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Whom can you talk to?
Policy provides guidance on communication

The question of what patient information can be shared with whom is hardly a new one; the issue is as old as medicine itself. But with the implementation of the Health Insurance Portability and Accountability Act, disclosing patient information to inappropriate individuals is a potential privacy violation. HIPAA establishes for the first time that patients have a legal right to determine, with some exceptions, with whom their medical information can be shared.

To guide physicians in this area, Stanford Hospital & Clinics has established a policy on communication with friends, family and others involved in the patient's care.

Joe Schlesinger, a manager in SHC's privacy office, said the new policy is important because individuals not involved in a patient's care - including those with ulterior motives - may seek information about the patient and use it in a way that is not in the patient's best interest. Inquiries from a non-custodial parent, abusive ex-spouse or a news reporter posing as a family member are notable examples.

To protect patients' privacy rights under HIPAA, physicians and other health-care personnel should follow these guidelines:

Sharing information about the patient is permitted with family, friends and others involved in the patient's care when the patient indicates either implicitly or explicitly that such communication is appropriate. For example, when the patient brings another individual into the treatment room, it is implied that sharing information with this individual is appropriate.

In situations where it is unclear whether individuals accompanying the patient or calling by phone are involved in the patient's care, the clinician should ask for the patient's permission before sharing information. In addition, when a friend or family member calls seeking information, the physician should make a reasonable effort to be sure the caller is who he/she claims to be.

It is best not to discuss very sensitive information over the phone.

If the clinician cannot establish that an individual seeking information has a strong, established relationship with the patient or a legitimate need to know, the information shared should be limited to directory information and the patient's general condition.

If the patient is unconscious or otherwise unable to indicate which individuals can receive information, clinicians must use their professional judgment in determining what information should be shared with whom, based on the patient's best interests. In these cases, the clinician should consider factors including:

- Whether the individual has a family relationship with the patient.
- Whether the individual lives with the patient.
- How long the individual has known the patient.
- Whether the individual has accompanied the patient to medical appointments or treatment.

If the patient does not want anyone to know about his/her admission to the hospital, the patient can ask for a confidential stay and be removed from the hospital directory.

SHC's new communications policy "is essentially common courtesy codified into law," said Joseph Hopkins, clinical professor of medicine and associate chief of staff.

"When there are visitors in the patient's room or when someone calls asking for information, we need to stop and ask ourselves, 'Can I really talk to this person?'" Hopkins said. "In the past, if you gave out information inappropriately, you could get the patient really upset. Now if you do it, you could be violating the law."