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In-service April 2015
Private Encounters, Confidential Patients, and Requests for Alternative Communications
Anita Westbrook
Privacy Officer
in conjunction with: Sarah Webb‐King
Credentialed Trainer/Instructional Designer
Cadence/Prelude/Referrals/Welcome Patient Directory 3.1.20
The Directory may include:
• Patient Name
• Location in our facility
• General statement of condition (good, fair, etc.)
• Religious affiliation (available only to clergy)
Unless the patient tells UAMS not to, the above information may be provided to people who ask for the patient by name. We informally refer to patients who “opt out of the directory” as “no info” patients or “private encounters” in Epic. 2
Private Encounter
1. An example of a person who might choose not to be in the Directory is a high profile politician or movie star. 2. UAMS may sometimes choose to opt a patient out of the Directory for the safety of the patient or our staff. An example would be a crime victim. 3. Outpatients are informed about the Patient Directory in their appointment reminders
4. ED and Admissions staff verbally tell those patients about the Patient Directory and offer them the ability to “opt out”.
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Private Encounter Patients
5. If a patient asks to be excluded from the Directory, update the patient’s registration by marking “yes” in the Private Encounter field on the Encounter Info screen.
6. The Patient Information Desk will no longer see the patient on their list. 7. “episode driven” field ‐ remind patient to request a private encounter at each visit if they let you know they want to be opted out of the Patient Directory.
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Private Encounter Patients
8. Patients opting out of the directory should understand that, if a florist wants to make a delivery, or a family member calls for their room number, we will have to tell them we do not show the patient in our system
9. Giving a patient a patient type of prisoner, automatically gives them a Private Encounter. 5
SWK44
Private Encounter
What is this screen showing you? How would you make this icon appear on the Appointment Desk? That the appointment is marked as a Private Encounter. Path: Registration>>Appointment Info
Slide 6
SWK44
This is really great!
Webb-King, Sarah A, 2/17/2015
SWK45
Private Encounter
What is this screen showing you? How would you make this icon appear on Patient Station? That the appointment is marked as a Private Encounter. Registration>>Appointment Info
Slide 7
SWK45
This is really great!
Webb-King, Sarah A, 2/17/2015
SWK46
Private Encounter
What is this screen showing you? How would you make this icon appear on the DAR? That the appointment is marked as a Private Encounter. Path: IFS>>Appointment Info
Slide 8
SWK46
This is really great!
Webb-King, Sarah A, 2/17/2015
Break the Glass
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Although all patient records are protected by the HIPAA laws, an individual may ask to have their record placed under an extra level of security, for example, an employee who is a patient here, or UAMS may determine that additional protections should be placed on a patient’s record, for example a high profile patient in the media who has been admitted to UAMS.
In EPIC, a Confidential Patient Type during registration is used for this purpose. The user will be required to “break the glass” in most cases and give a reason for the access in order to view the patient’s information.
If you need the chart to carry out your specific job duties, it is still available to you after providing a reason. 9
Break the Glass
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Patients with a Private Encounter (no info) are not necessarily also behind break the glass
It helps to think about a “private encounter” as private to callers and visitors and “break the glass” as extra security on the patient’s record. A crime victim’s visit may need to be “private” so callers can’t get his room number, but his medical record wouldn’t necessarily need extra protection. An employee might want extra protections on her record with a Confidential Patient type. However, she may not want a private encounter because she wants the information desk to provide her room number to visitors. A movie star may need both – a private encounter so people can’t get her room number and also to be behind break the glass to deter “snooping”.
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SWK20
Confidential, Identify Theft & Private Encounters Recap
What is this screen showing me? How would you make this appear when looking up a patients’ record? That the patient is marked as Confidential. Path: IFS>>Detailed View>>Additional Info Slide 11
SWK20
This is really great!
Webb-King, Sarah A, 2/17/2015
SWK47
Confidential Patients
Identity Theft Flag
Scenario: You are checking in Julie for her appointment in Cardiology, she asks how she can place her medical records behind “break the glass”. How would mark this patient? Private Encounter
Confidential Patient Path: IFS>>Detailed View>>Additional Info
Slide 12
SWK47
This is really great!
Webb-King, Sarah A, 2/17/2015
SWK48
Confidential, Identify Theft & Private Encounters Recap
Identity Theft Flag
Scenario: Continuing with the same scenario, Julie also lets you know that she does not want her room number available to visitors or callers or her location in the outpatient clinics? Private Encounter
Confidential Patient Path: IFS>>Detailed View>>Additional Info
IFS>>Appointment Info
Slide 13
SWK48
This is really great!
Webb-King, Sarah A, 2/17/2015
Confidential, Identify Theft & Private Encounters Recap
T/F: When you mark an encounter as Private, the system automatically makes the patient Confidential. False
If the patient wanted to be Confidential, how could you do this as a separate action?
IFS>>Detailed View<<Additional Info Reference Tip Sheet: Confidential and Private Encounters, Putting it All Together
Requests for Communications by
Alternative Means or at Alternative
Locations
Examples include:
• A patient with an abusive spouse may request to receive mail from UAMS at a work address instead of their home address. • The legal guardian of an elderly patient may request communications from UAMS be sent to the guardian instead of the elderly patient. • Patient may request telephone communications be limited to home telephone
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Requests for Alternative
Communications
• UAMS will honor reasonable requests and does not require the patient to disclose an explanation or reason for the request.
• If necessary, we will require the patient to identify how payments will be made. • UAMS will not honor a patient’s request if it is unreasonable. An example of an unreasonable request would be a patient who requests that all communications containing protected health information be sent by overnight mail to an address in Canada. 16
Requests for Alternative
Communications
• If the patient requests their mail (appointment reminders, bills, etc.) be sent to an address other than their home address or requests phone calls be made to a phone number other than their home or work phone numbers, the temporary address and guarantor fields in Epic will be utilized as appropriate depending on the request. • Although the patient is not required to give an explanation or reason for the request, pertinent, available information regarding the request should be documented in the notes field.
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Requests for Alternative
Communications
• If the patient specifies an address or phone number that should never be utilized, even in the case of an emergency, that information should be left out of or removed from the system. For example, if a patient says that they never want to be called at work, the work phone number should not be included. • Employees communicating with patients must take care to use information present in the temporary address fields in Epic with current effective dates for all communications. • Supervisory approval must be obtained prior to using any information outside of the temporary address fields to contact the patient.
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Requests for Alternative
Communications
If the patient cannot be located by the alternative method requested, any available contact information may be used to locate the patient in the event that:
1. UAMS determines there is a situation where there is a medical emergency or similar situation where the patient’s health may be at risk if he/she is not contacted immediately, OR
2. if the patient has not provided adequate information on how payments will be made.
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Requests for Communications by
Alternative Means or at Alternative
Locations
Examples include:
• A patient with an abusive spouse may request to receive mail from UAMS at a work address instead of their home address. • The legal guardian of an elderly patient may request communications from UAMS be sent to the guardian instead of the elderly patient. • Patient may request telephone communications be limited to home telephone
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SWK42
Temporary Address
Temporary addresses MUST have a Start date and End date
Slide 21
SWK42
This is really great!
Webb-King, Sarah A, 2/17/2015
Additional FYI’s  We will no longer use the Confidential Address tab. BOTH Temporary addresses & Confidential Addresses will be stored in the Temporary Address field.  You MUST enter a start and end date for Temporary Addresses. Additional FYI’s Remember that Demographics addresses are used for appointment reminders and informative mailings. Billing statements are sent to the Guarantor address. If a patient wants his/her bills sent to a different address than the demographics address, you MUST also change the Guarantor address. Set the address link to No and enter the billing address that the patient would like to be used. Additional FYI’s Scenario: Kathy is remodeling her home and staying with her mother‐in‐law; during this time she would like all of her mail sent to her mother‐in‐law’s address. How do you mark this in the system? A. Change the demographics address to Kathy’s mother‐in‐law’s address
B. Change the BOTH the demographics and guarantor address to Kathy’s mother‐in‐law
C. Enter a temporary address of Kathy’s mother‐in‐law
D. Enter a temporary address of Kathy’s mother‐in‐law AND enter Kathy’s mother‐in‐law’s address in the guarantor address AND set the address link to “No”. Additional FYI’s What questions do you have???
For additional questions/reference, check us out on the web! Link to HIPAA Office: http://hipaa.uams.edu/
Phone: 603‐1379
Link to UConnect Training:
http://inside.uams.edu/uconnect/training/
Phone: 686‐8966