Re: HIPPA and Patient Follow-up

[Rollie Parrish <rparrish@flightweb.com>]

On Sat, 5 Apr 2003, Jeff Brosius wrote:

> Anyone figure out a way to do follow-ups on patients brought in by EMS
> (ground or air) without violating the new Hippo - er, HIPPA - rules?  For
> the lawyers on the list, WOULD a patient follow-up request be a violation?
> Can we do this, or are follow-ups a thing of the past, relegated to the
> antiquities collection thanks to unexpected consequences of good-intentioned
> legislation reforms?

First of all, I am not a lawyer, (and I don't play one on TV.) From what
I've learned, a follow-up letter (or even a phone call) can be OK
depending on how it's done. There are at least a few ways around this.

First is to have each patient sign a consent form allowing you to access
their protected health information (PHI) AND allowing you to re-disclose
that information, specifically for the purpose of follow-up phone calls
and letters. I've seen some consent forms that were supposedly for this,
but they are much too vague and only refer to allowing access to PHI "for
quality assurance purposes."

The second option is to just not include patient-identifying information
in the letter. Just leave it as "a xx-year old patient was transported
from your facility for further evaluation and treatment of..." The people
that were involved in the transport will recognize the patient, and others
may benefit from the feedback, without knowing who it refers to.

There are a number of other health care industries and organizations that
are dealing with the same issue. Some are taking a position that follow-up
reports are OK because they fall under the "health care operation"
definition. This might be true for some flight programs, but most of the
follow-up letter systems I've seen are really about marketing, not
bona-fide quality improvement programs. To me, a letter that basically
states, "This is what we did, this is what the hospital did, and this is
how the patient ended up. You did a great job, thank you for calling
us. If you need more pins, transfer packets, calendars, please let us
know." isn't necessary to run the business or support the core functions
of treatment and payment.

Here's just a few supporting links:

American College of Surgeons FAQ on Cancer referal follow-up reports:
http://www.facs.org/dept/cancer/coc/hipaafaq.pdf

ACS CoC Sample letter for follow-up info request:
http://www.facs.org/dept/cancer/coc/follow-upinforequestsample.pdf

HIPAA definitions (health care operations)
 http://www.hipaadvisory.com/regs/finalprivacymod/guses.htm


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Rollie Parrish
FlightWeb: For Air Medical Professionals
http://www.flightweb.com











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