Sunday, February 04, 2007

In Pursuit of Patient Privacy

Some of you already know this. Apologies to you. Others may not.

Have you ever noticed that a hospital will not offer comments to newspapers and other media when there is a story on a patient complaint, a lawsuit, or other such matter? This is not part of a p.r. strategy to stonewall the reporter. It is because we are not permitted, under state and federal law, to comment on patient-specific matters.

The federal law that governs this, known as HIPAA, has very strict privacy provisions and very large penalties for those who violate them. In Massachusetts, there are even more stringent state statutes that supersede some of the federal rules.

Hospitals hold training sessions for new employees, interns, residents, and doctors on this stuff. Many of us also have electronic audit procedures in place to make sure that people who look at patient records are (1) authorized to do so and (2) are doing so for legitimate reasons. Here at BIDMC, only authorized people have access to our patient medical records system. And for these people, when they log into our view a record, there is an electronic "trail" that records when and why they did it. These audit results are regularly reviewed by our compliance people.

By the way, when a celebrity is in the house, we will often assign a fake patient name to the person. We will not confirm to the media that the person is a patient. Also, no enterprising fan or gossip columnist can slip through and call the hospital operator and ask to be connected to that person's room. We did have an amusing case in which we had done all of that to protect the privacy of a celebrity - who then called the media to make sure reporters would get a picture of him as s/he left the hospital!

(Of course, if a reporter wants to publicize his or her own hospital experience, that is a different matter. This can often result in an impressive program that helps educate thousands of people.)

But our rules go further than that. If you are a TV or newspaper photographer -- or even just a patient or visitor -- and want to take images on our property, you need to get prior permission and you need to be accompanied by one of our staff people when you are videotaping or photographing. Why? Because we do not want you to inadvertently capture the image of any patient and be able to display publicly the fact that that person was a patient.

One of the more sensitive questions occurs when one of our employees is a patient in our own hospital. Clearly, co-workers want to know enough offer support and encouragement and to visit their colleague. Here, too, we must be acutely sensitive of the desire to protect his or her privacy. Our folks always err on the side of confidentiality. But if the person happens to say, "You can tell people I am here and would like visitors", you can bet that there is a stream of well-wishers to that room!

To get back to the media, it can be frustrating to a hospital when a lawyer suing the hospital on behalf of a patient goes to a reporter to get a human interest story to engage public support that person's claim. We just cannot comment even if the claim is totally frivolous. We can't even comment if we think the claim is legitimate and that we have learned from the specific medical error. So, the TV or newspaper story can end up appearing one-sided -- and the hospital can look like it is stonewalling.

The better reporters and more responsible media outlets understand this and often will choose not to run stories of this nature. They know that they can be manipulated by a clever attorney in a heart-rending case with great human interest -- and they refuse to be used that way. Other media outlets will run the story anyway, even knowing that one side is legally handcuffed in its ability to respond.

I don't want this to change, notwithstanding the occasional discomfort to hospitals. In a society that is moving more and more to open access about all of our detailed life history, finances, habits, and other characteristics, let's hope that our medical history and experiences are kept behind an opaque veil.


Anonymous said...

As the point person at BIDMC for a lot of those patient information requests, I think this post should be required reading at every local outlet.

I've actually been told by a desk assistant at a local TV station that I was denying a person their constitutional rights when I would not allow an in-room interview (no doubt about how it felt to be in a massive fender-bender). The news person was not at all assuaged when I said the patient could be interviewed at home if they felt like telling their story.

It's only a matter of time before I will find myself having to tell someone that a person's right to privacy outweighs the public's right to know, at least within our walls.

Anonymous said...

most hospitals will use a patient's real name so their clinical information is attached to their name. BIDMC has terrific privacy blockers that prevent staff who don't need to know from accessing locations, clinical info, etc. Additionally, there's a trail for VIP patients, employees and any patient who does not wish to disclose his/her presence in the hospital. It's one of the best systems I've seen by far, thanks to some really dedicated staff in patient access, medical records and information systems. In the extra sensitive cases, a name may be changed, but any BIDMC patient should feel that his/her info & location is safe....

Anonymous said...

As someone who keeps wondering how every mortgage lender in the country knows my information and writes me about how much better their deal would be, I am thrilled to learn that no one can find out about my specific medical problems, can you imagine the junk mail.
Seriously, as a patient of BIDMC, this is good news.

Emily DeVoto, Ph.D., said...

Giving a patient a false name actually makes me nervous. You'd think that a celebrity gets extra-attentive care, but what about transitions of care in the wee hours, and staff who don't necessarily know who he/she is? Sounds like a recipe for mixups.