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A HIPAA Dilemma

Published February 28, 2014 6:05 AM by Scott Warner

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is designed to protect a patient’s healthcare information from unauthorized disclosure among other things. Laboratories, for example, may do so “for treatment purposes without patient authorization, as long as they use reasonable safeguards,” by fax, email, telephone, etc. But what if the disclosure is unintentional?

As a department manager, I frequently review results, charts, and history for quality and workflow purposes. For example, I might review a history and physical of a person admitted from the ED who has had blood cultures drawn. It’s easy to run across test results and healthcare information for people I know personally in the community. It’s part of the job but falls within “treatment purposes.” We can’t help but see this kind of stuff in our professions, unless we work a city away.

I don’t have access to all information. I can’t look at results just because I know the patient. If it is within the course of my duties or work, that’s fine. I might, for example, review a urine culture on a close relative that I didn’t know had been collected as part of quality assurance. Like everyone else working at the hospital, I have to put a patient’s personal information aside and be discreet.

This can be difficult.

What if, for example, a tech delivers a result to the emergency room and discovers her husband has just arrived with chest pain? She sees the chart, sees his name on a computer screen, or hears a nurse or doctor mention the name. It’s impossible in these situations to remain objective. There’s no way the tech can return to the lab and work, obviously.

This is an interesting dilemma, since it is understood in normal circumstances that the wife would be at her husband’s side during this ordeal. HIPAA allows disclosure to a family member if the information is directly related to patient care or payment. But in this case the spouse learns of the event because of unintentional access to information that was impossible to ignore.

Has this happened to anyone? And how was it handled?

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1 comments

Being a hospital in a small town, you remember names/people and lots of people know each other.  Since I am not from the area, it doesn't bother me.  Others, well-it's weird.

One time-the phlemb's sis came in the ER and she didn't know til she saw the labels.  She clocked out and went to be with her with permission.  Most people just leave work at the times of emergency.

However-if it's your blood work as an outpatient or a relative's, we ask someone else to result. We can also go to the sister hospital in our network for privacy.  Example: I had blood work done and my insurance only covers in-network (i.e. has to be done at the hospital).  I had the phlembs draw me and I spun it down and put it on the machine-I was working that shift.  But, I went to another tech to do the results.  I didn't look at them-strict hands off, eyes off.

I asked my former lab director about this exact thing-she had told me that it's such a gray area to just play it safe and have someone else result it.  Even though it is your job to result-don't.  Only if you are literally the only one who could result it (i.e. one tech on 3rd shift-no one else) would it most likely be ok.  

I worry that by even telling someone their relative is in the ER might be a problem.  What if it's your cousin coming in for something they don't want people to know about and you just show up in the ER, all concerned.  Yep-that scares me more than resulting.

Veronica February 28, 2014 1:32 PM

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About this Blog


    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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