Monday, December 12, 2011

Author Beware: The Law-- HIPAA (Part 1/3)

Several months ago, I was watching a local TV news station when a nurse manager was being interviewed about the fact that you could look up ER wait times on the Internet before checking in. That's a whole other can of worms I won't get into today but the problem with her interview was that the camera shot included her standing next to their patient tracking board in which you could clearly see the last name of the patient, their age, and their medical complaint.

I almost fell out of my chair. This was a clear HIPAA violation and that ER manager should have known better than to be standing anywhere near that board.

Each time you visit the doctor's office or sign into the urgent care or emergency department for treatment, you should be given a paper that outlines your rights under HIPAA which stands for the Health Insurance Portability and Accountability Act. It basically outlines rules on how to deal with a patient's "protected health information" or PHI.

What this boils down to for the bedside clinical worker falls into a couple of areas and I'll give some examples below.

1. I should be providing direct care to a patient or should have provided recent care in order to look up their chart. Some of you may remember the healthcare workers that were fired for accessing Brittney Spears medical information. They were likely fired under this provision.

2. I can't share any specific information (name--never, age, and complaint) listed together in areas where other's could become aware of the patient's visit. This would include areas like social media (a big no-no). When cases are presented at medical conferences, generally all patient information is blacked out (say on x-rays). And the patient is only spoken of in general terms. Such as: 16y/o presented to the ER for evaluation of neck pain. Now, across the USA for one day, probably several patients presented with this complaint so how do you know which one it was?

3. I shouldn't be sharing patient information with my spouse unless he has provided direct care to the patient as well. Therefore, since my husband is an accountant, I can't say--- "Oh, by the way our neighbor's daughter was seen for a broken arm today in the ER." Unless I've asked the mother specifically if it's all right that I mention this to my husband, I have violated that patient's rights by sharing that information with my spouse. Working in pediatrics, I've been in the situation often and don't mention the visit at all when home.

4. Requests for information about a patient from the media generally go through the public relation's office. This tends to happen more off hours, a reporter will get through to the ER desk and begin to ask questions. Most, if not all hospitals, are very firm that all media inquiries go through public relations. This allows them to control the message.

5. Patient information cannot be given over the phone unless specified by permission. This is why, when you fill out those HIPAA forms at your doctor's office, they generally ask who they can talk to and what kind of information they can share. Perhaps you don't want your husband to know why you were at the OB's office. A caveat to this is giving information to your personal physician who is following up on your ER complaint. We will generally give specifics for this because they are providing your follow-up care.

Next post I'll talk specifically about HIPAA and minors.


  1. Hi, Jordyn. Thank you so much for this series. As an editor, I often see HIPAA violations, and sometimes correcting them creates serious plot issues. I'm definitely going to link this on FB.

    One thing I see a lot, but I'm NOT sure about whether it violates HIPAA: If two (or more) people have been involved in a common incident, such as an attack, car accident, etc., what is the policy on medical personnel discussing the condition of the people involved? For instance, if the hero asks a nurse how the heroine is doing. Obviously, he already knows her condition, but he's not a relative. What would the nurse be allowed to share, if anything?


  2. Ah yes! I've dealt with this some in my /shudder/ romantic suspense. Poor hero was left cooling his heels till Mom said he could come back and see his son - since he wasn't on any of the paperwork [and in fact hadn't even known said son existed until earlier that day]. Even his badge didn't help ;).

    Fortunately, DH deals with HIPPA stuff regularly and I can usually ask him for help if I don't know for sure about something. And I've discovered it's always better to err on the side of "I'm sorry ma'am I can't tell you that" than to give out the info.

  3. Unfortunately there are HIPPA violations both in real life and in fiction writing. Name on the SCREEN - ohmigoodnessgracious on TV! Some years back there was a book where the psychologist violated so many confidentiality guidelines that I finally had to set it aside. The writer clearly had not consulted with a licensed professional before she wrote it.

  4. Ramona... thanks for linking this to your Facebook page. I really appreciate the support. Hopefully, you'll find Wed and Fri posts equally as interesting.

    As to your question, this is how I would handle it as a nurse. Since they are not married, I would ask the heroine if it's okay to speak about her condition to said hero. It could be as simple of the nurse saying to said hero..."She's worried about you too so she said I could share with you how she's doing... and not to worry." If the character cannot respond due to her condition or doesn't want information shared-- as the nurse, I would give a condition: Stable, Fair, Serious, Critical. This information is allowed to be released to the public. Him not knowing can acutally increase the tension of the scene as well.

    Thanks for your comment, Carol. Looks like you handled the situation well.

    Carrie, it does get frustrating because some medical situations aren't that hard to figure out. Just posing a few simple questions to a medical expert is well worth the time. And often, you'll discover ways to increase the conflict!

  5. I like an informative blog! I'll be back to scroll through archives.

  6. That's great...Gene Pool Diva! And, thanks for following, too. Let me know if there are any topics you'd like to see.

  7. Thank you so much for addressing this, Jordyn! I see this all the time in fiction, and it bugs me - woman asks nurse about her love interest in the hospital, and nurse tells her love interest's complete condition! Oh no, no, no. Wouldn't (shouldn't) happen. It may be convenient for the plot, but health care professionals may fling book across room.