Post on 25-Dec-2015
Protected Health Information (PHI)
Privileged Communication
• An exchange of information between two individuals in a confidential relationship. (Examples: Lawyer-client, Doctor-patient)
• A privileged communication is a private statement that must be kept in confidence by the recipient for the benefit of the communicator.
Medical Records
• Contain Protected Health Information• Fall under regulations of HIPAA• Deliberate alteration of a medical record is
illegal and unethical.• Errors can be corrected by a health
professional, if it is done correctly• Patients may request copies of medical
records and request corrections to entries.
HIPAA
• HIPAA Health Insurance Portability and Accountability Act
• Federal protection for privacy of health information in all states.
• Requires healthcare workers, insurance companies, and other professionals, to keep Protected Health Information (PHI) confidential.
Examples of Protected Health Information - PHI
Name Birth Date Fax Number Account Number Street Address Admission Date email address License Plate Number City Discharge Date Social Security Number
Date of Death Medical Record Number Full Face Photographic Images Zip Code Telephone Number Finger prints Any Other Unique Identifying Number,
Characteristic, or Code
The Privacy Rule
– Provides patients with certain rights - these rights are commonly referred to as the PATIENT PRIVACY RIGHTS.
– These rights are communicated to the patient in the Notice of Privacy Practices.
– If a patient wishes to exercise any of these Patient Privacy Rights (which are outlined on the next slide), they must do so in writing.
– Example – A patient has a right to obtain a copy of all medical records – A fee may be charged and it may need to be requested days in advance.
The Patient Privacy Rights Right to access PHI
Right to request an amendment to PHI
Right to request restrictions on how PHI is used for treatment, payment, and healthcare operations
Right to receive confidential communications
Right to request an accounting of disclosures
Right to complain to the Department of Health and Human Services’ Office for Civil Rights
Examples of Privacy Compliance Rules
• Keep all PHI locked and secured when you are away from your work area.
• Do not include any patient identifiers in the subject line of an email.
• Do not discuss PHI in public or common areas.
• Computer passwords should be complex
Fixing Errors in Medical Records
• Paper records – Draw one line through the error (it should remain readable). Date and initial the correction.
• Electronic records - make a new entry with today's date and time, stating your name and that you are correcting an error in a previous entry; give the date and time of the previous entry; and enter the corrected data or explanation.