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Tip: Consult with patients before leaving messages

HIPAA Weekly Advisor, November 8, 2002

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It's not always easy to get in touch with patients. Staff from physician offices, clinics, and hospitals often must resort to leaving messages on answering machines or with friends or family. But you don't usually know who has access to those messages or whether patients want you to share information with others.

HIPAA doesn't specifically address what information to leave in messages, but the minimum necessary standard requires you to release only the essential information to get the job done, says Jill Callahan Dennis, JD, RHIA, principal of Health Risk Advantage in Denver.

"You don't want to do anything to hurt the patient's care."

Staff should leave generic, innocuous information, she says. "You don't want to give away the store."

Go over the policies and procedures for leaving messages with all employees who may do so as part of their job. Dennis recommends the following:

1. Find out the patient's preference.
Ask patients whether you should leave messages and how to do so, says Dennis. "Getting an upfront agreement is the best possible situation. Check with patients during their first visit to see what's appropriate."

Consider developing a form to indicate the patient's instructions and periodically updating it.

Ask patients whether you should call a particular number or leave specific details, says Dennis. "Some patients might say 'It's just me at home. Go ahead and leave a message,' or 'It's family. I don't care if they hear anything.' "

2. Leave very little information.
In many cases, you can't get an up-front agreement, says Dennis. "It may be the first time that you've worked with the patient or you've only talked to them over the phone." In those situations, consider leaving the following message:

"This is Dr. Smith's office with a message for Ms. Dow. Please call us at 800/123-4567."

"That's about the best you can do," says Dennis. "Don't mention any appointment, because that starts to get you on a slippery slope, where you are giving away more and more information."

Some might argue that if you leave the name of the physician, someone who overhears the message might be able to figure out the type of care the patient is receiving, she says. But, "Just because an obstetrician's office wants to talk to me, doesn't necessarily mean I'm pregnant," says Dennis. "It could be anything."

3. Consider omitting the doctor's name.
If you leave only a number, and don't give any information about who is calling, you're unlikely to get a call back, says Dennis. Patients may think the call is from a telemarketer.

If you are concerned that leaving the physician's name provides too much information, try simply saying, "This is the doctor's office with a message for Ms. Dow. Please call us at 800/123-4567," she says. "It's a little less information, but at least the patient has an idea that it might be a call he or she should return."

"If patients want more information, that's fine, but document that in their files," Dennis says.

Editor's note: From the November 2002 issue of Briefings on HIPAA.

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