Through thoughtful planning, hospitals can adhere to the Health Insurance Portability and Accountability Act without erecting barriers between patients and clinicians.
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| Susan E. Mazer |
The poet Robert Frost's statement "Good fences make good neighbors" implies that some separation between people is a good thing. Certainly this was the idea behind the Health Insurance Portability and Accountability Act of 1996 (HIPAA): that an informational fence should be erected to maintain patients' privacy.
Clearly, however, some information needs to breach the fence, or caregivers can't do their jobs. The challenge for hospitals, then, is to find ways to keep proprietary information private while providing clinicians with adequate information. Fortunately, much of this can be done by redesigning the environment in which care is delivered.
Finding the Balance
Patients want everyone who is able to help them get better. They expect needed information to flow easily from caregiver to caregiver and not be stuck in red tape, even when it's justified. Families cringe at the idea that the right hand of the primary care physician does not know what the left hand of the surgeon is doing. Delays in sharing information because of the new HIPAA mandates could be costly, frustrating and possibly life-threatening.
So how do we find a balance in complying with the honorable but imperfect HIPAA mandates?
The key to the appropriate protections for patients and staff can be found in the environment of care, which ultimately will determine HIPAA compliance. Although perhaps oversimplified, the questions who, what, where, why and when are the major tests of HIPAA's regulatory triggers. Inside the health care arena, HIPAA has determined that who--patients' identities--and what--their diagnoses or conditions or other information--are to be assumed confidential (inside the fence) unless otherwise indicated. The why information is exchanged is perhaps the most critical place where protection is needed. Motives behind information seeking and management are perhaps the greatest fear of the patient. However, where information is exchanged and when the information should be accessible are also more questionable and leave much room for dispute, delay and confusion.
Take the auditory environment. Regardless of acoustic treatment, closed doors and barriers of the highest quality, patients, families and staff may still hear proprietary information and absorb it with varying degrees of accuracy. Likewise, nurses and physicians exchange critical information at the right time but in the wrong place. Patients whose rights have been violated are both grateful and resentful, depending on the news and their situation. The bottom line is that no one will care as long as the information is not used inappropriately or by a predator, such as a defensive employer or insurance company that might want to deny treatment, coverage, care or continuing employment.
Redesigning the Environment
There are very effective means of supporting the ethics and practices of providers while providing the intended protections for patients and families. Visual barriers, conditioned sound environments and ongoing monitoring of the density of people in a patient's vicinity all help ensure that patient privacy (and dignity) are adequately tended to.
Layering the auditory environment with therapeutic sounds can soothe patients at the same time they protect their privacy. By balancing opaque visual barriers with transparent sound baffles, such as Plexiglas walls, providers and patients alike can better learn to trust the environment. Nursing stations that are accessible but not exposed, controlled paperwork (as long as it exists) and computer monitors that are carefully placed are not difficult to implement, if thought through carefully.
Yes, good fences make good neighbors, but safe patients and effective care require a health care "neighborhood" that is in alignment with its own mission, not a demilitarized zone of secrecy where needed information is put into unintended isolation. A new standard of information management is required. Ultimately, time and practice will reveal what is best and practical for the optimal outcomes of everyone involved. For HIPAA to be an effective policy and not a liability, the environment must no longer be considered just a regulation or a good idea, but must be acknowledged as the custodian, if not a guardian, of privacy and confidentiality.
Susan E. Mazer is president of Healing Healthcare Systems, a Reno, Nev., company that develops educational programming for patient television and other products and services to assist health care organizations in providing clinical environments that are directly supportive of healing and recovery.
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This article 1st appeared on August 24, 2004 in HHN Magazine online site.
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