Remember the early days of the Clinton administration, when âol Bill anointed his wife Healthcare Czarina and threw her to the lions, with orders to come back with medical insurance for all Americans?
Alas, poor Hilary got eaten alive by the insurance lobbyists inside the Beltway, and the First Ladyâs quest for universal health coverage died a quick death.
One innovation that did survive, however, was âinsurance portabilityâ â the right to carry your medical coverage over from one employer to the next without undue restriction, such as having a âpre-existing conditionâ or a family history of a disease. This was protected in a 1996 federal law called, in the elegant phrasing that only Washington can come up with, the Health Insurance Portability and Accountability Act, or HIPAA.
âHIPAA.â Remember that term. Say it five times fast: âHIPPA, hippa, hippa...â Because even if you donât do a lot of healthcare-facility work, you may still be required to protect âpatient confidentialityâ under HIPAAâs new âspeech privacyâ rules. That could involve a project as seemingly innocuous as a drugstore, a dental office building, or a long-term nursing home. Letâs see what this means in practical terms.
From data protection to speech privacy
Among its many goals, HIPAA originally set out to protect the confidentiality of patientsâ insurance and medical records, especially computerized files. Given the threat from hackers and others who might misuse sensitive medical information, this seemed a perfectly reasonable thing to do.
Starting April 14, however, the ante goes up. Thatâs when the new federal speech privacy rule, âStandards for Privacy of Individually Identifiable Health Information,â goes into effect.
At that time, healthcare providers will have to show that they have created âreasonable safeguardsâ to protect the confidentiality of patientsâ conversations with doctors, nurses, medical students, PhD candidates, pharmacists, medical technicians, receptionists, clerks, secretaries â even clergy, volunteers, and maintenance staff.
At the University of Chicago Hospitals, for example, more than 10,000 people are being educated via computer-based training and live sessions.
Historically, most hospital designers and contractors have given lip service to concerns over whether confidential information might be overheard due to poor design. Hospital administrators and facilities managers also wanted precious construction dollars spent on more visible improvements.
But, even without HIPAA, there are sound reasons for tightening up on speech privacy in medical settings. As any experienced nurse or doctor will tell you, patients often withhold embarrassing or sensitive information â an unwanted pregnancy, a history of alcoholism, venereal disease, even homelessness â if they think they might be overheard. Who could blame them?
Without complete information about a patientâs history and condition, though, a doctor might prescribe the wrong drug, or otherwise pursue an inappropriate or ineffective course of treatment.
This can take matters straight from the hospital to the courtroom. Even though the new federal rules wonât go into effect till April, at least 60 lawsuits have already been filed in state courts, with patientsâ lawyers claiming that HIPAAâs privacy rules set a âstandard of careâ that must be adhered to by healthcare providers.
According to David M. Sykes, PhD, vice president of CSM/Acentech, Cambridge, Mass., and Susan A. Miller, JD, a partner with The Kearney Group, Concord, Mass., in one such case, a jury in Washington, D.C., awarded $25,000 to a patient whose HIV status was inadvertently revealed to the patientâs coworkers by a hospital employee.
A drugstore chain in California settled a suit involving a company pharmacist who revealed a customerâs HIV-positive condition to the manâs ex-wife. She used the information in a custody battle.
But donât panic. You should be able to solve the problem within your budget and using currently available resources. Sykes and Miller note that the feds, in the form of the Department of Health and Human Services, will be looking for four things.
First, solutions should be based on accepted standards. Kenneth P. Roy, senior research scientist at Armstrong World Industries, Lancaster, Pa., says such standards have been developed by the American Society of Testing and Materials, the American National Standards Institute, and the International Standards Organization.
Second, DHHS will ask if you followed âbest practices.â
Third, the feds will be looking for solutions that can be measured and monitored objectively.
Finally, youâll be expected to comply without making expensive âfixes,â such as building walls or installing costly new systems. And youâll have a year to make the retrofit before the feds jump on you.
What might such âreasonable safeguardsâ look like? According to Armstrongâs Roy, who holds a PhD in acoustics and is a U.S. representative to the ISO, you should be able to meet HIPAAâs oral privacy standards fairly easily, using a three-tiered approach: 1. Absorb sound, using ceiling panels. 2. Block sound, with walls, ceiling panels, doors, and partitions. 3. Cover up sound, with high-quality sound-masking systems, or âwhite noise.â
In simple terms, says Roy, âyou have to be aware of the signal-to-noise ratio.â In other words, you have to determine not simply how much sound is blocked, but what effect ambient (or supplied) noise has in masking conversations between patients and caregivers.
Roy says he started preaching about speech privacy in healthcare four years ago, but didnât get much reaction from hospital administrators. âNow thereâs the force of law to make that happen,â he says.
There. Now youâre hip to HIPAA. Donât you feel better already?
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For more information:
Armstrong World Industries
Kenneth P. Roy, PhD
c/o Linda A. Neal
laneal@armstrong.com
www.armstrong.com
717-396-5700
CSM/Acentech
David M. Sykes
david.sykes@remington-group.com
www.acentech.com/ssHIPAA.htm
The Kearney Group
Susan A. Miller, JD
tmsam@aol.com
USG Interiors
Free âHIPAA Brochureâ
800-USG-4YOU
www.usg.com
For a listing of speech privacy lawsuits, visit: www.healthprivacy.org.