Sunday, March 18, 2012


I wrote this some time in October and never got around to publishing. It was in Drafts. (Also revised on March 31, 2012.)

This morning, one of my patients urgently needed to go to a particular outpatient program. He had called them and left a message. They did not call him back. So I called them. I spoke to an administrative assistant. She told me the intake supervisor would call when she came in. She called back in the mid-afternoon. This genius told my assistant that because of HIPAA, she could not allow us to tell her about the patient until she had the patient's explicit permission. The patient could not be reached before the facility closed for the day, so my urgent case is stalled for the weekend.

The Health Insurance Portability and Accountability Act of 1996 is all that remains of Bill Clinton's efforts at healthcare payment reform. It was supposed to facilitate the exchange of medical records between providers. There are many different pieces of this law, some of which may be useful, but the word 'HIPAA' makes doctors cringe mostly because of a part of the ironically-named Administrative Simplification [sic] Provisions.

Administrative Simplification [sic] Provisions are supposed to facilitate communications by standardizing requirements for patient consent for disclosure of confidential information. For me, who is among the few lawyer/doctors, they actually seem like common sense. However, because health professionals don't think like lawyers and lawyers don't think like health professionals (I'll include administrators in this category for the purposes of this post.), the attempted 'clarification' has done nothing but obfuscate. Now, instead of 'common sense' discretion that was used in the past (highly variable and sometimes completely wrong, but very efficient), health professionals face a wall of legalistic definitions and procedures. A lawyer will happily dive in and parse the language. A health professional will curl up in a terrified ball and moan, haunted by visions of vicious litigators.

The case in point is an excellent illustration of the problem. The intake supervisor was completely clueless. HIPAA does not prohibit a health professional from accepting information from anybody. (Nor, for that matter, does it prohibit a health professional from giving the patient their own information, another misinterpretation I have encountered.) But HIPAA is summarized for us once during orientation, and the only thing most people seem to remember is that the boogie monster/lawyer is going to eat them if they share information.

Thus, the default reflex, upon coming anywhere near confidential health information, is to play dead. This has clogged the medical information superhighway like LA at rush hour. It must cost the system uncounted billions of dollars and thousands of lives while professionals and clerical staff burn precious hours performing pointless protocols to avoid apparitional attorneys. HIPAA SCHMIPAA!

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