As regular readers of The Madhouse might know, I have issues with the implementation of HIPPA ( the Healthcare Insurance Privacy and Portability Act). Sometimes just blogging about it makes me feel better. So, sorry if you've heard this all before, but I have realized something new that might spice the discussion up. I've had the opportunity to talk with an attorney about HIPPA, and am told that there is, so far, very little case law on it...it's new, not many lawsuits have been filed. The courts haven't had the opportunity to clarify the issues yet. There are many ordinary people reading the massive new regulation, making interpretations about what must be done in response to it, and so forth. A few people will have to sue before we get a clear picture of what's required.
My blog-related issue is the feedback I've recieved that tends to take the position that we, in effect, aren't allowed to blog about patients at all, even if their identifying information is removed...the rub comes, near as I can tell, in the interpretation of "identifying information". My stance is that even if my co workers/readers can piece together the real identity of my subjects, no one else could...and who's to say that, after "piecing together the clues", even my co-workers are right when they "guess" an identity? I could assert that they're wrong, I was writing about an entirely other or imaginary person, couldn't I? And who would bring the complaint? and why? For a suit, doesn't someone need to be "harmed" in some way? ... blah blah blah, I could go on forever...
It would be extremely odd to suggest that we are prohibited from discussing our patients, their symptoms, the therapeutic interventions that we've tried...our reactions to it all....particularly in this field. What would happen to Freud under HIPPA? Are we not to learn from one another?
Here's an example of the interpretation of HIPPA as played out lately in our enchanted kingdom:
The evening program on the unit includes a community meeting. Formerly, a patient who had been elected by his/her peers to serve for one week as the leader of the group, would call roll from a clipboard, marking who was present, who was not. Now, for some reason, staff is required to perform the "leadership" role. I asked the reason for the change and was told that having a patient read the list of names of other patients is a HIPPA violation; further, running the meeting was "too much pressure" for the patients.
When pressed, staff agreed that the HIPPA issue was really a non-starter as the list was comprised of first names only...but, too late, I had already pictured the new world. Imagine a psyc unit where 24 psyc patients in crises live together, eat together, go to groups together, use the bathroom together...but are not allowed to know one another's names....interesting.
...and the next step is the staff are not allowed to know the patients names....and they can only talk about patients in supervised settings. Naturally, in order to manage the confusion, administration assigns numbers for each person which must be displayed prominently at all times...perhaps a tattoo....
The advertised "intent" of this regulation, was to insure that people moving from one job to another could continue their health insurance regardless of their pre-existing conditions. That's the "portability" part. The "privacy" part, I thought, was intended to make the "portability" part work.
But as it's been implemented in hospitals, it has resulted in very "unhealthy" situations where neither portability nor privacy are served. I remember taking my sister-in-law to the hospital where she was being treated for cancer. She was very sick, she came in at least every week for one thing or another...towards the end she was there repeatedly to have fluid drained from her chest so she could breathe...she would be panicky from lack of air by the time we arrived at the hospital. Each and every time, we were required to get into line and sign a bunch of paperwork...the same bunch of paperwork as the week before.....before being allowed to proceed. Each week we would hear the HIPPA apology from the frazzled clerk, as my sister-in-law - in such distress - had to repeat the "admission" process for what would be a 15 minute proceedure.
Now if she's had her number tattooed on her forehead, the clerk could've just scanned her and in she could go.
hmmm.
Forgive me for rambling, but this all somehow relates to Identity Theft....in both cases, people are seen to have digitized "identities" that require tending to...HIPPA creates a digital health care you. "Credit scores" create a digital financial you.... Social security numbers tie them all together. We're very busy trying to protect these digital identities...and we're finding such protection, as well as the identities themselves - have odd, burdensome consequences.
I just think we haven't thought this through. It's the electronic age, all right...and I love it...but, still....
Ah well. I'm going back to the Dahlia.
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4 comments:
Loosely related is the current loss of information by a headnurse/acting team leader for an admissions team (not 1).
Staff of that unit have asked for the lost informationm to be documented as stolen, and placed in their personel files. Thinking that down the road if two or three, or the whole twentyfive of those state employees had that information used against their interests as in identity theft, some recourse to file a claim would be supported.
Why you can understand that the human service legal advisors would have pause to agree to do this, it is still that state employeed supervisor who was acting for the state that is at fault. And the state should step up to support that documentation protecting it's employees from the neglegence of that supervisor.
As little time goes by, a little more information becomes known, re client info. An estimate of 250 clients may have been listed. Present and former clients, Maybe the HIPPA staff are up to their ears in how to sort this one out. Not some vague discriptions that could be similar to a dozen clients that have passed through the hospital, but Treatment Plan Review notes, have the patients been informed, hmm?
I think for going a little further to inquire about HIPPA particulars,
a tulip should be added to the dalhia. Recently, the folks who run the show (from offices a fair distance from the care units) at the madhouse, decided to advise, redirect even, employees who did a job. Kinda surprizing considering the employees who were working this unit did their jobs under some tough conditions, as do many, many linestaff. I guess the fact that although there were bumps in the road, these staff managed to get their jobs done. Maybe they didn't do an outstanding job, but they were professional, and even to some observers commented, a good job. Why do administrators and managers worry so much about the small stuff, when the big stuff gets done? Why question a simple decision, when a major one needs to be addressed? Why be maneuvered by one or two employees who didn't do much more than give lip service, into hashing out with other workers what was said, done, accomplished? Why have a whole hospital retrain regarding HIPPA when it was a single manager who violated the regulation? I guess the answer is - because they can.
But just cause they can, should they? Not if they value their employees who work with the backbone of the institution, the patients! I think you gotta give credit where it is due, realize that sometimes a decision that works is OK, even if it wasn't one that was politically favorful, and sometimes, you gotta make an example out of an employee who was wrong and put others at risk, as opposed to alienating a low maintenance type who trugdes along hour after hour,just doing their job. Cake and pizza provided by management are nice, but only a quick fix and it would behove the powers that be to help, protect and encourage their employees to do what they think is right. I'm just a lowly linestaff (who doesn't have a terribly advanced degree or high salary) but who knows the difference between right and wrong.
Now it should get interesting. Both Channels 7 and 9 have reported on the theft of records containing personal information on employees and clients of a state agency. Said records were apparently stolen from the car of a supervisor who had removed them from the workplace in a clear violation of state policy. Hmmm.Poor Richard.
I'd sure like to see some of the return coorespondence, or hear some of the calls that will come, from the paranoid, disguntled, been off meds former patients, and/ or current ones. The staff of that unit need to agree that when this issue comes up, the manager that is responsible, is the one that staff refer these clients to. Good luck to anyone who's info was stolen.
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