A story of confidentiality

Here is an example of one case study in Problems and Cases in Health Information Management, written by Susan Pritchard Bailey, MBA, RHIA, a consultant with Bailey & Associ-ates in Lenox, MA. Bailey calls "The Patient’s Story" case the "soap opera of HIM." This case addresses the threat of inappropriate release of information even when the information is being used appropriately.

In "The Patient’s Story," Jane Doe is a 20-year-old woman who has been married to her high school sweetheart for one year. One day she visits her gynecologist in her small city for her annual checkup. She has been seeing this physician since she was 16. During the post-examination interview, Doe confides that she has been having trouble in her marriage. She also confides that an uncle abused her when she was a little girl. This is the first time she has told anyone of the abuse.

The gynecologist, George Smith, suggests Doe see a woman psychologist to whom the doctor has made successful referrals in the past. At Doe’s request, Smith agrees to set up an appointment with the psychologist, Dorothy Jones. That afternoon, Smith asks his secretary to set up the appointment with Jones’ secretary, giving sexual anxiety as the diagnosis, and promising a follow-up letter introducing Jane Doe and her problem. After Smith dictates the letter, it is transcribed and a signed copy is placed in Doe’s medical record.

Before her appointment with Jones, Doe then fills out several forms and signs a "general consent" form. To keep her problem confidential, Doe chooses to pay for her sessions herself.

Back at Smith’s office, however, the coder sees the letter to Jones and her reply to Smith and assigns codes related to situational anxiety instead of those relating to a routine office visit. The bill is mailed to the HMO, which kicks it out of the system because of the "mental illness" diagnosis.

The scenario continues until Doe’s husband opens a bill asking for payment for Smith’s office visit. He demands to know about her "mental illness."

After reading this case, instructors can then discuss ways that the risks of disclosure through appropriate access could have been reduced.

"The cases do not pretend to be perfect academic exercises," Bailey says. "They have flaws, omissions, tricks, and red herrings — just like real life.

"Students are forced, as in actual practice, to make decisions and solve problems in an environment of imperfect information," Bailey continues.

"This produces a challenge to the instructor, as well. The instructor must help the student accept and understand the frustration of having to work with inadequate or insufficient information. Sometimes some quick thinking and the inventing of additional information’ is required to keep discussions moving. Every time the cases are used, the results will be different. This keeps the process fresh and interesting," she adds.

[For more information about the book, Problems and Cases in Health Information Management, contact the Lenox Publishing Company at (888) 261-9648. Or visit the Web site at www.lenoxpublishing. com.]