RE: Followups

["Jeanine Hanson" <HANSONJ@nahealth.com>]

Just saw this email.  Same story as before.  Thanks.

>>> pmwright@home.com 02/28/01 06:40PM >>>
Unfortunately, the winds of change are blowing pretty stiffly in
regards to medical information and followup letters may have to be
viewed differently in the present and the future than they have been
in the past.  While the approach you've described
is still permitted in some jurisdictions, it is not in others and the
State regulation you can cite in Florida may not exist in other states.

But the 800 pound gorilla to be dealt with will be the new privacy
regulations adopted under HIPAA.  While there is still some question in
my mind as to how many transport programs will qualify as "covered
entities" under the Rule as adopted, I believe the principles embodied
in that regulation will be broadly applicable to all healthcare entities.

Under HIPAA, there is a distinction made between information that identifies
the individual and that which does not.  However, it is clear that merely
omitting
the patient's name will not suffice if the situation is sufficiently unique
as
to permit identification by a description of the circumstances, nature of
injuries, etc.  Unfortunately, most transport followup letters are in this
category.

There is also a distinction drawn between information that is used for
quality
assurance or peer review and information that is used for marketing
activities.
On the basis of the original post, as well as Dr. Abernathy's somewhat
strident
response, one would have to consider that the primary value of these letters
might
well be marketing and that would place them in a different, and far more
restrictive
category under the HIPAA Rule.

The HIPAA Rule takes effect on April 14, 2001 with a mandatory
implementation
deadline of two years thence.  This will be a regulation similar in scope,
complexity
and controversy to COBRA/EMTALA so I'm guessing it will be another decade
before we
really understand what it means to our operations but I would encourage
everyone who
is working on any kind of information disclosure or transfer project to
visit the
HCFA HIPAA Web site at http://aspe.os.dhhs.gov/admnsimp/pl104191.htm.  You
also point your Web search engine to HIPAA and you will find several
privately-funded interpretive sites devoted to this topic.

My guess is that written followup letters will be relegated to a position of
historical interest.  I have mixed feelings about that, but I can draw no
other conclusion from the information currently available.

regards!

paul






> Ms. Snow,
> Follow up letters are still allowable to the extent that 1)
> the pt's name is
> not mentioned in the letter; 2)general follow-up information
> is included; 3)
> a disclaimer citing your State's governmental regulation
> number followed by
> something to the effect of "the preceding information is confidential
> pursuant to (your state) State Regulation # blah! blah! blah!
> and is not for
> general distribution. It is intended for those individuals
> involved with
> this patient's care.
>
> Something to that effect. Ask your hospital's attorney's or
> risk management
> to reference the exact statute that covers this.
>
> Good luck.
> Alex
> Bayflite 2
> Sarasota, FL


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