis LLP 
 701 Fifth Avenue, Seattle, Washington 98104 
 *Direct: 206.613.7118 - *Cell: 206.683.9125 
 * [EMAIL PROTECTED] 
 
 -Original Message-
 From: [EMAIL PROTECTED] 

RE: HIPAA privacy and telephone

2003-01-17 Thread Ribelin, Donald
So far, the best scenario I have seen is the phone call that requests the
patient to call back to the office.  Part of the call back involves a pin or
secret code that the patient was provided previously.

Donald L. Ribelin
HIPAA Project Manager
Firsthealth of the Carolinas
(910) 215-2668
[EMAIL PROTECTED]

 -Original Message-
From:   Doug Webb [mailto:[EMAIL PROTECTED]] 
Sent:   Friday, January 17, 2003 9:51 AM
To: WEDI SNIP Privacy Workgroup List
Subject:Re: HIPAA privacy and telephone

An extension to this -- how do you handle answering machines?

My gut feeling is that either a no-no (the machine more questionable than a
family member) -- the information could only be released to the patient or
his/her representative designated in a written authorizaton.  Perhaps
another signature on your main consent/authorization form to allow these
types of communications is what's needed???

The opinions expressed here are my own and not necessarily the opinion of
LCMH.

Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital  Health Care Centers
[EMAIL PROTECTED]

This electronic message may contain information that is confidential and/or
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- Original Message - 
From: [EMAIL PROTECTED]
To: WEDI SNIP Privacy Workgroup List [EMAIL PROTECTED]
Sent: Thursday, January 16, 2003 04:04 PM
Subject: HIPAA privacy and telephone


 I would like the lists opinion on this topic.
 
 Patient comes to the office to have their potassium checked because they
are on a diuretic.  Later, the physician's nurse calls the patient at home
with results but the patient is not home.  Spouse answers the phone.  Can
you tell the spouse that the potassium was fine and that he/she should tell
the spouse to continue the same dose of diuretic and potassium supplement?
If you say no, this type of disclosure is not allowed, would it matter
that we put a statment in our Notice of Privacy Practices that stated  (in
the section on Payment, treatment and  health care operations) On occasion,
we call test results to your home and leave the results with a family member
if you are not present.  Now, obviously, we would not do this with a HIV
result but it seems like such a waste of everyone's time to play phone tag
to accommodate the one patient in a million that is actually upset because
you told the spouse what the potassium result was.  Thank you.
 
 Rich Fairley, 
 Dubuque, IA


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Re: HIPAA privacy and telephone

2003-01-17 Thread Leah Hole-Curry
The OCR guidance at http://www.hhs.gov/ocr/hipaa/privacy.html under
incidental disclosures indicates that leaving information with family
members or on an answering machine or mailing information is allowed,
but also cautions that professional judgment should be used to assure
that the information is limited to what is necessary and assure that its
in the interests of the patient.  

Regards, lhc

Leah Hole-Curry, JD
FOX Systems, Inc.
602.708.1045 
Information transmitted is confidential and may be proprietary to FOX
Systems, Inc.  It is intended only for the person or entity to which it
is addressed.   Anyone else is prohibited from disclosing, copying, or
disseminating the contents or attachments.  If you receive this in
error, please notify sender immediately, or us at www.foxsys.com and
delete from your system.
 Doug Webb [EMAIL PROTECTED] 01/17/03 06:38 AM 
An extension to this -- how do you handle answering machines?

My gut feeling is that either a no-no (the machine more questionable
than a family member) -- the information could only be released to the
patient or his/her representative designated in a written authorizaton. 
Perhaps another signature on your main consent/authorization form to
allow these types of communications is what's needed???

The opinions expressed here are my own and not necessarily the opinion
of LCMH.

Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital  Health Care Centers
[EMAIL PROTECTED]

This electronic message may contain information that is confidential
and/or legally privileged. It is intended only for the use of the
individual(s) and entity(s)  named as recipients in the message. If you
are not an intended recipient of the message, please notify the sender
immediately,  delete the material from any computer, do not deliver,
distribute, or copy this message, and do not disclose its contents or
take action in reliance on the information it contains. Thank you.



- Original Message - 
From: [EMAIL PROTECTED]
To: WEDI SNIP Privacy Workgroup List [EMAIL PROTECTED]
Sent: Thursday, January 16, 2003 04:04 PM
Subject: HIPAA privacy and telephone


 I would like the lists opinion on this topic.
 
 Patient comes to the office to have their potassium checked because
they are on a diuretic.  Later, the physician's nurse calls the patient
at home with results but the patient is not home.  Spouse answers the
phone.  Can you tell the spouse that the potassium was fine and that
he/she should tell the spouse to continue the same dose of diuretic and
potassium supplement?  If you say no, this type of disclosure is not
allowed, would it matter that we put a statment in our Notice of
Privacy Practices that stated  (in the section on Payment, treatment and
 health care operations) On occasion, we call test results to your home
and leave the results with a family member if you are not present. 
Now, obviously, we would not do this with a HIV result but it seems like
such a waste of everyone's time to play phone tag to accommodate the one
patient in a million that is actually upset because you told the spouse
what the potassium result was.  Thank you.
 
 Rich Fairley, 
 Dubuque, IA


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official opinion, post your question to the WEDI SNIP Issues Database at
http://snip.wedi.org/tracking/.   These listservs should not be used for
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and services.  They also are not intended to be used as a forum for
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Re: What does it mean to have a separate authorization?

2003-01-17 Thread Leah Hole-Curry
I have always considered this to mean that you did not necessarily need
separate types of forms, but that certain authorizations must be limited
to single purposes.  

However, if only one authorization form is created, it has to be
designed carefully to meet all the different types of situations
applicable to your business.  I suspect that entities will find a
generic form will work for most disclosures, but that certain
disclosures, if applicable (like where you are allowed to condition
treatment/enrollment or where, in research, it is combined with other
information) would need a special form because the language will be
different from the general circumstances where you cannot condition
treatment or where it is combined with other types of
permission/information.

lhc


Leah Hole-Curry, JD
FOX Systems, Inc.
602.708.1045 
Information transmitted is confidential and may be proprietary to FOX
Systems, Inc.  It is intended only for the person or entity to which it
is addressed.   Anyone else is prohibited from disclosing, copying, or
disseminating the contents or attachments.  If you receive this in
error, please notify sender immediately, or us at www.foxsys.com and
delete from your system.
 [EMAIL PROTECTED] 01/17/03 06:40 AM 
I realized that I may be confused over what it means to have a separate 
authorization. The privacy rules clearly state that a separate
authorization 
is needed for psychotherapy disclosures, that you cannot combine an 
authorization for psychotherapy with an authorization for most other 
disclosures. I assumed that meant you actually had to draft a separate
form 
for psychotherapy disclosures but someone recently pointed out to me
that it 
meant you could use the same authorizations for all disclosures, as long
you 
when you used it for disclosures for psychotherapy, it was just used for
that 
purpose

Thoughts?

Also, the rules state that you cannot combine authorizations where the
entity 
can condition treatment upon its signing (like disclosures to a third
party) 
with disclosures that cannot be conditioned. I assumed that you again
had to 
draft separate disclosures forms but am I mistaken?


Jill Rubin, Esq.
(617)388-2404
[EMAIL PROTECTED]


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RE: Here is a good Privacy Issue that will cause problems

2003-01-17 Thread Christiansen, John (SEA)



HIPAA 
is not intended to *preclude* use of PHI for treatment. Consultation with other 
providers for treatment purposes is specifically permitted, under the broadest 
terms of any of the HIPAA use/disclosure provisions.

But 
the definition of CE does not include governmental *law enforcement* agencies - 
though it does include governmental *providers and plans* - and consultation 
with *law enforcement officials* is not *treatment.*(Unless you want to 
argue that becoming the subject of acriminal investigation and potentially 
criminal prosecution is "treatment," which would be an interesting semantic 
stretch and more to the point an interpretation inconsistent with the rules' own 
distinctions between the two types of PHI use.) Since a 
disclosure tolaw enforcement it is not for *treatment* other rules apply, 
which should not be difficult to comply with, though the failure to comply could 
expose the CE to penalties.

Likewise, the disclosure of PHI to another pharmacist to advise him or 
her of possible drug-seeking behavior is not for the purpose of *treatment* 
unless both pharmacists have a professional relationship to the possible 
drug-seeker; the goal then would indeed be the provision of clinically sound 
treatment services. That purpose is *not* presentwhen a pharmacist sends 
that kind of information to another pharmacist who doesn't have a relationship 
to the individual in question -the latter is not engaged in "providing, 
coordinating or managing health care or related services" to the individual (the 
definition of "treatment"), so the former *cannot* be disclosing the PHI for 
that purpose. 

The 
question then is, if the disclosure to the second pharmacist is not for purposes 
oftreatment, what *is* the purpose of the disclosure? Once you have 
articulated that purpose accurately, you look at the rules to see if it is 
permitted, and if so under what conditions. If it is permitted, you disclose 
under the conditions the rule states (if any). If it is not permitted, you don't 
make the disclosure.

I 
guess at this point I'm not sure what the resistance or disagreement is 
about.I think the prudent approach is to read the rules and work within 
them, and I think they can be worked with to legitimately handle the kind of 
situation described in Rebekah's original scenario (which is what I am still 
responding to). There appears to be a disagreement with this position and I'd 
like those who disagree to clarify what their own position in fact 
is.

Is the 
disagreement based on the beliefthat this approach encroaches too much on 
traditional professional discretion of pharmacists to disclose patient 
information according to their own judgment, not according to bureaucratic 
rules?If so that is a legitimate position, one that has been articulated 
by a number of professionals in a number of settings, and one I sympathize with 
to an extent. Butit is also a position that in the final analysis is about 
HIPAA resistance, not HIPAA compliance.

If the 
requirement to comply with bureaucraticrules improperly infringes on 
professional discretion, from the professional's point of view the solution is 
to abolish the rules (i.e., HIPAA), or to ignore them and be ready to take the 
consequences as a matter of taking the moral high ground against an intrusive 
government. But if you accept that the rules are legitimate, or at least that it 
is too risky to violate them, the solution is to read them and comply with them, 
and to the extent they do cause problems try to get HHS to reform 
them.

If 
this is not an accurate description of the basis for disagreement with the "read 
the rules" approach, it would be helpful to know what the basis for the 
disagreement in fact *is.* If we are going to have divergent standards for 
approaching compliance we better get them on the table so we know what we are 
talking about.

  -Original Message-From: Matthew Rosenblum 
  [mailto:[EMAIL PROTECTED]]Sent: Thursday, January 16, 2003 4:57 
  PMTo: WEDI SNIP Privacy Workgroup ListSubject: RE: Here 
  is a good Privacy Issue that will cause problems
  
  
  John,
  
  Under HIPAA, a 
  pharmacist's job is to provide direct treatment services and to use and 
  disclose related PHI in accordance with the privacy, security and TCS 
  rules. So if a pharmacist needs to consult with other CE's in the 
  neighbor (or to contact government offficials) to provide a clinically sound 
  treatment service, how would HIPAA preclude those 
activities?
  
  I hope that this 
  helps.
  
  Your questions are 
  always welcome.
  
  Matt
  
  Matthew 
  Rosenblum
  Chief Operations 
  Officer
  Privacy, Quality 
  Management  Regulatory Affairs
  
  CPI 
  Directions, Inc.
  10 West 15th Street, 
  Suite 1922
  New 
  York, NY 
  10011
  
  (212) 
  675-6367
  [EMAIL PROTECTED]
  
  CONFIDENTIALITY 
  NOTICE: This E-Mail is intended only for the use of the individual or entity 
  to which it is addressed and may 

RE: HIPAA privacy and telephone

2003-01-17 Thread Benjamin W. Tartaglia
With all due respect, and I mean it sincerely.

Good idea for privacy Based on my many years of management
engineering and the application of voice, data and image telecommunications
systems in healthcare as an employee and later as a consultant I suggest it
is unworkable. (really long and ill structured sentence).

The major premise is When the patient calls back, someone who can accept
the call and pin number is available.  The major premise, although well
intentioned, is false.

When I try to get to my Doctor's office, I get a call management system 99%
of the time.  If I'm really lucky, I may get an answering service.  People
who work for many answering services are part timers, sometimes from
temporary employment companies, working for minimum wage, with little or no
healthcare background.  Try and get them HIPAA certified.
(I have also done consulting on Doctors' answering services.)

I believe such a system would simply generate round after round of call
backs which are unsuccessful.  If anyone thinks this would actually work,
should get another opinion and only pay for that opinion when the system is
proven effective.

I really would like to talk to the people who have used this successfully so
that I might add to my professional knowledge and moderate my opinion on he
matter or... is this simply a scenario from a brainstorming session?

Additional comments are welcomed and desired.  I find I learn more from
people who disagree.

Ben Tartaglia
Benjamin W. Tartaglia, MBA, BSIM, CSP
Director, Client Services
BWT Associates, HealthCare Consultants

HIPAA, JCAHO, Telemedicine, Contingency Planning, Telecommunications,
Telephone Fraud  Abuse, Training Programs, Policy  Procedures, Management
Audits.

PO# 4515, Shrewsbury, MA 01545
Phone: 508-845-6000
EMail: [EMAIL PROTECTED]

-Original Message-
From: Ribelin, Donald [mailto:[EMAIL PROTECTED]]
Sent: Friday, January 17, 2003 10:09 AM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: HIPAA privacy and telephone


So far, the best scenario I have seen is the phone call that requests the
patient to call back to the office.  Part of the call back involves a pin or
secret code that the patient was provided previously.

Donald L. Ribelin
HIPAA Project Manager
Firsthealth of the Carolinas
(910) 215-2668
[EMAIL PROTECTED]

 -Original Message-
From:   Doug Webb [mailto:[EMAIL PROTECTED]]
Sent:   Friday, January 17, 2003 9:51 AM
To: WEDI SNIP Privacy Workgroup List
Subject:Re: HIPAA privacy and telephone

An extension to this -- how do you handle answering machines?

My gut feeling is that either a no-no (the machine more questionable than a
family member) -- the information could only be released to the patient or
his/her representative designated in a written authorizaton.  Perhaps
another signature on your main consent/authorization form to allow these
types of communications is what's needed???

The opinions expressed here are my own and not necessarily the opinion of
LCMH.

Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital  Health Care Centers
[EMAIL PROTECTED]

This electronic message may contain information that is confidential and/or
legally privileged. It is intended only for the use of the individual(s) and
entity(s)  named as recipients in the message. If you are not an intended
recipient of the message, please notify the sender immediately,  delete the
material from any computer, do not deliver, distribute, or copy this
message, and do not disclose its contents or take action in reliance on the
information it contains. Thank you.



- Original Message -
From: [EMAIL PROTECTED]
To: WEDI SNIP Privacy Workgroup List [EMAIL PROTECTED]
Sent: Thursday, January 16, 2003 04:04 PM
Subject: HIPAA privacy and telephone


 I would like the lists opinion on this topic.

 Patient comes to the office to have their potassium checked because they
are on a diuretic.  Later, the physician's nurse calls the patient at home
with results but the patient is not home.  Spouse answers the phone.  Can
you tell the spouse that the potassium was fine and that he/she should tell
the spouse to continue the same dose of diuretic and potassium supplement?
If you say no, this type of disclosure is not allowed, would it matter
that we put a statment in our Notice of Privacy Practices that stated  (in
the section on Payment, treatment and  health care operations) On occasion,
we call test results to your home and leave the results with a family member
if you are not present.  Now, obviously, we would not do this with a HIV
result but it seems like such a waste of everyone's time to play phone tag
to accommodate the one patient in a million that is actually upset because
you told the spouse what the potassium result was.  Thank you.

 Rich Fairley,
 Dubuque, IA


---
The WEDI SNIP listserv to which you are subscribed is not moderated. The
discussions on this listserv therefore represent the views of the individual

RE: HIPAA privacy and telephone

2003-01-17 Thread Ribelin, Donald
A but who said anything about calling back and getting a human?  Call
back, get the robot, type in the secret code (pin), get the recording with
the nurse and/or physician's message about my lab work.  

Donald 

 -Original Message-
From:   Benjamin W. Tartaglia [mailto:[EMAIL PROTECTED]] 
Sent:   Friday, January 17, 2003 12:17 PM
To: WEDI SNIP Privacy Workgroup List
Subject:RE: HIPAA privacy and telephone

With all due respect, and I mean it sincerely.

Good idea for privacy Based on my many years of management
engineering and the application of voice, data and image telecommunications
systems in healthcare as an employee and later as a consultant I suggest it
is unworkable. (really long and ill structured sentence).

The major premise is When the patient calls back, someone who can accept
the call and pin number is available.  The major premise, although well
intentioned, is false.

When I try to get to my Doctor's office, I get a call management system 99%
of the time.  If I'm really lucky, I may get an answering service.  People
who work for many answering services are part timers, sometimes from
temporary employment companies, working for minimum wage, with little or no
healthcare background.  Try and get them HIPAA certified.
(I have also done consulting on Doctors' answering services.)

I believe such a system would simply generate round after round of call
backs which are unsuccessful.  If anyone thinks this would actually work,
should get another opinion and only pay for that opinion when the system is
proven effective.

I really would like to talk to the people who have used this successfully so
that I might add to my professional knowledge and moderate my opinion on he
matter or... is this simply a scenario from a brainstorming session?

Additional comments are welcomed and desired.  I find I learn more from
people who disagree.

Ben Tartaglia
Benjamin W. Tartaglia, MBA, BSIM, CSP
Director, Client Services
BWT Associates, HealthCare Consultants

HIPAA, JCAHO, Telemedicine, Contingency Planning, Telecommunications,
Telephone Fraud  Abuse, Training Programs, Policy  Procedures, Management
Audits.

PO# 4515, Shrewsbury, MA 01545
Phone: 508-845-6000
EMail: [EMAIL PROTECTED]

-Original Message-
From: Ribelin, Donald [mailto:[EMAIL PROTECTED]]
Sent: Friday, January 17, 2003 10:09 AM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: HIPAA privacy and telephone


So far, the best scenario I have seen is the phone call that requests the
patient to call back to the office.  Part of the call back involves a pin or
secret code that the patient was provided previously.

Donald L. Ribelin
HIPAA Project Manager
Firsthealth of the Carolinas
(910) 215-2668
[EMAIL PROTECTED]

 -Original Message-
From:   Doug Webb [mailto:[EMAIL PROTECTED]]
Sent:   Friday, January 17, 2003 9:51 AM
To: WEDI SNIP Privacy Workgroup List
Subject:Re: HIPAA privacy and telephone

An extension to this -- how do you handle answering machines?

My gut feeling is that either a no-no (the machine more questionable than a
family member) -- the information could only be released to the patient or
his/her representative designated in a written authorizaton.  Perhaps
another signature on your main consent/authorization form to allow these
types of communications is what's needed???

The opinions expressed here are my own and not necessarily the opinion of
LCMH.

Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital  Health Care Centers
[EMAIL PROTECTED]

This electronic message may contain information that is confidential and/or
legally privileged. It is intended only for the use of the individual(s) and
entity(s)  named as recipients in the message. If you are not an intended
recipient of the message, please notify the sender immediately,  delete the
material from any computer, do not deliver, distribute, or copy this
message, and do not disclose its contents or take action in reliance on the
information it contains. Thank you.



- Original Message -
From: [EMAIL PROTECTED]
To: WEDI SNIP Privacy Workgroup List [EMAIL PROTECTED]
Sent: Thursday, January 16, 2003 04:04 PM
Subject: HIPAA privacy and telephone


 I would like the lists opinion on this topic.

 Patient comes to the office to have their potassium checked because they
are on a diuretic.  Later, the physician's nurse calls the patient at home
with results but the patient is not home.  Spouse answers the phone.  Can
you tell the spouse that the potassium was fine and that he/she should tell
the spouse to continue the same dose of diuretic and potassium supplement?
If you say no, this type of disclosure is not allowed, would it matter
that we put a statment in our Notice of Privacy Practices that stated  (in
the section on Payment, treatment and  health care operations) On occasion,
we call test results to your home and leave the results with a family member
if you are not present.  Now, 

RE: HIPAA privacy and telephone

2003-01-17 Thread Lawson, Pam
This is exactly what my physician does.  When I have lab work at his
office, I am given a slip of paper that has dial-in instructions, the
pin number and my code number and when I can expect for the results to
be available.  I dial-in and listen to my physician's pre-recorded
message to me regarding the results of my lab work and any comments
about it.  Only if the results are really bad does the doctor or
nurse personally call and discuss the results (and this is prior to
the results being available on the dial-in system).  I like the system
since there is no phone tag, I can listen to the results when
convenient for me, don't have to worry about family members accidently
erasing the message and I can listen to it again (for up to so many
days).  The only down side is when the doctor does call you know
immediately that it is not good news.

-Original Message-
From: Ribelin, Donald [mailto:[EMAIL PROTECTED]] 
Sent: Friday, January 17, 2003 11:47 AM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: HIPAA privacy and telephone


A but who said anything about calling back and getting a human?
Call back, get the robot, type in the secret code (pin), get the
recording with the nurse and/or physician's message about my lab work.


Donald 

 -Original Message-
From:   Benjamin W. Tartaglia [mailto:[EMAIL PROTECTED]] 
Sent:   Friday, January 17, 2003 12:17 PM
To: WEDI SNIP Privacy Workgroup List
Subject:RE: HIPAA privacy and telephone

With all due respect, and I mean it sincerely.

Good idea for privacy Based on my many years of management
engineering and the application of voice, data and image
telecommunications systems in healthcare as an employee and later as a
consultant I suggest it is unworkable. (really long and ill structured
sentence).

The major premise is When the patient calls back, someone who can
accept the call and pin number is available.  The major premise,
although well intentioned, is false.

When I try to get to my Doctor's office, I get a call management
system 99% of the time.  If I'm really lucky, I may get an answering
service.  People who work for many answering services are part timers,
sometimes from temporary employment companies, working for minimum
wage, with little or no healthcare background.  Try and get them HIPAA
certified. (I have also done consulting on Doctors' answering
services.)

I believe such a system would simply generate round after round of
call backs which are unsuccessful.  If anyone thinks this would
actually work, should get another opinion and only pay for that
opinion when the system is proven effective.

I really would like to talk to the people who have used this
successfully so that I might add to my professional knowledge and
moderate my opinion on he matter or... is this simply a scenario
from a brainstorming session?

Additional comments are welcomed and desired.  I find I learn more
from people who disagree.

Ben Tartaglia
Benjamin W. Tartaglia, MBA, BSIM, CSP
Director, Client Services
BWT Associates, HealthCare Consultants

HIPAA, JCAHO, Telemedicine, Contingency Planning, Telecommunications,
Telephone Fraud  Abuse, Training Programs, Policy  Procedures,
Management Audits.

PO# 4515, Shrewsbury, MA 01545
Phone: 508-845-6000
EMail: [EMAIL PROTECTED]

-Original Message-
From: Ribelin, Donald [mailto:[EMAIL PROTECTED]]
Sent: Friday, January 17, 2003 10:09 AM
To: WEDI SNIP Privacy Workgroup List
Subject: RE: HIPAA privacy and telephone


So far, the best scenario I have seen is the phone call that requests
the patient to call back to the office.  Part of the call back
involves a pin or secret code that the patient was provided
previously.

Donald L. Ribelin
HIPAA Project Manager
Firsthealth of the Carolinas
(910) 215-2668
[EMAIL PROTECTED]

 -Original Message-
From:   Doug Webb [mailto:[EMAIL PROTECTED]]
Sent:   Friday, January 17, 2003 9:51 AM
To: WEDI SNIP Privacy Workgroup List
Subject:Re: HIPAA privacy and telephone

An extension to this -- how do you handle answering machines?

My gut feeling is that either a no-no (the machine more questionable
than a family member) -- the information could only be released to the
patient or his/her representative designated in a written
authorizaton.  Perhaps another signature on your main
consent/authorization form to allow these types of communications is
what's needed???

The opinions expressed here are my own and not necessarily the opinion
of LCMH.

Douglas M. Webb
Computer System Engineer
Little Company of Mary Hospital  Health Care Centers [EMAIL PROTECTED]

This electronic message may contain information that is confidential
and/or legally privileged. It is intended only for the use of the
individual(s) and
entity(s)  named as recipients in the message. If you are not an
intended recipient of the message, please notify the sender
immediately,  delete the material from any computer, do not deliver,
distribute, or copy this message, 

RE: HIPAA privacy and telephone

2003-01-17 Thread Bruce Bradigan
Can anyone point me towards vendors of systems like this (off list, please)

Thank you,
Bruce Bradigan
Healthcare Consultant

 -Original Message-
 From: Lawson, Pam [mailto:[EMAIL PROTECTED]] 
 Sent: Friday, January 17, 2003 1:03 PM
 To: WEDI SNIP Privacy Workgroup List
 Subject: RE: HIPAA privacy and telephone
 
 
 This is exactly what my physician does.  When I have lab work 
 at his office, I am given a slip of paper that has dial-in 
 instructions, the pin number and my code number and when I 
 can expect for the results to be available.  I dial-in and 
 listen to my physician's pre-recorded message to me regarding 
 the results of my lab work and any comments about it.  Only 
 if the results are really bad does the doctor or nurse 
 personally call and discuss the results (and this is prior to 
 the results being available on the dial-in system).  I like 
 the system since there is no phone tag, I can listen to the 
 results when convenient for me, don't have to worry about 
 family members accidently erasing the message and I can 
 listen to it again (for up to so many days).  The only down 
 side is when the doctor does call you know immediately that 
 it is not good news.

(prior messages snipped)



---
The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions 
on this listserv therefore represent the views of the individual participants, and do 
not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If 
you wish to receive an official opinion, post your question to the WEDI SNIP Issues 
Database at http://snip.wedi.org/tracking/.   These listservs should not be used for 
commercial marketing purposes or discussion of specific vendor products and services.  
They also are not intended to be used as a forum for personal disagreements or 
unprofessional communication at any time.

You are currently subscribed to wedi-privacy as: archive@mail-archive.com
To unsubscribe from this list, go to the Subscribe/Unsubscribe form at 
http://subscribe.wedi.org or send a blank email to 
[EMAIL PROTECTED]
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http://subscribe.wedi.org



RE: HIPAA privacy and telephone

2003-01-17 Thread Beth . Kranda
Title: RE: HIPAA privacy and telephone



Be 
careful -
If you 
say that an authorization is required, a y/n question will not fill the void 
even if you track it.
If you 
say that an authorization is required, it must be a HIPAA valid authorization 
and there are a list of about 10 required components to be a valid 
auth.

I 
happen to agree that an auth would be required with one exception - an 
authorizedpersonal representative could be given the patient's 
info.
There 
is also the paragraph about exceptions in the treatment relationship when the 
family member is involved in the carebut this may be an area that is too 
gray for this type of situation.
BK

  -Original Message-From: Clay, Roy III (NO) 
  [mailto:[EMAIL PROTECTED]]Sent: Friday, January 17, 2003 4:09 
  PMTo: WEDI SNIP Privacy Workgroup ListSubject: RE: HIPAA 
  privacy and telephone
  My feeling is that unless you have authorization from the 
  patient, anything other than giving the results directly to the patient is not 
  allowed. You wish you can have an opt-in question on the order of "Do we have 
  your permission to leave medical information with your spouse?(Y/N) These 
  responses would have to be tracked and adhered to. 
  -Original Message- From: Doug 
  Webb [mailto:[EMAIL PROTECTED]] 
  Sent: Friday, January 17, 2003 8:51 AM To: WEDI SNIP Privacy Workgroup List Subject: 
  Re: HIPAA privacy and telephone 
  An extension to this -- how do you handle answering 
  machines? 
  My gut feeling is that either a no-no (the machine more 
  questionable than a family member) -- the information could only be released 
  to the patient or his/her representative designated in a written 
  authorizaton. Perhaps another signature on your main 
  consent/authorization form to allow these types of communications is what's 
  needed???
  The opinions expressed here are my own and not necessarily the 
  opinion of LCMH. 
  Douglas M. Webb Computer System 
  Engineer Little Company of Mary Hospital  Health 
  Care Centers [EMAIL PROTECTED] 
  "This electronic message may contain information that is 
  confidential and/or legally privileged. It is intended only for the use of the 
  individual(s) and entity(s) named as recipients in the message. If you 
  are not an intended recipient of the message, please notify the sender 
  immediately, delete the material from any computer, do not deliver, 
  distribute, or copy this message, and do not disclose its contents or take 
  action in reliance on the information it contains. Thank 
  you."
  - Original Message - From: 
  [EMAIL PROTECTED] To: "WEDI SNIP Privacy 
  Workgroup List" [EMAIL PROTECTED] Sent: Thursday, January 16, 2003 04:04 PM Subject: HIPAA privacy and telephone 
   I would like the lists opinion on this topic. 
Patient comes to the office 
  to have their potassium checked because they are on a diuretic. Later, 
  the physician's nurse calls the patient at home with results but the patient 
  is not home. Spouse answers the phone. Can you tell the spouse 
  that the potassium was fine and that he/she should tell the spouse to continue 
  the same dose of diuretic and potassium supplement? If you say "no, this 
  type of disclosure is not allowed", would it matter that we put a statment in 
  our Notice of Privacy Practices that stated (in the section on Payment, 
  treatment and health care operations) "On occasion, we call test results 
  to your home and leave the results with a family member if you are not 
  present". Now, obviously, we would not do this with a HIV result but it 
  seems like such a waste of everyone's time to play phone tag to accommodate 
  the one patient in a million that is actually upset because you told the 
  spouse what the potassium result was. Thank you.
Rich Fairley, 
   Dubuque, IA 
  --- The WEDI SNIP listserv to which 
  you are subscribed is not moderated. The discussions on this listserv 
  therefore represent the views of the individual participants, and do not 
  necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. 
  If you wish to receive an official opinion, post your question to the WEDI 
  SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs 
  should not be used for commercial marketing purposes or discussion of specific 
  vendor products and services. They also are not intended to be used as a 
  forum for personal disagreements or unprofessional communication at any 
  time.
  You are currently subscribed to wedi-privacy as: 
  [EMAIL PROTECTED] To unsubscribe from this list, go to 
  the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to 
  [EMAIL PROTECTED]
  If you need to unsubscribe but your current email address is 
  not the same as the address subscribed to the list, please use the 
  Subscribe/Unsubscribe form at http://subscribe.wedi.org---The WEDI SNIP 
  listserv to which you are subscribed is not moderated. The 

RE: HIPAA privacy and telephone

2003-01-17 Thread Gerry Friberg
Title: RE: HIPAA privacy and telephone



164.510 allows, but does not require covered entities 
to disclose or use protected health information to:
Family 
members, close friends, or others assisting in an individuals 
care.

Rule 
requires that the individual be notified in advance and given the opportunity to 
agree or prohibit or restrict the use or disclosure. This can be oral 
agreement.

So 
this is a matter of #1 Notification and #2 during the office visit obtaining 
permission to inform the spouse or other family members who are involved in the 
medical care of the individual. 

Gerry Friberg Client Service Manager Professional 
Business Services 7700 A Street 
Lincoln, NE 68510 402-489-7131 www.pbssite.com 


  -Original Message-From: Clay, Roy III (NO) 
  [mailto:[EMAIL PROTECTED]]Sent: Friday, January 17, 2003 3:09 
  PMTo: WEDI SNIP Privacy Workgroup ListSubject: RE: HIPAA 
  privacy and telephone
  My feeling is that unless you have authorization from the 
  patient, anything other than giving the results directly to the patient is not 
  allowed. You wish you can have an opt-in question on the order of "Do we have 
  your permission to leave medical information with your spouse?(Y/N) These 
  responses would have to be tracked and adhered to. 
  -Original Message- From: Doug 
  Webb [mailto:[EMAIL PROTECTED]] 
  Sent: Friday, January 17, 2003 8:51 AM To: WEDI SNIP Privacy Workgroup List Subject: 
  Re: HIPAA privacy and telephone 
  An extension to this -- how do you handle answering 
  machines? 
  My gut feeling is that either a no-no (the machine more 
  questionable than a family member) -- the information could only be released 
  to the patient or his/her representative designated in a written 
  authorizaton. Perhaps another signature on your main 
  consent/authorization form to allow these types of communications is what's 
  needed???
  The opinions expressed here are my own and not necessarily the 
  opinion of LCMH. 
  Douglas M. Webb Computer System 
  Engineer Little Company of Mary Hospital  Health 
  Care Centers [EMAIL PROTECTED] 
  "This electronic message may contain information that is 
  confidential and/or legally privileged. It is intended only for the use of the 
  individual(s) and entity(s) named as recipients in the message. If you 
  are not an intended recipient of the message, please notify the sender 
  immediately, delete the material from any computer, do not deliver, 
  distribute, or copy this message, and do not disclose its contents or take 
  action in reliance on the information it contains. Thank 
  you."
  - Original Message - From: 
  [EMAIL PROTECTED] To: "WEDI SNIP Privacy 
  Workgroup List" [EMAIL PROTECTED] Sent: Thursday, January 16, 2003 04:04 PM Subject: HIPAA privacy and telephone 
   I would like the lists opinion on this topic. 
Patient comes to the office 
  to have their potassium checked because they are on a diuretic. Later, 
  the physician's nurse calls the patient at home with results but the patient 
  is not home. Spouse answers the phone. Can you tell the spouse 
  that the potassium was fine and that he/she should tell the spouse to continue 
  the same dose of diuretic and potassium supplement? If you say "no, this 
  type of disclosure is not allowed", would it matter that we put a statment in 
  our Notice of Privacy Practices that stated (in the section on Payment, 
  treatment and health care operations) "On occasion, we call test results 
  to your home and leave the results with a family member if you are not 
  present". Now, obviously, we would not do this with a HIV result but it 
  seems like such a waste of everyone's time to play phone tag to accommodate 
  the one patient in a million that is actually upset because you told the 
  spouse what the potassium result was. Thank you.
Rich Fairley, 
   Dubuque, IA 
  --- The WEDI SNIP listserv to which 
  you are subscribed is not moderated. The discussions on this listserv 
  therefore represent the views of the individual participants, and do not 
  necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. 
  If you wish to receive an official opinion, post your question to the WEDI 
  SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs 
  should not be used for commercial marketing purposes or discussion of specific 
  vendor products and services. They also are not intended to be used as a 
  forum for personal disagreements or unprofessional communication at any 
  time.
  You are currently subscribed to wedi-privacy as: 
  [EMAIL PROTECTED] To unsubscribe from this list, go to 
  the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to 
  [EMAIL PROTECTED]
  If you need to unsubscribe but your current email address is 
  not the same as the address subscribed to the list, please use the 
  Subscribe/Unsubscribe form at http://subscribe.wedi.org---The WEDI SNIP 
  

Re: HIPAA privacy and people

2003-01-17 Thread fwdanby
With the same due respect, and I, too, mean it sincerely, the word
'unworkable' is very tempting to apply to the whole HIPAA scenario where
there is an interface with patients.
Take a look at what all you very bright and well-intentioned folks have been
posting over the past several months. This is a high level of confusion
among intelligent people. Now translate that to the undeniable fact that
half the people in the real world are below average intelligence (IQ  100)
and the world we physicians live and work in is populated by patients who,
through no fault of their own, exhibit an even higher percentage of room
temperature IQs.
Sure, we will get some of the people complying some of the time, but all of
the people all of the time is, in a word, unworkable.
To have us exposed to legal liability in this situation is, in another word,
unfair.
I believe we providers should demand an umbrella of some sort to protect us
from unwarranted, arbitrary, over-zealous enforcement of an essentially
unworkable set of regulations.
I'd love to hear other opinions on this - here if you think it warranted,
privately if you think otherwise.
FWDanby, MD [EMAIL PROTECTED]

- Original Message -
From: Benjamin W. Tartaglia [EMAIL PROTECTED]
To: WEDI SNIP Privacy Workgroup List [EMAIL PROTECTED]
Sent: Friday, January 17, 2003 12:17 PM
Subject: RE: HIPAA privacy and telephone


 With all due respect, and I mean it sincerely.

 Good idea for privacy Based on my many years of management
 engineering and the application of voice, data and image
telecommunications
 systems in healthcare as an employee and later as a consultant I suggest
it
 is unworkable. (really long and ill structured sentence).

 The major premise is When the patient calls back, someone who can accept
 the call and pin number is available.  The major premise, although well
 intentioned, is false.

 When I try to get to my Doctor's office, I get a call management system
99%
 of the time.  If I'm really lucky, I may get an answering service.  People
 who work for many answering services are part timers, sometimes from
 temporary employment companies, working for minimum wage, with little or
no
 healthcare background.  Try and get them HIPAA certified.
 (I have also done consulting on Doctors' answering services.)

 I believe such a system would simply generate round after round of call
 backs which are unsuccessful.  If anyone thinks this would actually work,
 should get another opinion and only pay for that opinion when the system
is
 proven effective.

 I really would like to talk to the people who have used this successfully
so
 that I might add to my professional knowledge and moderate my opinion on
he
 matter or... is this simply a scenario from a brainstorming session?

 Additional comments are welcomed and desired.  I find I learn more from
 people who disagree.

 Ben Tartaglia
 Benjamin W. Tartaglia, MBA, BSIM, CSP
 Director, Client Services
 BWT Associates, HealthCare Consultants

 HIPAA, JCAHO, Telemedicine, Contingency Planning, Telecommunications,
 Telephone Fraud  Abuse, Training Programs, Policy  Procedures,
Management
 Audits.

 PO# 4515, Shrewsbury, MA 01545
 Phone: 508-845-6000
 EMail: [EMAIL PROTECTED]

 -Original Message-
 From: Ribelin, Donald [mailto:[EMAIL PROTECTED]]
 Sent: Friday, January 17, 2003 10:09 AM
 To: WEDI SNIP Privacy Workgroup List
 Subject: RE: HIPAA privacy and telephone


 So far, the best scenario I have seen is the phone call that requests the
 patient to call back to the office.  Part of the call back involves a pin
or
 secret code that the patient was provided previously.

 Donald L. Ribelin
 HIPAA Project Manager
 Firsthealth of the Carolinas
 (910) 215-2668
 [EMAIL PROTECTED]

  -Original Message-
 From: Doug Webb [mailto:[EMAIL PROTECTED]]
 Sent: Friday, January 17, 2003 9:51 AM
 To: WEDI SNIP Privacy Workgroup List
 Subject: Re: HIPAA privacy and telephone

 An extension to this -- how do you handle answering machines?

 My gut feeling is that either a no-no (the machine more questionable than
a
 family member) -- the information could only be released to the patient or
 his/her representative designated in a written authorizaton.  Perhaps
 another signature on your main consent/authorization form to allow these
 types of communications is what's needed???

 The opinions expressed here are my own and not necessarily the opinion of
 LCMH.

 Douglas M. Webb
 Computer System Engineer
 Little Company of Mary Hospital  Health Care Centers
 [EMAIL PROTECTED]

 This electronic message may contain information that is confidential
and/or
 legally privileged. It is intended only for the use of the individual(s)
and
 entity(s)  named as recipients in the message. If you are not an intended
 recipient of the message, please notify the sender immediately,  delete
the
 material from any computer, do not deliver, distribute, or copy this
 message, and do not disclose its contents or take action