Practice Management Q&A

February 1, 2008

Disclosing information outside the scope of HIPAA; When you can't get away from a patient; Long-term storage of electronic records; Liability for workers' comp exams

Disclosing information outside the scope of HIPAA

I recently dismissed a patient from my pediatric practice. When the child's father asked why we let his son go, we explained that his wife had been abusive to my staff. Now she claims we had no right to release this information to her husband without her consent. Did we violate HIPAA or any other privacy rule?

No, you did nothing wrong in truthfully answering the father's question. He has the right to know why you no longer wish to treat his child. It's true that nonmedical information can be protected under HIPAA, but it has to be information about the patient. As a physician, you have no duty to keep confidential information about the mother's behavior.

Sometimes I get held up in the exam room by someone who just wants to chat. How can I end the visit without offending the patient?

You can always say, "I'd love to talk, but my staff keeps me moving. See you next time." Or when you know you're seeing a patient who's hard to get away from, keep your medical assistant in the exam room. That usually inhibits small talk. Or arrange for your nurse to provide your getaway excuse by knocking at the door at the end of the visit and announcing, "Doctor, the MRI report is ready for you."

Long-term storage of electronic records

With an EHR, doctors no longer have to worry about long-term off-site storage of thousands of paper charts. Is storage as simple as backing up the records onto discs or cartridges and keeping them in a bank vault?

It could be that easy. But you should store a copy of the EHR software along with the data itself, to make sure the records can be read in the future. Alternatively, you could save the data in PDF format so it can be read without special software.

If you use an application service provider-where your data is stored by the EHR vendor and you access it online-your contract should include terms that insure your data will be available to you when you're ready to make arrangements for long-term storage.

Liability for workers' comp exams

A couple of colleagues have told me that there's no true doctor-patient relationship in a workers' compensation exam because it's conducted at the request of the employer, not the patient. Do I still have to worry about malpractice liability?

In most cases, no, as long as you don't offer medical advice, treat the employee, or injure him in the course of the exam.

However, in some states, courts have held that physicians have a duty to inform an employee when an exam reveals an abnormality or positive finding that could lead to the diagnosis of a serious illness or condition. This is also the stance of the AMA's Council on Ethical and Judicial Affairs. So be sure to notify the patient in such a case and advise him to seek care from a qualified physician. Document your actions in the chart.

In this issue, the answers to our readers' questions were provided by: Judy Bee, http://www.ppgconsulting.com, La Jolla, CA; Margaret Davino, JD, Kaufman Borgeest & Ryan, New York City; James Lewis Griffith Sr., JD, Fox Rothschild, Philadelphia; Rosemarie Nelson, MGMA Health Care Consulting Group, Syracuse, NY.

Send your practice management questions to: PMQA Editor, Medical Economics, 123 Tice Blvd., Woodcliff Lake, NJ 07677-7664, or send an e-mail to mepractice@advanstar.com (please include your regular postal address).