Interhospital Quality Improvement and HIPAA

Wed Sep 5 06:20:14 BST 2007

Dr. Pret

  The first scenario you detailed seems almost like somebody who would want to give out information but was dancing around a technicality, naming without naming. 

  The second scenario, seems a bit more like an accidental disclosure, which may be a bit beyond the control of a "prudent" person. For example, if I were to present a case of a male in a recent accident, listing in a PCR format of presentation, physical findings, labs, history and treatment/disposition, it wouldn't take too much effort to track me down and find out where I was at. (therby being able to identify the pt.) I am not exactly in hiding. How do you control that maybe the media does a story a day or two later and somebody makes an effort to connect the dots? Personally I do my best to not make  it overly obvious as in the first scenario, but where is the line drawn?

  I have never quite grasped the idea of living in fear and don't plan to start, but the whole context idea seems very gray to me.

  Consider: Not long ago a man near me was involved in an auto accident. a respected physician in the community was making a public statement. It had all the hall marks of a prudent statement. "the victim..." "car accident..." "critical condition..." (I still haven't figured out this whole serious or critical dialog yet) "stable...", "rehab..." "possible complications include..." two days later the media flashes a picture of his car with license plate, picture of him, and his name. I wouldn't say the physician unduly disclosed his identity or condition, but you could pick up a whole lot when you put the two stories together. Actually, anyone in my locale should be able to identify this without much effort at all, and I was not involved in his care or privy to any info other than the media reports on TV. 

  Looking at the damage to his vehicle, the dash cam video, mech of injury and index of suspicion, and the media details of his being transported to the area level 1, 24 hours later transferred to a hospital closer to his home (names named), and expected to make a long recovery. From just that I could probably may some accurate speculation on several things. As I mentioned before his license plate was on TV, clear as day, the media was even kind enough to identify what city he was from. But I would think that was the media disclosing his identity, not the physician. There is also no way the physician could have forseen the media giving the details they did when his statement was made. 

  Does it really come down to who gives the identifying info or protected info first? How does it play out if the media would have published its story and then the physician made a statement? I am sure the medical center's legal department or at least PR approved the statement. It seemed like a prepared statement. 

  Please, I am not an expert at this by any measure, and it is an interesting discussion at least to me. The cases I have seen since joining this list, from .sig files alone I could probably figure out where people are from. even without them, some of the more prestegious members' locations are well known. I would think they'd never be able to post a case under the circumstances of context.(Believe it or not I am not a stalker) I am sure most places in the US get the same media coverage as here. How anonymous are these patients really? What about unique cases? I have helped treat a person thrown from a bull. It took us several minutes to realize it was an animal and not a mechanical device. (we are a little far north and east for this to be a "normal occurence.") I'll bet there are only a few around here (all that night) who have seen that before. (I know the Southern people on the list are likely laughing at this story.)  

  Mike

  p.s I once again apologize for my poor typing and not proofing my earlier statement.

Pret Bjorn <p.bjorn at netzero.net> wrote:
  We can't discuss the private health information of the son of a former
Minnesota governor injured in a car crash in Florida last week. Even though
we haven't named him or divulged his Social Security number, context is
sufficient to reasonably identify him.

If you bring to the List the case of a teenage male who lost his arm in a
recent backhoe accident, and your email address is drsmertka at emory.edu, and
you detail his surgical repair or his blood alcohol level or his bipolar
disorder, then you'd better hope there's no mention in the Atlanta media of
a young man who lost his arm to a backhoe. Context.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Mike Smertka
Sent: Tuesday, September 04, 2007 6:39 PM
To: Trauma &, Critical Care mailing list
Subject: Re: Interhospital Quality Improvement and HIPAA

I would think trauma.org would only be liable for violations if there was an
identifier like name or ssn involved. otherwise wouldn't it possibly fall
under the same category as education or possibly QI, I don't know, I am not
a legal mind. But if I were liable everytime i discussed how other would
handle a similar patient or asked advise, the local law pors might as well
take what little i have now.

Mike

Connie Potter wrote:
Dear Trauma.org members:

Patient privacy and hospital/caregiver liability are both serious
issues. Unfortunately, discussions of this type will likely result in
more hospital CEOs and Boards deciding that being a trauma center poses
too great a legal and fiscal risk, particularly if some of the
trauma.org "lurkers" might be plaintiff attorneys or regulatory bodies.

HIPAA does forbid this type of disclosure, there is NO interstate
protection of PI anywhere in this nation, and only a few state trauma
systems have statutory interhospital protection of these types of
discussions. 

We need an interstate trauma care system, to include PI with all of the
protections afforded peer review within the hospital, as well as Good
Samaritan protection for those who deal with the final result of these
problems. Until then, we should beware of such in-depth critiques of
clinical and systems care issues on this website, particularly since
emails are subject to disclosure. I actually wonder if trauma.org might
be liable for patient privacy or HIPAA violations. Just my personal
opinions.

Connie Potter, RN, MBA 

-----Original Message-----
From: Ronald Gross [mailto:Rgross at harthosp.org] 
Sent: Monday, August 20, 2007 9:12 AM
To: KMATTOX at aol.com; ccm-l at ccm-l.org; Trauma & Critical Care mailing
list
Cc: SURGINET at listserv.utoronto.ca
Subject: RE: [ccm-l] Fwd: Interhospital Quality Improvement

Pret,

You were the first to come to my mind when I read Jeff's post but
decided to remain silent for your sake! ;-)

Ron

>>> "Bjorn, Pret" 
8/20/2007 10:54 AM >>>
Thanks, and well stated. 

Last time I noted this, I was flame bait for weeks.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Jeffery Hammond
Sent: Monday, August 20, 2007 10:47 AM
To: KMATTOX at aol.com; trauma-list at trauma.org; ccm-l at ccm-l.org 
Cc: SURGINET at listserv.utoronto.ca 
Subject: RE: [ccm-l] Fwd: Interhospital Quality Improvement

Aside from the clinical and systems implications, there is also a
ethical/legal issue here involving HIPAA. My understanding is that HIPAA
prohibits discussion of cases in which the patient can be identified by
date/time/location/circumstances etc. For our legal eagles, does the QI
shield/exemption apply to discussions such as these by parties who are
not
directly involved in the QI process? In short, can these discussions
legally
take place on the internet?

Jeffrey Hammond MD, MPH
New brunswick, NJ

_____ 

From: ccm-l-bounces at ccm-l.org [mailto:ccm-l-bounces at ccm-l.org] On Behalf
Of
KMATTOX at aol.com 
Sent: Sunday, August 19, 2007 2:44 PM
To: trauma-list at trauma.org; ccm-l at ccm-l.org 
Subject: [ccm-l] Fwd: Interhospital Quality Improvement

My friends on CCM-L and Trauma-list, this case was sent to me from the
SurgiNet list server. I have not commented yet, but I will to them.
I
was wondering if any of you have any comments. The City was BOSTON.
The
sending hospital was a MAJOR hospital in the region. There are
patient
care, EMS, trauma system, and even legal issues here, to say nothing of
ethical. 

I can and will forward to SURGINET at listserv.utoronto.ca any comment sent
to
me which does not have surginet in its sending list. 

k

_____ 

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