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Focus your amendment process on accurate information, patient satisfaction

HIPAA Training Advisor, September 7, 2006

Section 164.526(a)(1) of the privacy rule gives patients the right to amend their PHI. But HIPAA compliance is just one piece of the picture. A reliable process for handling patient amendments can ensure that your facility corrects important inaccuracies and soothes patient concerns.

"Patient amendments can benefit a lot of people if they're used correctly," says Holly Ballam, privacy officer and physician liaison for Boston-based Beth Israel Deaconess Medical Center. In a recent example, the son of an elderly Beth Israel patient amended incorrect information in his mother's medical record regarding a cancer that she hadn't actually had. "If she went to get another kind of medical insurance and they got copies of her record that hadn't been amended, she might not have coverage because the insurance company would consider it a preexisting condition when she in fact never had it," says Ballam.

Put your customer service hat on
However, for each essential PHI amendment, there are plenty of illegitimate amendment requests. For example, patients who dislike physicians' characterizations of them might try to amend the information, even though their records are accurate and complete as-is, Ballam says. This often occurs when there are sensitive notations about drug or alcohol use. In these situations, a facility is within its rights to deny the amendment request.

However, just because HIPAA allows you to deny the amendment doesn't mean that you should take a dismissive attitude toward the patient, says Stephanie Argoitia, MSW, JD, privacy manager at University of Utah Healthcare in Salt Lake City. "Amendment requests are [often] emotionally charged. Some patients are very upset about what [they find] in their record," she explains. "Be prepared to respond to them in a responsible, supportive way."

Argoitia makes her organization's amendment-request form easily accessible on the University of Utah Healthcare's Web site and personally phones patients who submit them. She is often able to assuage patients' concerns simply by explaining the reasoning for the notation. For example, patients might be concerned that a statement that they came to the emergency room in an excited or agitated state could make them appear difficult. Argoitia explains that the note is merely a helpful reminder to physicians to pay special attention to patients' concerns. This customer-service-oriented approach often results in patients dropping the amendment request altogether, Argoitia says.

Likewise, patients' amendment requests at Beth Israel go first to a patient-care representative. These representatives are ideal for being on the front line of the amendment process because they deal with patient complaints daily. "Most of the patients seeking amendments are angry," says Ballam. "That's why the patient-care representative is so important. They know how to defuse the situation."

Establish a sympathetic denial process
Beth Israel's patient-care representative passes the request to the original author of the record or the chief of the affected service line, who can either agree or disagree with the amendment. If he or she disagrees, the patient-care representative provides the patient with a written denial and offers him or her the opportunity to appeal to Beth Israel's review board. Organizations have 60 days to respond to patient requests in writing, but can take one 30-day extension by notifying the patient of the reasons for the delay.

If Beth Israel's review board denies appealed requests, patients can always have their initial requests or statements of disagreement filed with their records. Patient-care representatives can also tell patients that they can file complaints with OCR. Providing patients with these open avenues to air their concerns is important to ensuring customer satisfaction in a population that might initially perceive your organization in a negative way.

"Understand where the patient is coming from," Argoitia explains. "Even if you have to deny the amendment, be very empathetic about it and keep the lines of communication open with the patient. It's just good customer service."

Editor's note: Adapted from "Focus your amendment process on accurate information, patient satisfaction," Briefings on HIPAA, September 2006.

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