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HIPAA and the modern blended, extended family: Train staff members to deal with the seemingly limitless variables

HIPAA Training Advisor, July 24, 2008

Protecting patient information has always been challenging. But these days, it’s downright maddening. The major obstacles remain the same. But now, healthcare facilities must also respond to the challenge of responding to requests for information from patients’ blended families—a club that seems to add new members every day.
 
Because more than half of marriages in the United States end in divorce, the lines that separate authorized and unauthorized disclosures are increasingly blurred. “Add in foster parenting, adoption, domestic partnerships, reverse parenting [adult children taking care of the elderly parents], second marriages, and minors having children, and you have what we in the HIM world refer to as the blended family,” says Rhonda Edgecomb, RHIT, CHP, chief privacy officer at Community Health and Counseling Services in Bangor, ME. “It extends far beyond mother, father, 2.5 children, and the family dog,” she says. “Today’s families are more likely to be biological mother, stepfather, half-brother, stepsister, the family dog, and possibly a ferret or two.”
 
It’s not as much of a problem if the patient is competent or at least conscious; he or she simply decides to whom you may speak. A signed proxy also eliminates the confusion, says Aviva Halpert, MA, RHIA, CHP, chief HIPAA officer at The Mount Sinai Medical Center in New York City. But otherwise, knowing which information you may disclose, and to whom you may disclose it, is a real challenge.
 
Consider the following tips to help ensure the appropriate response to disclosure requests in combination with complex relationships and blended families:
  • Do your homework. Research your state law’s provisions with respect to extended families. For example, New York does not have a surrogate law that permits a succession of people to make decisions on behalf of a patient who lacks the capacity to do so for him- or herself, says Halpert, MA. “However, New York does look the other way when a decision needs to be made,” says Halpert. “Generally, they will look away when the next of kin makes care decisions and/or accesses the chart in such circumstances.”
  • Train staff members to ask the right questions. Train staff members to always ask questions and to never assume anything about family situations. “We can no longer assume that the gentleman escorting a minor child to a well-child checkup is the biological parent of that child or that he has rights to consent for the care of that child,” says Edgecomb. “We also cannot assume that gentleman is entitled to access the PHI of that child under the federal HIPAA privacy rule or under other state laws.” Edgecomb recommends staying informed of the most recent court documents, as they will dictate who has legal rights and responsibilities for care, consent, and authorization.
  • Teach your staff to remain alert when fielding telephone calls. Your patients may have family members who simply don’t get along—and if they contact you by telephone, trying to sort out what you can say can be a nightmare. “It is a tremendous burden on the staff. They not only have to make sure that the person who is requesting the PHI has access to it, but they also have to verify the person is who they say they are over the phone,” says Halpert. Use passwords, callbacks, and other strategies to protect the patient in these situations.
  • Designate a someone with whom staff members can consult when they face a confusing situation. That person is often the privacy officer or risk manager.
  • Teach your staff members to maintain a professional demeanor. This is especially when staff members face with what Edgecomb calls “the human factor.” For example, a biological mother might beg you to prevent her abusive husband from obtaining a copy of their son’s therapy notes because she “cannot live with the thought of losing custody of her baby,” says Edgecomb. Although it may be difficult, try to remain objective.
  • Use formal training sessions and frequent refresher classes can keep staff members sharp. Targeting sessions for specific audiences is an effective method. “Use real-life situations to teach. Then ask the group to bring their questions so that they have help with their day-to-day work,” says Halpert. “We can make theoretical policies all day long, but in the end, it is front-end staff who have to implement it. If it doesn’t work in the real world, it is not of any value.”

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