MED INF 407 – Group Case Study #1Jody LinImran Khan (Project Manager)Lemuel DizonSteven StanfordTamanna Ahmed

Outline

•Grandmother’s Call

•Chicago PD Call

•BCBS Call

•Wife’s interaction

Summary | Issues | Considerations | Recommendations

Grandma Calling…

Summary• Elderly woman calls ICU

Nursing Station

• Claims to be Grandmother of patient John Smith who had an Emergency Surgery due to an accident at his work factory

• Grandmother distressed and wants to know how her grandson is doing…

Issues

•Grandmother’s Identity?

•Is it for the correct John Smith?

•Do we have the patient’s consent to share information?

•What information can be shared?

Considerations•If Patient is conscious:

▫Check if patient is able to talk himself▫Else, get Patient’s consent to disclose any

information

•If Patient is unconscious:▫If emergency contact or the person present

during time of admission for patient available, defer grandmother to him or her

▫Else, ask grandmother to contact patient’s work to obtain emergency contact

Recommendations

•Develop strong privacy policies and guidelines

•What kind of information could be shared?

•Who could it be shared with? Just with immediate family members?

•Have patient consent available in EMR / patient charts to quickly refer to

RecommendationsPros Cons

• Reduced liability of disclosing patient information

• Preserve patient confidentiality

• Prevent any possible identity theft

• Legally Correct

• Unpleasant family experience

• Overly cautious?

• Too defensive?

• Is it ethical?

Chicago PD Calling…

Summary• Chicago Police Officer calls ICU

Nursing Station

• Requests faxed copies of patient’s blood tests and other lab results because Mr. Smith’s supervisor suspects accident was drug-related

Issues•Does law enforcement (Chicago PD) have

legal right/standing to patient’s information?

•Should PHI be faxed to police department?

•Does employer have right to patient’s PHI (CPD is calling at the behest of the employer)?

Considerations•Per HIPAA, hospital may disclose PHI to

law enforcement only in a medical emergency - no such emergency exists

•If threshold was met for medical emergency - analysis of blood tests would still be excluded

•Although CPD may not have right to patient’s PHI, the employer may as the accident was work related

Recommendations

•Do not provide Chicago Police with patient’s lab results

•Ensure that written privacy policies and procedures are consistent with Privacy Rule and cover disclosure of PHI to law enforcement

RecommendationsPros Cons

• Legally Correct

• Reduced liability of disclosing patient information

• Preserve patient confidentiality

• May appear uncooperative to law enforcement

BCBS Calling…

Summary

Blue Cross Blue Shield representative calls for additional information regarding medical treatment.

Issues

•Is it appropriate to give out the information to the representative?

•Will there be breach in confidentiality?

Considerations•Withhold the requested information?

•Provide the requested information?

Recommendation

Provide the requested information to the BCBS

representative

RecommendationPros Cons

• Consistent with HIPAA provisions

• Expedite Payment Activity

• Failure to Preserve Patient Confidentiality

Wife Interaction…

Summary

• Wife asks nurse about husbands care & nurse gives wife copy of 1-year old internal memo.

• Wife discusses memo w/ independent informatics consultant

• Wife then calls hospital CEO & demands husbands medical bills be forgiven because she feels hospital caused the post-op infection.

• She threatens to alert Chicago Tribune to this problem and provide copy of internal memo.

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Issues

•Nurse’s Actions

•Independent Informatics Consultant Actions

•Wife’s demands to forgive all medical bills

•Wife’s threat to provide Chicago Tribune with copy of internal memo.

•What actions should CEO take?

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Nurse

•Nurse’s Inappropriate Actions▫Nurse’s statement made to the patient’s

wife, “this kind of post-op infection still happens all the time here.”

▫Providing wife w/ 1 year old internal memo•Hospital Actions to be taken

▫Educate staff regarding risk management and internal project confidentiality.

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Independent Informatics Consultant•Consultant’s Inappropriate Actions

▫Discussing 2-yr research project w/ wife▫Action violated a business associate

contract•Hospital Actions to be Taken

▫Educate personnel on confidentiality of internal projects

▫Possible grounds for termination

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Issues - Wife’s Demand to Forgive Medical Bills

•Consider the following questions:▫Any substance to Mrs. Smith’s accusation?▫Hospital’s post-op infection rate vs.

national average▫Result of 2-year project: Did the post-op

infection trend reverse?▫What improvements have been made as a

result of the study?

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Issues - Wife’s Demand to Forgive Medical Bills

•Consider the following questions:▫Cost of defending a lawsuit from this case?

▫Cost of negative publicity from this case?

▫Would acquiescing to Mrs. Smith’s demands invite more patients to do the same?

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Recommendations - Wife’s Demand to Forgive Medical Bills•Meet with Mrs. Smith

▫Involve Risk Management and Attending Physician

▫Frame discussion around quality care▫Emphasize the following points:

Commitment to improve Mr. Smith’s health Commitment to quality care

▫Assess Mrs. Smith’s motivation

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Options - Wife’s Demand to Forgive Medical Bills

•Option one: Acquiesce to Mrs. Smith’s demands

•Option two: Partial reduction of medical bills

•Option three: No reduction of medical bills

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Recommendation:

• Option three: Decline reduction in medical bills▫ 1-year old internal memo represents outdated

information

▫ Post-op infection rates since 1-year old memo show improvement and are below the national average

▫ Chance of successfully defending litigation high

▫ Should face little negative publicity

▫ Direct the Smith’s to a financial counselor if necessary

Option Three: No reduction in bills

Pros Cons

• Principled stance

• May dissuade future litigants from pursuing frivolous litigation

• Likely will result in legal action

• Likely will need to deal with media regarding publicizing internal memo

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Questions

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