HIPAA Regulatory Alert: Confidentiality may involve sticky legal, ethical issues

Think before you share patient-sensitive information

When it comes to confidentiality issues, health care professionals often walk a tightrope, Mindy Owen, RN, CRRN, CCM, asserts.

Case managers, for example, have to be careful about what kind of information they share with family members, insurers, employers, and even people who provide outside resources, adds Owen, chairwoman of the ethics committee and a member of the executive board of the Commission for Case Management Certification (CCMC) in Rolling Meadows, IL.

"One of the key skills of a case manager is effective communication, and 90% of communication is listening. Being a good listener means being able to figure out what is necessary to move the case forward and what is their accountability in terms of confidentiality," Owen says.

In addition to looking at ethical issues before they share information, case managers must be aware of HIPAA rules and regulations and how that will affect their practice.

"Case managers are working with health care issues that revolve around medical treatment. So many times they are working with ancillary or adjunct resources that want information on their clients in order to provide a wheelchair or set up a financial account. Case managers have to be careful about what information they give out because of privacy issues," Owen says.

For instance, a payer is having its bills paid by an outside firm that audits the file and pays the bills. The firm requests a copy of the case file for an individual patient.

Without thinking, a case manager may go ahead and send in the information to make sure the bills get paid, but he or she would be sending confidential information to someone who is not a part of the health care team, points out Susan Gilpin, JD, chief executive officer of the CCMC.

Dealing with employers

Workers’ compensation includes many confidential issues around medical care and treatment and how much information goes back to the employer.

A case manager could be working with a worker who is injured on the job but finds out that the employee has cancer. The employer has the right to know about the injury but does not have the right to know about the cancer.

The issue is a sticky one even in the case of an injured employee who has a potentially contagious disease.

Case managers have to be careful what information they share with the employer. If a case manager is working with someone and reporting back to the insurance company, the same kind of issue may arise if the case manager finds out something that is not directly related to the case for which he or she was hired but that could affect the individual’s insurability.

Confidentiality issues also arise when case managers work with a family. For instance, a patient may not want her husband or children to know about her disease.

Computer issues

Computers raise another confidentiality issue that could have implications if ethical issues arise.

Owen tells of a case manager working with a psychiatric patient who did not agree with the psychiatrist’s treatment plan and wrote notes to that effect on her computer.

However, she did not take her concerns up the chain of command. The patient committed suicide. The family sued not only the insurance company but also the case manager for not following procedure in raising questions about the patient’s care.

"It goes back to the idea that if it’s documented, it happened and if it isn’t documented, it didn’t happen," Owen says.

Keep in mind that you are not the only one who will read the notes in your computer. Computers can be subpoenaed as easily as hard-copy files.