Discussions in public; appointment reminders; picking up prescriptions; using a fax machine; sign-in sheets; where to put charts.
Answers to your questions about . . .
Q: Are doctors permitted to have confidential conversations with other doctors or patients when there's a chance they'll be overheard?
A: Yes. Doctors may engage in communications necessary to provide quick, effective, high-quality care, even though they run the risk of being overheard. For example, they may discuss lab results in a joint treatment area. But physicians and their staff members must take reasonable precautionssuch as speaking in a lowered voice or walking away from others.
Q:Can staff members leave appointment reminders on patients' answering machines or with family members?
A: Yes. Unless a patient asks you not to, you and your staff members may continue to communicate with patients about their health care through mail, telephone, e-mail, or other means. You can also leave messages. But, as a precaution, you should always limit the amount of information you disclose. To confirm an appointment, for instance, a staff member should leave only your name, the date and time of the appointment, and a phone number.
Q:In the past, we've allowed spouses and significant others to pick up reports, X-rays, and prescriptions for a patient. Is this practice still allowed under HIPAA?
A: It is. Staff members may make reasonable inferencesbased on their experiencewhen it's in patients' best interests to have someone else act on their behalf. But, when in doubt, reasonable steps should be taken to verify this person's identity. For example, call the patient first to confirm that the individual has the authority to act on his behalf. Then, once the person arrives at the office, check his identification.
Q:Can we use a fax machine to communicate protected health information?
A: Yes, but you need to adopt special safeguards. Locate your fax machine in an area that's not accessible to the public. Schedule fax transmissions in advance with the recipient, and be sure to verify that the fax was received. Use cover sheets with an "unintended recipient" notice. These notices spell out the legal consequences for unauthorized access to the accompanying information.
Q:Can we still use patient sign-in sheets and call out the names of patients sitting in the waiting room?
A: Certainly. Such incidental disclosures are permitted, as long as the information disclosed is kept to a minimum. So sign-in sheets should ask only for patients' names.
Q:When the assistant leaves the exam room, she puts the chart on a rack on the door for the doctor to pick up on his way in. Can we still do this?
A: Yes, as long as you take adequate precautions. These include limiting access to the area, ensuring the area is supervised, escorting nonemployees while in the area, and placing patient charts in their holders so that identifying information is facing the wall or otherwise covered.
Katherine Layman. HIPAA Consult: Answers to your questions about. . .. Medical Economics Jul. 11, 2003;80:35.