Do You Use Employee Privacy and Security Policy and Procedure Checklist Templates?

Posted on September 12, 2019 by Jean Eaton in Blog

Why Do You Need Employee Onboarding and Exiting Checklists?

There is much excitement when we welcome a new hire to our team and many administrative tasks need to take place to get this individual up and running.

Policies and procedures must be in writing, available to employees, and monitored to ensure that they are followed to protect patient privacy as required by our professional colleges and privacy legislation. Otherwise, you face all sorts of risks, including privacy breaches and other legal problems.

To ensure that onboarding a new employee is a smooth transition, it is imperative to follow a practical checklist procedure to make sure no important steps are missed. There are also many other managerial benefits to adopting this high-quality process

Better job performance and satisfaction
Greater commitment to protecting privacy in the organization
Reduced stress and better staff retention

Employee Privacy and Security Checklist

Policies and procedures is a reasonable safeguard to protect the personal and health information entrusted to us. But polices and good intentions alone is not enough; we also need to take action to ensure our policies are understood and being followed by all our employees.

Training new and existing staff on privacy and security best practices is instrumental in making your healthcare practice a success and maintaining its fine reputation. Following a systematic approach to welcoming a new employee, transitioning an existing employee into a new position, or offboarding an employee who is exiting will guarantee that valuable privacy and security training and accesses are completed.

Read this Privacy Breach Nugget that explains what can happen if you don’t have these good practices in place. Do You Know Where Your Policies And Procedures Are?

New Employee Orientation / Onboarding

New employees are a welcome addition to any team and there is a vast amount of training that needs to take place from general procedures on how to handle phone calls to signing confidentiality oaths to becoming familiar with all policies and procedures, in addition to learning the everyday job duties for their own position.

Since privacy is good for business, we do not want to miss any important opportunities to train our new staff on privacy and security best practices. Using the Employee Privacy and Security Checklist will help facilitate training discussions and document the authorized accesses of each employee.

Existing Employees / Annual Review

The checklist will also act as a tool for each employee at their performance review. Provide positive feedback and observations of an employee’s successes in protecting personal information. Discuss opportunities for improvement, too. This is also a good time to review an employee’s current authorized role based accesses and determine if any changes to match the employee’s current job duties is needed.

Ensure that the employee still has ‘tokens’ that they were given at the time of their hire, like identity badge, keys to the clinic or Alberta Netcare RSA fob.

Privacy and security best practice dictate that confidentiality oaths should be signed on an annual basis and annual privacy awareness and security refresher training should also be provided to all employees. In the event of a privacy incident or breach, it is imperative that a healthcare practice can prove by their documentation that regular privacy and security training is provided to their staff.

Transferring / Exiting Employees

When an employee transitions into a new role or is terminated, review, and update the privacy and security checklist to ensure that access and permissions are appropriately modified or terminated.

Custodian Responsibility

Custodians have an obligation to ensure reasonable safeguards to protect the privacy and security of health information. This includes having appropriate policies and procedures in place, as well as demonstrating and documenting that you have implemented your plans. This is a requirement of professional college standards of practice and privacy legislation like the Health Information Act (HIA).

See the article Do You Know Where Your Policies And Procedures Are? to learn what can happen to you if you don’t have your employee training process well documented

The Employee Privacy and Security Checklist will make it easy for you to ensure your new hires, existing employees, and transferring or exiting employees are privacy and security compliant.

Download the FREE Report - Employee Privacy and Security Policy and Procedure Checklist Template

If you are a member of Practice Management Success, login and access the webinar replay, and the policy, procedure, and checklist template.

When we know better, we can do better…

Jean L. Eaton is constructively obsessive about privacy, confidentiality, and security expecially when it comes to the handling of personal health information. If you would like to discuss how I can help your practice, just send me an email. I am here to help you.

Jean L. Eaton
Your Practical Privacy Coach
INFORMATION MANAGERS

clinic, health care, healthcare, medical, policy, Practice Management Success, privacy, procedure, template

Do You Know Where Your Policies And Procedures Are?

Posted on September 2, 2019 by Jean Eaton in Blog

This is a cautionary tale.

And it could save you a lot of embarrassment – even legal issues.

The way a healthcare provider collects, uses and discloses personal health information (PHI) is critical to an efficient healthcare practice.

It’s also required by legislation and professional college regulations and standards.

Policies and procedures must be in writing, available to employees, and monitored to ensure that they are followed. Otherwise, you face all sorts of risks, including privacy breaches and other legal problems.

Policies and procedures must be in writing, available to employees, and monitored to ensure that they are followed. #PoliciesClick to Tweet

Don't let this happen to you!

Everyone in a healthcare practice — including front office staff, wellness practitioners and physicians and other custodians — must be aware of and follow these policies and procedures.

These policies and procedures also become the foundation of your privacy impact assessment (PIA).

That’s why, in this Privacy Breach Nugget, we’ll review a privacy breach investigation report from Alberta's Office of the Information and Privacy Commissioner (OIPC). Whether you have a new practice, or an existing practice, we have a number of services and resources designed to help you manage your practice in a way that not only meets legal requirements, but is streamlined and efficient, and keep your information secure.

What Happened

This report started with an employee suspected of accessing health information for an unauthorized purpose.

It started with at the clinic with a conflict between the employees and the employer.

An employee (Employee A) was on leave from her position at the clinic. Her access to the electronic medical record (EMR) was suspended during her leave.

Employee A wanted to access patient information to support her dispute with management. Over two months, Employee A used Employee B’s credentials to access patient records.

This action is in contravention of the Health Information Act (HIA) sections 27 and 28.

This is where this case becomes even more convoluted and, in fact, a better case study of what not to do.

Employee Dispute

Understanding the Health Information Act

The Health Information Act (HIA) requires the custodian (the physician, in this case) to take reasonable steps to maintain administrative, technical, and physical safeguards to protect patient privacy as required by sections 60 and 63 of the HIA, and section 8 of the Health Information Regulation.

In November 2013, the clinic submitted a privacy impact assessment (PIA) to the OIPC prior to its implementation of an electronic medical record (EMR).

The PIA included written policies and procedures.

The letter to the OIPC accompanying the PIA was signed by two physicians, as well as Employee A who was the privacy officer at that time.

The physician named in the investigative report is not the current custodian at the clinic. The physician was hired in 2015 and therefore not a member of the clinic in 2013 and not involved in the initial PIA submission.

During the investigation, both employees indicated that the policies and procedures to protect patient privacy were in a binder in the clinic, but it was never used or shared with the staff.

Oaths of confidentiality may have been previously signed by the employees, but the documents could not be produced during the investigation.

Section 8 (6) of the Regulation states the ‘custodian must ensure its affiliates are aware of and adhere to all of the custodians administrative, technical, and physical safeguards in respect of health information.’

It’s common practice for clinics to require employees to sign confidentiality agreements and ensure that they receive patient privacy awareness training with regular updates.

But in this investigation, the employees said they never received privacy awareness training.

Policy and Procedure Manual

Access To Patient Information

The employees also stated it was common practice at this clinic for individuals to not log off of their EMR account on the computers at the reception desks. It was common practice for other employees to access an open session to quickly perform a task in the EMR.

The investigator concluded that the physician was in contravention of the HIA section 63(1) which requires custodians to establish or adopt policies and procedures that would facilitate the implementation of the Act and regulations.

These specific findings were made:

The custodian failed to ensure the clinic employees were made aware of and adhered to the safeguards put in place to protect health information in contradiction contravention of section 8(6) of the regulation.
The custodian was in contravention of section 8(6) of the regulation which requires custodians to ensure that their affiliates are aware of and adhere to all of the custodian’s administrative, technical, and physical safeguards with respect to health information. It’s important to note any collection use or disclosure of health information by an affiliate of a custodian is considered to be the collection, use, and disclosure by the custodian.
The custodian failed to ensure the employee and the other clinic staff adhered to technical safeguards as required by section 60 of the HIA and section 8(6) of the regulations.

Privacy Breach Nuggets You Need to Know

Privacy breaches are in the news every day. The more you know how breaches can affect you allows you to be more proactive to prevent privacy breach pain.

Get Your Privacy Documents In Order

To protect yourself and your practice from patient privacy breaches (and massive fines, see the conclusion to this article), follow these steps.

Find your policies and procedures and review them with all staff and custodians. Make sure you document that this has been done.
Review and update your privacy awareness training and ensure all staff, including custodians, have completed this recently. Make sure you have this documented, including certificates of attendance if available.
Oath of confidentiality documents should be signed by all of all clinic staff and custodians and maintained in a secure location.
Review your privacy impact assessment and ensure all of your current custodians have read this and understand it. Visit this post for more information to help you determine if you need a PIA amendment.

Monitor

This incident occurred in 2016. The OIPC office did not recommend any additional sanctions against the clinic, physicians, or employees.

To get templates of policies and procedures for your healthcare practice, be sure to sign up for the Practice Management Success Membership

New Amendments To The HIA

This case might have turned out differently today.

New amendments, as of 2018, provide a provision for fines under the HIA ranging from $2,000 to $200,000.

The public — and our patients — expect and trust us to make sure that their personal health information is kept secure and confidential.

It’s our responsibility to make sure we have these administrative, technical, and physical safeguards in place and are maintained in a consistent fashion.

When you've done the hard work to implement your patient privacy policies and procedures and your privacy impact assessment, make sure you continue your journey and keep these documents up-to-date and current. To help you, sign up for the Practice Management Success Membership.

There are many patient privacy breaches in the news each day, and you never know when it could happen to you.

The more you know about the breaches and how they can affect you allows you to be more proactive to prevent privacy breach pain. If you need to prepare your privacy breach management plan, start your on-line training 4-Step Response Plan right away!

If you need templates of policies and procedures for your healthcare practice, be sure to sign up for the Practice Management Success Membership. These tips, tools, templates, and training will help you save time and money to develop and maintain policies and procedures in your healthcare practice.

When we know better, we can do better…

I’ve helped hundreds of healthcare practices prevent privacy breach pain like this. If you would like to discuss how I can help your practice, just send me an email. I am here to help you protect your practice.

PRIVACY BREACH NUGGETS are provided to help you add a ‘nugget' to your privacy education program. Share these with your staff and patients as a newsletter, poster, or staff meeting.

Jean L. Eaton, Your Practical Privacy Coach

Click Here To Register for the FREE Training Video "Can You Spot the Privacy Breach?"

Did you enjoy this article? If you’d like to look at similar posts, visit these links:

Do You Know Where Your Policies And Procedures Are?

Why Do You Need Health Information Policies and Procedures?

Healthcare Policies And Procedures: Essential in EVERY Practice

Safeguards: The What, Why, and How

When Do You Need a PIA Amendment?

When is a Privacy Breach a Privacy Breach?

References and Resources

Alberta Office of the Information and Privacy Commissioner. Investigation Report H2019-IR-01 Investigation into alleged unauthorized accesses and disclosures of health information at Consort and District Medical Society Clinic. May 21, 2019. https://www.oipc.ab.ca/media/996888/H2019-IR-01.pdf

#PrivacyBreachNugget, Alberta, clinic, custodian, health, Health Information Act, healthcare, HIA, medical, Patient privacy, physicians, Policies and procedures, Prevent privacy breaches, privacy, privacy breach, Privacy Impact Assessment, reasonable safeguards, templates

Privacy Principles Applies After Death

Posted on August 5, 2019 by Jean Eaton in Blog

Are your staff looking at medical records when they shouldn’t be?

Many people have the mistaken impression they can look at a patient's medical records as long as they don’t tell anyone else.

You can’t.

We see over and over again in ‘snooping’ cases where seasoned and new healthcare providers and support team members don’t realize that looking at patient’s health information without a need to know that information to provide a health service right away is wrong.

Kate Dewhirst summarized this as

Privacy = don’t look
Confidentiality = don’t tell

We still need privacy awareness training – even those experienced healthcare providers who push back and say that they have been in the business for years still often have more to learn.

Yes, we still need privacy awareness trainingClick to Tweet

In this post I am sharing an example of the Ontario’s Information Privacy Commissioner (IPC) complaint investigation from the family of a deceased individual. Whether you have a new practice, or an existing practice, we have a number of services and resources designed to help you manage your practice in a way that not only meets legal requirements, but is streamlined and efficient, and keep your information secure.

What Happened

In 2014, a physician acting in his role as a coroner, accessed the deceased’s health record. Shortly thereafter, the family alleged that the physician, who was also a family member of the deceased, continued to access the deceased’s personal health information (PHI) contrary to Ontario’s Personal Health Information Protection Act (PHIPA).

The family submitted a complaint to the hospital. Initially, the hospital's response did not satisfy the family. The family filed a complaint to the Information and Privacy Commissioner (IPC) of Ontario.

The IPC started a complaint investigation.

Privacy Breach Investigation

Privacy Complaint Investigation

Under PHIPA, the hospital is a health information custodian and the physician is an agent of the hospital.

During the IPC investigation, the physician confirmed he “accessed the health information in response to his concern about the individual’s well-being.”

“I know now that proceeding in this way was misguided and wrong.” He would never disclose the information to anyone; that would be a violation of patient privacy and a breach of doctor – patient confidentiality.

The physician acknowledged he did not fully appreciate the related but distinct concepts of patient privacy, the circle of care, and the ‘need to know’ principle.

Confidentiality rights arise out the special relationship between the client and the health professional or provider.

In contrast, privacy rights are the general rights of all persons to limit the access to their PHI. Individuals have the right to privacy, even after death.

Individuals have the right to #privacy, even after death. Click to Tweet

4 Step Response Plan

The hospital received a complaint from the family, which triggers the first step to spot and stop the breach.

Secondly, the hospital did an initial investigation to evaluate the risks of the incident. Later, after the IPC initiated their complaint investigation, the hospital re-visited the internal investigation and completed a comprehensive review and used audit log reporting tools to assist them.

Eventually, the hospital took the third step and notified the individuals’ family of the privacy breach. However, the notification was not timely. A more comprehensive response to the families’ complaint, followed by a notice to the family may have provided a better response.

Preventing a similar breach is the fourth step.

Since this incident, the hospital has:

installed a new auditing program that considerably enhances its ability to detect unauthorized access.
updated its Privacy and Confidentiality Policy, which applies to all agents of the hospital.
developed a yearly electronic privacy training program for all staff, volunteers and learners and will require all credentialed physicians to complete this training as part of the annual reappointment process.
strengthened the privacy warning on its electronic system, which warns users that unauthorized use of personal health information may result in disciplinary action.

Privacy Breach Physician Sanctions

The hospital’s Medical Advisory Committee recommended to the Board of Directors that the physician’s privileges be suspended for three months, that the hospital conduct enhanced monitoring of the physician’s access to the electronic medical record for three years, and that, on his return to practice, the physician be required to present at Grand Rounds on the topic of privacy.

The IPC concluded that the disciplinary consequences for the physician were sufficient in the circumstances.

Privacy Breach Nuggets You Need to Know

Privacy breaches are in the news every day. The more you know how breaches can affect you allows you to be more proactive to prevent privacy breach pain.

Privacy awareness education is more than just having policies and procedures. Demonstrating good practices, regular discussion about examples, and even gamification helps to ensure that all members of your healthcare team understand their roles and responsibilities.

If you need to start or update your privacy awareness training program, check out the on-line education Privacy Awareness in Healthcare: Essentials.

If you need to start or update your privacy breach management program, check out the 4 Step Response Plan; Prevent Privacy Breach Plan.

When we know better, we can do better…

PRIVACY BREACH NUGGETS are provided to help you add a ‘nugget' to your privacy education program. Share these with your staff and patients as a newsletter, poster, or staff meeting.

Jean L. Eaton, Your Practical Privacy Coach

Click Here To Register for the FREE Training Video "Can You Spot the Privacy Breach?"

References and Resources

Dewhirst, Kate. After Death: Who Can Access The Records Of A Patient After Death? May 7, 2019. https://katedewhirst.com/blog/2019/05/07/after-death-who-can-access-the-records-of-a-patient-after-death/

Ontario Information and Privacy Commissioner IPC Investigation Report PHIPA DECISION 74 HC15-4 Sault Area Hospital August 10, 2018.

#PrivacyBreachNugget, 4 Step Response Plan, clinic, complaint investigation, death, deceased, healthcare, IPC, medical, Ontario, PHIPA, privacy, privacy after death, privacy awareness training, privacy breach, privacy breach nugget, privacy principles

When Do You Need a PIA Amendment?

Posted on July 23, 2019 by Jean Eaton in Blog

A Privacy Impact Assessment Is Good For Business

A privacy impact assessment (PIA) is part of a regular business process if you collect, use, or disclose personal health information in your healthcare practice. When you have a previous PIA that has been prepared, submitted to the Office of the Information and Privacy Commissioner (OIPC) and it has been accepted for use–well, that is not the end of your PIA journey.

You need to ensure that you are updating and amending your PIA as your practice matures and as you make administrative and technical changes to the procedures in your practice.

You need a PIA Amendment when you have a previously accepted PIA and any one of these common triggers below.

You Have a PIA That Was Written More Than 2 Years Ago

It is time to review and update this!

Under Section 8(3) of Alberta’s Health Information Regulation, custodians must periodically review the safeguards they have in place to protect health information privacy. This means that custodians need to regularly review the privacy risk mitigation plans set out in PIAs to ensure they continue to protect against reasonably foreseeable risks to the privacy of health information. The submission of your PIA to the Office of the Information and Privacy Commissioner (OIPC) is mandatory and must precede implementation of your new system or practice.

Change in Health Information Act (HIA) Legislation and Regulations

The HIA has undergone significant amendments in 2006, 2010, most recently in August 2018. Make sure that you have updated your privacy breach management program and include mandatory privacy breach notification to the (OIPC) and the Minister of Health (MOH). Again, ensure that your team training has been updated so that they know how to spot, stop, and report a privacy breach. (See Mandatory Privacy Breach Notification)

Changes In Your Electronic Medical Record or Computer Network

You have the same EMR database, but maybe the configuration has changed. For example, a change from a local to an application service provider (ASP) or cloud-based data centre or Software as a Service (SAS) model would trigger a PIA amendment.

Another trigger is a change in your computer network vendor or changes in wireless networking, remote access, or implementing mobile devices.

PIA amendment EMR computer network

Change in Participating Physicians / Privacy Officer

Since your original PIA, you may have new custodians, including physicians, registered nurses, chiropractors, and other health professionals named in the HIA that have joined or left your practice. Your Privacy Officer may have changed, too. Your amendment should include an up-to-date listing of custodians and privacy officers.

New Users / Information Sharing

There have been many recent information sharing initiatives in healthcare. You might now plan to participate in evaluation projects, patient panel management, or other community initiatives. Make sure that you have your PIA amendment and information manager agreements completed, too. (See – The Top 3 Agreements Your Healthcare Practice MUST Have (and Why).

A quick word of caution: if your new information sharing project includes data matching–the creation of new information by combining two or more sets of data—requires custodians to prepare a privacy impact assessment before performing data matching involving health information (HIA sections 70, 71). The custodian that carries out the data matching is responsible for preparing the Privacy Impact Assessment.

PIA amendment new users

Communicating With Patients

If you are adding new technology to keep in touch with patients for appointment reminders, on-line appointment booking, secure email or patient portals, these will trigger a PIA amendment or, perhaps, a project specific PIA. Make sure that your policies and procedures are up to date, too. (See – Can You Use Text Message With Your Patients? )

PIA Amendment Communicating with patients

Alberta Netcare Portal (ANP) / Community Integration Initiative (CII) / CPAR

ANP updated their PIA in 2016 and, therefore, you need to make sure that your corresponding policies and procedures and training have been updated, too. Remember – when you agreed to participate in ANP, you promised that you would review your threat risk analysis (TRA) and update your Provincial Organization Readiness Assessment (p-ORA) when changes occur and at least every two years.

If you want to participate in new initiatives like CII and CPAR, you need to review and update both your PIA and your p-ORA, too.

Maturing Practice

You have learned and grown since your original Privacy Impact Assessment submission. Have you implemented everything that you said that you would? Can you demonstrate that your teams have received privacy and security awareness training? Have you reviewed your Health Information Management Privacy and Security policies and procedures in the last two years?

Keeping up to date without any other significant changes to your practice may not trigger a Privacy Impact Assessment amendment. Make sure that you document your careful review so that you are prepared for your next Privacy Impact Assessment submission.

Important Business Decisions

Creating and reviewing your PIA regularly can help you to spot errors or gaps between the way that you do the work in the clinic and the way that you said that you were going to implement in your clinic.

The questions that we ask during the PIA process are important. The time that you take now to identify the potential risks and prevent those incidents from happening may save you time, money, reputation and even jail time in the future.

You Know Your Practice Better Than Anyone Else

When you have a coach to guide you through the PIA amendment process, provide you with templates, and give you feedback on your work in regular live training webinars, join me in the on-line step-by-step course, Protect Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments.

Find out more here: Protect Your Practice, Your Assets, and Your Patients with Privacy Impact Assessments or send me an email.

Practice Management Nuggets Podcast

This topic is included in our Practice Management Nuggets podcast! Be sure to tune in to the podcast episode

When Do You Need a PIA Amendment? | Episode #078

Listen to the Podcast

#PrivacyImpactAssessment, #ProtectYourPractice, Alberta, clinic, health care, Health Information Act, healthcare, HIA, how to do a pia, medical, Netcare, PIA, Privacy Impact Assessment, privacy impact assessment amendment, training

How To Capture Patient Satisfaction With CareSay

Posted on July 2, 2019 by Jean Eaton in Blog

‘This call may be recorded to ensure quality control.’

We’ve all heard the recorded message when we call our bank or service provider .

But, is this the best way to capture patient satisfaction with their healthcare visit experience?

Are you looking for options to capture patient satisfaction with their interactions with your office staff during phone calls and their entire visit?

There are other options that require less technology, easier to implement, respects privacy, provides a more meaning constructive, helpful, feedback for your clinic team and engages your patients to improve their satisfaction.

I reached out to Brian Lee from Custom Learning Systems about his suggestions on how to explore patient satisfaction.

Brian Lee is my guest expert on Practice Management Nuggets Podcast for Your Healthcare Practice. Brian Lee is one of North America’s leading experts in the field of World-Class patient experience, staff engagement and culture change.

In this 16 minute episode, Brian Lee, shares options for the healthcare provider and business owner to easily capture and measure the patient's experience and give them an opportunity for feedback so that you can improve patient satisfaction and patient care in your healthcare practice.

Brian Shares His Key Tips Including

Options to create a patient experience survey (including CGCAPS).
New tools that empowers the patient to provide clinics with feedback about their experience.

New tools empowers the patient to provide clinics with feedback about their experience.

My Favorite Takeaways From The Podcast

Ensure that we do constructive, positive education with our caregivers.
Measure the patient's experience.
Empower the patient to provide the clinic and the caregivers with feedback.

Be sure to tune in to my interview with Brian Lee on How To Capture Patient Satisfaction With CareSay | Episode #077

Then, click here to get the free CareSay Review app: the unique new app to help you Connecting service providers and patients in a whole new way!

If you are a member of Practice Management Success, login here and view the webinar replay.

#digitalhealth, #PatientCenteredClinic, #PatientEngagement, #PracticeManagementNuggets, Brian Lee, CareSay, CGCAP, clinic, Everyone's a Caregiver, healthcare, medical, patient centered clinic, patient satisfaction, podcast, review

Are You Drowning in Patient Referrals?

Posted on May 13, 2019 by Jean Eaton in Blog

Are you drowning in patient referrals?

Playing telephone tag with specialists and patients?

Faxing is old technology, a massive time waster, and can be very costly both financially and emotionally when faxes get lost in the system.

In our Practice Management Nugget Webinars for Your Healthcare Practice series on October 12, 2017, I spoke with Dr. Denis Vincent, Physician Founder of ezReferral. There are many things that you can do right away to improve patient referral management.

Dr. Denis Vincent's #1 Tip to improve the patient referral process:

“Find more effective ways to involve and engage the patient in the referral process.”

The traditional referral workflow is inefficient

Using phone and fax messages from the referring provider to the consulting provider and back to the referring provider and then to the patient takes time. And every time that the message is transferred, there is a risk that the message is not understood or is lost.

So, we have a tendency to create complicated backup systems to double-check and make sure that none of the steps get missed. Many practices have created a ‘referral binder’ monster – the master referral list for the clinic. This binder is full of post-it notes, tags, and phone messages and reminders to help us make sure that the referral appointment is booked, the patient is notified, and the appropriate follow-up takes place.

Even in practices with an electronic medical record (EMR), we use a paper process to ‘make it easier’ to track patient referrals.

But the binder can only be used by one person at a time and only seen by the people in that office. The patient has no idea about the status of their referral so they phone the office regularly to ask for updates.

But wait! We want to make sure that everyone knows what is happening with the referral. We leave phone messages and voice mail and talk to the patient, the specialist, the referring provider to remind, confirm, and follow-up.

Save 60 minutes for each patient referral

Denis Vincent suggests that his family physician office referral coordinator used to spend an average of 75 minutes on each patient referral. That referral cycle can take months just to get to the point where the specialist appoint is confirmed and the patient is notified.

Now, using ezReferral, the entire referral process takes an average of 15 minutes of staff time per patient referral. That is a savings of 60 minutes per referral!

You can do this when you use a synchronous patient referral management system. EzReferral is a secure cloud-based solution that manages the patient referral process with clear real-time communication that the referring provider, specialist provider, and the patient can see at any time.

Multi-disciplinary healthcare team

ezReferral is designed to work with any multi-disciplinary referral pattern in your practice. For example, family physician to specialist physician or any other healthcare provider.

14 days from referral order to confirming appointment. Can you do that?

Starting in January 2017, physicians in Alberta must meet new time frames for acknowledging and responding to referral requests. If you are asked to consult on a patient, you will have:^[1]

7 days to acknowledge receipt of the request to the referring healthcare provider.
14 days to let the referring healthcare provider know whether you can accept the referral.
14 days to contact the patient to schedule an appointment or to confirm the status of the referral, if no appointment date has been determined.
30 days to provide the referring healthcare provider with a written report after your first appointment with the patient.
Consulting physicians will also need to be reasonably available to respond to referral requests and ensure their process is accessible.
Referring physicians will have to make sure they include all pertinent clinical information (including relevant investigation results) and the purpose of the consultation with their request, to enable the consulting physician to determine whether he/she can accept the referral within the mandated 14-day time frame.

([1] College of Physicians and Surgeons of Alberta)

These are good standards to meet for every type of healthcare provider.

You can meet these standards when you use a synchronous patient referral management system. EzReferral is a secure cloud-based solution that manages the patient referral process with clear real-time communication that the referring provider, specialist provider, and the patient can see at any time.

ezReferral Patient Text Message

Patient Benefits

Patient Engagement
Patient Satisfaction
Patient Peace of Mind
Better Patient Care

Referrer Benefits

Happier patients
Reduce workload
Eliminate the “black hole”
Satisfied Staff

Specialist Benefits

Reduced workload
Reduce no-shows
Reduce phone calls
Reduce overhead
Audit trail

Testimonial from Edmonton Eyelids

“Our office has been using ezReferral since July 2016. It’s easy to rave about this powerful communication tool – each referral received through this system takes a fraction of the time required through our faxed referral system, due mainly to the fact that most patients choose to receive referral notifications by text and/or email (thereby eliminating the “middle ground” in which some referrals can get lost). What truly sets ezReferral apart from ANY online interface that I have ever used: the support staff is accessible, proactive, and fast.”

Shawna Sazwan
Edmonton Eyelids

Dr. Vincent has implemented ezReferral in his family practice. I have to admit, I’m blown away with his experience that 95% of the patients choose to receive their notifications by text messaging. That’s much better than I anticipated.

This solution is ideal for healthcare practices with referrals within the medical community and even better when you are working with multidisciplinary referral teams. This works well for both paper based and electronic medical record based practices.

Watch the webinar replay now to see how you can save time, money, while improving the patients’ access to health care in a timely, efficient manner. You will also discover the key steps and timelines to prepare for implementation in your practice.

Practice Management Nugget webinar interview with Denis Vincent was recorded live on October 12, 2017.

Watch the Webinar

If you are a member of Practice Management Success, login here and view the webinar replay and access the members-only resources.

#PracticeManagementNuggets, Dr. Denis Vincent, ez Referral, ezReferral, fax, health care, healthcare, medical, patient referral management, practice management, review ezReferral

Fax Received in Error – Is this a Notifiable Privacy Breach?|

Posted on March 28, 2019 by Jean Eaton in Blog

Has this ever happened to you?

You are a clinic manager in a healthcare practice. One day, you receive a phone from a healthcare provider in another clinic.

They have received a fax with patients’ health information from someone in your clinic. But the fax is not addressed to them – they received it in error.

Is this a mandatory notifiable privacy breach under Alberta’s new Health Information Act (HIA) regulations?

Part A: Circumstances Where Notification Is Required

There are 5 triggers under the Alberta Health Information Act (HIA) that require mandatory privacy breach notification to the Office of the Information and Privacy Commissioner (OIPC) and the Alberta Minister of Health and the individual(s) affected in the breach.

In this scenario, the receiving custodian accessed health information for an individual who was not his patient. Clearly, there is a reasonable basis to believe that the information has been accessed (read) by a person (section 8.1(1)(a) of the Health Information Regulation.)

However, the sending custodian had no reason to believe that the information would be misused.

Fax Sending Receiving Error

Part B: Circumstances Where Notification Is Not Required

The sending custodian assessed the circumstances of the breach and concluded (as per section 8.1(1)(i) of the Health Information Regulation) that the receiving custodian:

Accessed the health information in a manner consistent with his role as a health services provider and did not do it for an improper purpose.
Is subject to confidentiality policies and procedures that meet the requirements of section 60 of the Act.
Did not use or disclose the information beyond determining that he received it in error.

The sending custodian assessed that the risk is appropriately mitigated and this privacy breach incident did not trigger mandatory notification requirements.

Next Steps

The sending custodian must record the privacy breach in their business records. (I suggest that you use an internal privacy breach reporting form and spreadsheet. You can access these templates in the 4 Step Response Plan.) Remember to include your determination that you do not need to report this breach and the reasons that support your decision.

We know that faxes are a frequent source of privacy breach incidents. What can you do in your practice to reduce the risk of faxes in error?

Practice Management Nuggets Podcast

This topic is included in our Practice Management Nuggets podcast! Be sure to tune in to the podcast episode Fax Received in Error – Is this a Notifiable Privacy Breach? | Episode #067 .

Listen to the Podcast

My Favorite Takeaways From the Podcast

Understand the mandatory privacy breach notification triggers and the circumstances where notification is not required.
Record your privacy breaches – even the ones that do not trigger mandatory privacy breach notification.
Review and improve your fax procedures. We know that this continues to be a frequent source of breaches. What can you do to better manage this known risk?

If you are a member of Practice Management Success, login here and view the webinar replay.

#PracticeManagementNuggets, clinic, fax, healthfare, mandatory privacy breach notification, medical, podcast, privacy breach

Curiosity Is NOT Need-To-Know

Posted on February 18, 2019 by Jean Eaton in Blog

I am often asked if it is ‘OK’ to look up patients information on Netcare when the patient hasn’t been seen for some time and the care provider wants to know how they are doing.

Let me be clear: If you are not currently providing a health service to the patient in a current episode of care, you must not look up that patient’s information on Netcare or any other EMR or paper system.

The patient has a right to privacy – which means don’t look unless you have a need to know.

Curiosity is not a legitimate need to know. That is snooping!

You Can Use This Privacy Breach Example to Review and Improve Your Practices

Pro-active Auditing Reveals Snooping in Sask eHealth

What Happened

On April 6, 2018, a highway collision occurred involving the hockey team Humboldt Broncos which left 16 dead and 13 injured.

The trustee of the Saskatchewan Electronic Health Record Viewer, eHealth, pro-actively audited their electronic health record system to identify potential unauthorized use of the system by authorized users.

eHealth detected that two physicians and an administrator at the Humboldt Clinic Limited inappropriately accessed the personal health information of two individuals involved in a collision involving the Humboldt Broncos.

The auditing revealed that there were many instances where access was made between April 7 and April 10 to the records of two patients. The records belonged to two individuals who died in the crash on April 6.

The physicians had provided care to the individuals in January of 2018 but were not involved in providing care to them on or about April 6. The physicians’ access was prompted because of their ‘concern’ for the individuals.

[click_to_tweet tweet=”Curiosity is NOT need-to-know! The patient has a right to privacy – which means don’t look unless you have a need to know to provide a current health service to the patient. @InfomanLtd #PrivacyBreach #Privacy #PrivacyBreachNugget” quote=”Curiosity is NOT need-to-know! “]

Clearly, these users of the Viewer were not currently providing care and treatment to the patients.

The access of the Viewer in this example not a legitimate need-to-know under Saskatchewan’s The Health Information Protection Act (HIPA).

eHealth reported these privacy breaches to the Information and Privacy Commissioner (IPC) of Saskatchewan.

4 Step Response Plan

The trustee, eHealth, undertook the first step to respond to a privacy breach by spotting and stopping the breach. The audit identified the breach. Then eHealth contained the breach by suspending or terminating access to the Viewer.

Secondly, eHealth appropriately notified the individuals’ next of kin of the privacy breach.

The third step is to investigate the breach. eHealth notified the IPC of the breach. The clinic, however, did not investigate the cause of the privacy beach.

Preventing a similar breach is the fourth step. The clinic has privacy policies and a privacy training strategy. The eHealth Viewer also has online training for its users.

IPC Recommendations

Subsequent to its investigation, the Saskatchewan IPC observed that the training had not prevented this breach.

The IPA recommended that the clinic provide further training to its employees and contractors on the need-to-know principle. Additionally, the clinic is recommended to document the privacy breaches and the lessons learned to prevent a similar privacy breach.

Reference: Saskatchewan IPC Investigation Report 177-2018, January 29, 2019

Privacy Breach Nuggets You Need to Know

There are many privacy breaches in the news each day. The more you know about the breaches and how they can affect you allows you to be more proactive to prevent privacy breach pain.

Privacy education is more than just having policies and procedures. Demonstrating good practices, regular discussion about examples, and even gamification helps to ensure that all members of your healthcare team understand their roles and responsibilities.

If you need to start or update your privacy breach management program, check out the 4 Step Response Plan; Prevent Privacy Breach Pain.

“When we know better, we can do better”

I’ve helped hundreds of healthcare practices prevent privacy breach pain like this. If you would like to discuss how I can help your practice, just send me an email. I am here to help you.

Jean L. Eaton, Your Practical Privacy Coach

#digitalhealth, clinic, healthcare, HIPA, Humboldt, medical, privacy breach, privacy breach nugget

The Top 3 Agreements Your Healthcare Practice MUST Have (and Why)

Posted on November 29, 2018 by Jean Eaton in Blog

In order to provide services, healthcare practices must collect pertinent information from patients. This data gathering often includes many sources of information, across different types of technology, among multiple vendors. Good business practices and health records management is supported by three agreements your healthcare must have: information manager agreement (IMA), information sharing agreement (ISA), and successor custodian agreement.

For instance, when a patient attends a clinic, their details are nearly always entered into a computer software program to maintain demographic information, manage patient appointments, and to process payments. Often, health service providers (including physicians, pharmacists, chiropractors, dentists, psychiatrists and more) record their patients’ notes into an electronic medical record (EMR).

Patient information is shared between providers where required. For example, when the patient visits a diagnostic lab for testing, results are often transmitted electronically to the ordering physician’s fax machine or to the EMR.

Custodians including physicians, pharmacists, chiropractors, dentists, and psychiatrists, as defined by the Alberta’s Health Information Act (HIA), must follow HIA legislation when they collect, use, and disclose health information.

Often, custodians are also the owners of independent healthcare practices. However, an owner of a healthcare practice is not the custodian if they are not also an active member of a regulated health profession named as custodians in the HIA.

1. Information Manager Agreement

The HIA allows custodians to contract with other health service providers and vendors for the purposes of providing information management or information technology services, so patients can receive health services, and make payments. This often requires the custodian to share patient information with a vendor (or give them access to) so the vendor can process, store, or provide information as needed.

The custodian selects one or more business to provide the services, equipment, or software to assist in the management of health information. For example: EMR provider, contracted transcriptionist, billing agent, remote backup service, etc. These businesses are known in the HIA as information managers.

Before sharing health information with someone else, the custodian must ensure that the partners and vendors have reasonable safeguards in place to protect sensitive health information. The custodians must ensure that there is a written agreement between the custodian and the information manager. These agreements are known as “Information Manager Agreements.” This requirement is stated in the HIA section 66(2).

The Information Manager Agreement (IMA) is one of three crucial agreements a healthcare practice must have in place.

If You Don’t Have an IMA

If you are a custodian who uses vendors as part of your business and you do not have an IMA with that vendor…

You are in breach of the HIA.
You may incur fines under the HIA.
You may face sanctions and disciplinary actions from your professional regulatory college.
Almost certainly, you will encounter conflicts, poor communication, between yourself and the vendor(s) and the other participating custodians in your practice.
You may lose control of the health information as reported in the Investigation Report H2013-IR-01from the Alberta Office of the Information and Privacy Commissioner (OIPC).

In a press release from the Alberta OIPC in 2013, Information and Privacy Commissioner Jill Clayton noted that:

“The HIA allows custodians to disclose health information to IT service providers, such as EMR vendors, under an appropriate Information Manager Agreement. When custodians do not sign these agreements, they may find themselves in the unfortunate position of losing control over the health information they need to provide health services.”

Investigation Report H2013-IR-01 (https://www.oipc.ab.ca/news-and-events/news-releases/2013/investigation-report-h2013-ir-01.aspx)

Who Must Create the Information Manager Agreement?

The custodian is responsible to ensure that there is an appropriate IMA created and signed.

The information manager can assist the custodian by preparing templates of the IMA including specific details of the services that they will provide and the safeguards that the vendor will implement to protect personal health information.

Key Points About IMAs

A few important notes about IMAs.

IMA must be signed by the custodian.
Agreements signed by individuals who are not custodians are not valid under the HIA.
Custodians are required under the HIA to have an IMA with the vendor before disclosing health information. If there is no agreement in place, the custodian is in breach of the HIA.
Custodians are responsible for the health information that they collect, use, and disclose. Therefore, the custodian is responsible for the IMA and to ensure that the health information will be handled confidently and securely.

Key Points IMA

The custodian can select the best vendor and information manager for the job. The vendor who understands the requirements of the HIA and who can demonstrate that they have implemented the appropriate reasonable safeguards and can assist the custodian to develop an appropriate IMA is, in my opinion, demonstrating a significant competitive advantage.

All healthcare providers in a community practice should spend time when creating their business to establish good business practices, including developing written contracts and agreements to improve the efficiency of the business and to make things happen in the way that they are planned.

Here is a common example

Dr. Alice and Dr. Mark created a welcoming family medical practice in a new sub-division of their city. They each worked hard to attract new patients, hire and train staff, and develop a profitable business.

In the last few years, Alice and Mark had differences of opinion on how to grow their business. In the end, Alice decided that this type of practice wasn’t for her. She decided to leave and join a larger practice in a neighbouring subdivision. Alice wanted to take her patient’s records with her to her new practice and continue to see her patients at the new location.

Mark, who had signed the IMA with the EMR vendor, did not agree to Alice’s request to transfer her patient records to her new group practice.

Alice and Mark argued and eventually involved a professional mediator to help them resolve their business conflict. Hurt feelings between the providers and staff, costly delays in their business and expenses could have been avoided if Alice and Mark had established clear expectations in the event of the termination of their business partnership when they started their group practice. An IMA between custodians in a group practice is a recommended best practice.

When You Have Multiple Custodians in Your Healthcare Practice

When the practice has multiple providers, the owner and custodian frequently assumes responsibility for maintaining the contracts and IMAs with the vendors. Each of the participating healthcare providers may delegate the responsibility of maintaining the vendor arrangements to the custodian owner. This can be achieved with an IMA between the owner / custodian and each participating custodian.

Custodian Owner IMA

Each healthcare provider custodian is considered the custodian of the health information that they collect. The custodians can jointly agree to all use the same EMR. This provides continuity of care for the patients and economy of scale for the participants of the practice.

When the owner/custodian signs the agreement with the EMR, they become the signatory custodian. The EMR vendor takes their instructions from the signatory custodian.

The owner / custodian is now an information manager for all the participating custodians. but does not become a custodian of the health information provided to them in their roles as an information manager.

For example,

Dr. Bill opened his medical practice, ABC Clinic. Later, additional physicians were recruited to work at ABC Clinic. The physicians are each custodians as defined by the HIA.

Dr. Bill assumes the responsibility for the operations of the clinic including the computer network and the contract with the EMR vendor. Dr. Bill is the information manager for the patient records at the clinic.

Each physician signs an IMA with Dr. Bill and agree that he will continue to manage the patient records on their behalf. Dr. Bill is operating as an information manager.

In his role of the information manager, Dr. Bill must follow the instructions from each physician, the custodian, as it relates to the management of their patients’ records.

2. Information Sharing Agreement (ISA)

When you have more than one physician in your practice, you need an agreement about how you will decide to manage the personal health information in your practice.

An Information Sharing Agreement (ISA) focuses on the internal decision making about all things related to personal health information whereas, an IMA is an agreement with a single vendor about the services that the vendor provides.

ISA IMA

An ISA may include things related to the services that a vendor provides but is not limited to just vendor services.

It also includes decisions about the process to ensure appropriate role based access to personal health information in the EMR, computer network, and paper formats; the regular review of health information privacy and security policies and procedures, ensuring privacy and security awareness training, the regular review of administrative, technical, and physical safeguards in the practice, and so on.

In larger organizations or when several smaller organizations participate in an information sharing initiative, a Data Management Committee may provide oversight and facilitate this process.

An ISA is a requirement of the College of Physicians and Surgeons of Alberta.

Identifying a successor custodian is also a requirement of the College of Physicians and Surgeons (CPSA).

3. Successor Custodianship Agreement

As a business owner, you need to plan a successor to the business. This might be an interim or short-term decision to ensure continuity during an absence or future retirement planning or unexpected illness or death.

In healthcare, physicians and custodians have the added responsibility as the ‘gatekeeper’ for patient records. In the event of a sudden inability to meet these responsibilities, physicians need to identify a successor custodian to ensure appropriate and continued access by patients to their health information for their continuing care and treatment and to ensure that the continuing confidentiality, security, and access to patient records continue to be fulfilled.

Have you identified a successor custodian? Each of the physicians in your group practice should also identify their own successor custodian.

This is a CPSA requirement and should also be included in the Privacy Impact Assessment if you have this information available. See CPSA, Patient Record Retention, s.5:

A regulated member acting as a custodian must designate a successor custodian to ensure the retention and accessibility of patient records in the event the regulated member is unable to continue as custodian. (Reference: Health Information Act Section 35(1)(q)

If you are a chiropractor, the Alberta College and Association of Chiropractors (ACAC) further requires its members to name a chiropractor as the successor custodian to maintain the status of ‘chiropractic’ records. (See the ACAC’s Standards of Practice s5.3 Custodianship of Health Records.)

A chiropractor, as a custodian of health records, is responsible for the care and control of the health records in their practices as required by the Health Information Act of Alberta. A custodian of active chiropractic files must be under the custody or control of an active, registered member of the ACAC.

Note that under the Health Information Act, a chiropractor may disclose files to another custodian who is not a chiropractor, and only a chiropractor may have custody or control of chiropractic files. Chiropractic files disclosed to a non-chiropractor should no longer be considered chiropractic files.

A custodian must implement technical and physical safeguards to protect the confidentiality of the information and privacy of individuals as well as protections against reasonably anticipated threats to the security or integrity of the information. A custodian must also defend against unauthorized uses, disclosures or modifications of the information. Safeguards must be periodically assessed and documented in policies and procedures.

If you are working in an owner/custodian scenario discussed above, clearly identifying a successor custodian becomes imperative. An unplanned absence of the owner / custodian can seriously jeopardize the business and the continuing care and treatment of patients.

The custodian can, but is not required to, name another custodian in the same practice to be their successor. Whatever your decision, ensure that this is well documented and easily accessible to the other custodians and key decision makers in your organization in the event of an emergency.

The best time to create IMA, ISA, and Successor Custodianship Agreements is when you start your healthcare business.

The second best time in now.

What are you waiting for?

If you need assistance, contact Jean L. Eaton, Your Practical Privacy Coach and Practice Management Mentor with Information Managers. I’m here to help you with your Practice Management Success.

Download the FREE Report - Top 3 Agreements Your Healthcare Practice MUST Have

If you are a member of Practice Management Success, login here to access the Top 3 Agreements.

When we know better, we can do better…

Jean L. Eaton is constructively obsessive about privacy, confidentiality, and security especially when it comes to the handling of personal health information. If you would like to discuss how I can help your practice, just send me an email. I am here to help you.

Jean L. Eaton
Your Practical Privacy Coach
INFORMATION MANAGERS

chiropractors, dentists, health care, Health Information Act, healthcare, HIA, IMA, information management agreement, information manager agreement, information sharing agreement, ISA, medical, physicians, Practice Management Success, successor custodian

How to Prepare Patient Records for a Court Order in Your Healthcare Practice

Posted on September 25, 2018 by Jean Eaton in Blog

You are working at the reception desk of a healthcare practice. Suddenly, there is a police officer or court officer giving you a court order to produce patient records!

Don’t Panic!

In this month’s Q&A with Jean, we discussed how to prepare patient records for a court order with confidence!

Now, just a reminder, I’m not a lawyer and I don’t play one on TV. These are my recommendations based on my experience as a director of health records in hospitals in Canada, as a court reporter, and as a mentor to clinic managers in independent healthcare practices and not legal advice.

Follow These Steps

In this article, I am not discussing a situation which relates to a life-threatening situation that requires an immediate response. I am also not discussing when order relates to the type or quality of healthcare provided to the patient or when the actions of the healthcare provider or clinic is being challenged or reviewed. These are topics for a different article.

Your reception staff should not accept the court order but, instead, immediately ask the officer to wait for a few minutes so that they can request their supervisor or privacy officer to meet with them.

When the court order is an administrative request for information, the supervisor or privacy officer will accept the court order from the officer. Before the officer leaves, make sure that you read the court order carefully and ensure:

Who is named in the court order often the clinic manager of the clinic. Your clinic should be specifically named or, perhaps, the name of your lead physician or healthcare provider.
Record the date and time that you received the order.
Clarify when the response is required.
The name and the contact person of the officer that delivered the court order (if possible) or, at minimum, the contact information of the court, for example, the court clerk’s office or the witness co-ordinator, or the sheriff’s office is included on the court order.
The province or jurisdiction of the court. Generally, it should be the same province where your clinic operates. If not, contact your lawyer for advice on how to respond.

Review Your Policies and Procedures

This is not a routine request from a patient to access their health records or a request to disclose their records to a third party like a lawyer or insurance company. In those routine requests, patients routinely require to provide a written, signed consent before you can disclose their records.

When you receive a court order or subpoena to produce patient records at a court or other legal proceeding, you are not required to get a signed consent from the patient.

Each healthcare practice should have detailed policies and procedures on how to prepare patient records for a court order. Review these now.

If you don’t have up-to-date policies and procedures, see the Practice Management Success Tip, How to Prepare Patient Records for a Court Order.

Validate the Court Order

Read the court order carefully. In particular,

Phone the contact number on the court order.
Confirm the date, time, and location that you are required to appear.

Locate the Patient Record

Find the patient information maintained in an electronic database, electronic medical record (EMR) and/or paper records. Remember to look for both active and inactive patient records as needed by the court order.

Read the patient record carefully, line by line, to ensure that the record is complete. For example, make sure that all lab reports, prescriptions, consultation notes, etc. are included in the record.

Secure the record to prevent snooping or modification to the record. Also ensure that the record is available for continuing care and treatment of the patient, if needed.

In an electronic record, prepare an audit log of all the transactions on that patients’ chart.

Ensure there is no duplicate or second chart for the patient that may have been created in error. Search by alternate names, spellings, date of birth, etc.

Ensure that each custodian included in the patients’ care and your healthcare practice’s privacy officer is informed of the court order to produce the record. The custodian should be provided an opportunity to review their clinic notes. Remind the custodian that they cannot further disclose the patient's record.

Prepare the Patient Record

Review the court order and identify exactly what information is requested. It might be for specific dates or a condition or treatment.

Keep complete and detailed notes about how you prepared your response to the court order. You will bring your notes with you to court to assist you in your testimony about how your clinic creates and maintains patient records and what you did to respond to the court order. After your court appearance, you will maintain your notes as part of the business records for the clinic.

Collect the information and record each of your steps and your results, including the records that you searched for and did not find any results.

If you maintain your patient records in an electronic medical record (EMR) or digital practice management software, print out a hard copy of all the information that responds to the information that is requested.

Sever (also known as redact or black-line) any information that is not appropriate to include in the disclosure. Cross-reference each redacted entry to the legal authority not to include the information in the disclosure.

If you are using an EMR, organize the paper print-out in a format that makes sense. This might be chronological date order, or group like records (clinic notes, lab results, etc.) together.

Create a ‘Table of Contents’ of the information in the patient record. This will help you in your testimony to quickly find requested information, help the court to locate information in the records that you have prepared.

At the same time, handwrite in ink at the bottom of each page the sequential page number in the package. Update the table of contents with the page numbers.

Stamp ‘COPY’ on each page.

When the package is complete, make a photocopy (or two) of the entire package. The ‘original’ paper copy will be maintained at the clinic. Bring the original and the copy to court and ask the court to accept your copy. Return the original package to the clinic and securely maintain this as part of the business records of the clinic until the court file is complete.

When You Attend At Court

As the clinic manager, your role at the court is to tell the court how patient information is collected and maintained in your healthcare practice. Your job is not to interpret the content of the clinic notes.

A few days prior to the court date indicated on the court order, phone the clerk’s office or witness support office to confirm the date, time, and location of the proceedings and if you are still required to attend.

On the day of the proceedings, report to the clerk of the court.

Bring with you the court order, your photo ID, the patient record, and your notes. Bring a good book to read in case you have a long wait.

You will be advised (again) if you are required that day. If you are not required, the clerk will make a notation on your court order to appear that you attended and that you have been dismissed. Keep this in your business records with the patient record.

If your testimony and the patient records are required, you will be called as a witness during the court proceeding.

You will be asked to swear or affirm an oath to speak honestly during your testimony.

Typical questions that you should be prepared to answer include:

Your name.
Your role at the clinic, how long you have been in that role, your routine tasks and responsibilities at the clinic.
Describe how patient records are maintained. Be prepared to explain your EMR or computer patient management system (if you have one).
Bring your notes about the steps that took to prepare for the court order. You may ask permission of the court to refer to your notes that you created when preparing to respond to the court order during your testimony, if necessary.
Explain that the patient records are kept electronically and that you have prepared a paper print-out of those notes.
Be prepared to explain how you know that the records are complete, not missing any details, etc.
If the court asks you to enter the records into evidence, explain that you have an ‘original’ and a ‘copy’ and ask the court to accept the ‘copy’ into evidence.

When You Return to the Clinic

Complete your notes by documenting your day at the court. Write a short summary of your day including:

Did you give a copy of the patient records to the court? To whom?
Remember to add this notation to the patients’ record that you disclosed this information according to the court order.
Any follow-up required for this disclosure?
Review your procedures. Anything that you would edit or provide additional instructions that will help you to be better prepared for next time you receive a court order?
Submit a copy of your out of pocket expenses (parking receipts, meals, etc.) for re-imbursement by your employer, if applicable.

What You Should Do Now

Review your policies and procedures now to ensure that it includes how to respond to a court order.
Train your reception staff on what to do if they receive a court order.
Train your privacy officer and clinic manager on how to prepare a patient record for a court order.

Depending on where you work, you may receive a court order regularly or it might be a once-in-a-career experience. When you have policies and procedures and a little bit of training to assist you, you can respond to a court order calmly and confidently.

If you are a member of Practice Management Success, login and access the ’Procedure: Preparing Patient Records for a Court Order’ template and the replay of the tutorial video.

Download the FREE eBook - Preparing Patient Records for a Court Order Now!

When we know better, we can do better…

Jean Eaton is constructively obsessive about privacy, confidentiality, and security especially when it comes to the handling of personal health information. If you would like to discuss how I can help your practice, just send me an email. I am here to help you.

Jean L. Eaton
Your Practical Privacy Coach
INFORMATION MANAGERS

court order patient records, health care, health records, healthcare, medical, Practice Management Success, subpoena to produce patient records, template procedure

1 2 3 4 5