The issue of confidentiality has become one of the hottest issues in medicine in the previous years using the introduction of the new federal laws encompassed underneath the acronym HIPAA (Medical health insurance Portability and Accountability Act). The concept of medicine has always regarded confidentiality as one of its highest ethical principles.
Psychiatry has put even greater restrictions on confidentiality given the highly sensitive nature from the issues patients discuss. As a result, no information is released to anyone without a written authorization by the patient allowing for such release.
An itemized authorization for discharge of general medical records is not enough. The patient must knowingly and specifically request psychiatric and/or substance information to be sold before it can be. Every effort is made to protect a patient's right to privacy. However, exceptions exist to that right, and it behooves everyone to be aware what those exceptions are.
First, confidentiality does not apply when a patient is recognized as to be a threat to others, unless hospitalized. Second, confidentiality does not apply once the law requires mandatory reporting. This includes communicable diseases, child or elder abuse, impaired driving, and any other requirement in a particular jurisdiction.
Third, depending on the state, court-ordered or subpoenaed records can be released with no patient's written authorization. However, a great clinician will often notify the individual and make an effort to obtain written authorization before honoring the court's request.
Certain states (such as Connecticut) have laws that supercede the government HIPAA laws on "protected" records subpoenaed by the court. Most states still need a HIPAA authorization for release towards the court be signed by the patient. If a signed patient authorization cannot be obtained, appropriate steps should be taken under state law by the clinician to resist the subpoena. These actions usually involve engaging a lawyer to file such motions in the state court system.
Fourth, hospitals and offices may release minimally necessary healthcare information with no patient's written permission for that purposes of treatment, payment, or operations (such as quality control, peer review, and teaching). This is encompassed under the HIPAA rules (discussed later here).
The most important step to bear in mind whenever a clinician releases psychiatric information about someone to a different person without that patient's consent is the concept of "duty to 3rd parties." Most lawyers would rather to protect a breach of confidentiality case than a wrongful death case.
Clinician's understand this very well and in emergency situations may feel obligated to violate a patient's autonomy and confidentiality in order to protect her or him and the community from some greater harm. This is especially true when the patient is being evaluated in an urgent situation room.
In those instances, clinicians will normally not feel comfortable discharging someone before obtaining outside resources, and refusing to permit such contact will only delay discharge and in all likelihood ensure hospitalization under an involuntary commitment. A great clinician, however, will always inform the individual of his or her decisions and whom they are contacting.
The initial impetus behind HIPAA ended up being to extend the ability of people to maintain their healthcare insurance after termination of employment and reduce the exclusions for pre-existing conditions.
HIPAA was also an effort by the government to provide further controls over fraud and abuse of the Medicare system as well as standardize the electronic claims system between providers and third-party vendors. However, to many people, HIPAA is becoming synonymous with privacy because one of the first orders of business when one enters a doctor's office today is to receive a notice of privacy practice and sign that one received such notice.
The notice of privacy practice outlines the rights of the patient regarding privacy and the provider's duty to protect the health information generated inside the office or entity, describing the various ways in which one's healthcare information could be shared without requiring written permission unless the person objects to any such release in writing beforehand as outlined earlier.
Again, the notice also outlines the discharge of healthcare information as mandated legally as pointed out previously here. Additionally, it specifically mentions that psychiatric and drug and alcohol information are specially protected, although limited amounts of home elevators these diagnoses might be shared for the purpose of treatment, payment, or operations.
The notice specifically states that unless supplied with an itemized request it is assumed that information for example appointments could be shared via phone, mail, or with family members, etc. Finally, patients have the to view and amend their healthcare information by submitting an itemized request. This can be denied under specific circumstances outlined in the notice, but the patient has a to know the reasons and may appeal such denials.
Generally, when one first enters a doctor's office and begins filling out an array of forms, one form will be to authorize release of information for purposes of treatment, payment, and operations. With respect to payment, one's health insurance company requires medical information for that purposes of payment because it wants to understand what it's spending money on.
The term that insurance providers use to authorize payment is "medical necessity," meaning that they want proof that the bill delivered to them for any particular service was medically necessary and for that reason worthy of payment. This means that the clinician must send the insurer diagnosing and also the treatment rendered in order to show medical necessity, which may include copies from the clinician's documentation.
If a patient refuses to allow the release of such information, either the clinician may refuse to see or treat the individual, or if seen, the patient will be responsible for the balance. Again, it was the purpose of HIPAA to provide the patient with the right to make an informed decision on his / her health information privacy.
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