Medical records gain
By Helen Altonn
new protection starting
next July
Star-BulletinHawaii residents will have strong privacy rights regarding their medical records starting July 1, next year.
Even relatives, florists and news media will be unable to get information on hospitalized patients if the patients don't want it released.
After four years of conflict, a task force representing diverse health care interests succeeded in getting a confidentiality bill passed and signed into law this year.
The Society of Professional Journalists, Hawaii Chapter, had urged Gov. Ben Cayetano to veto the measure. The SPJ says it will prevent hospitals from disclosing medical conditions on patients, including crime and accident victims.
"The news media would not be able to determine and report the severity of crimes or accidents, leading to some articles not getting run," the chapter said.
A similar bill in Maine was repealed in January after a public uproar because hospitals, without a patient's consent, could provide little information to relatives and none to the news media or florists.
Moya T.D. Gray, director of Hawaii's Office of Information Practices, says the new law here "starts with the idea that patients need control over their information. It empowers patients."
She said patients will be able to look at their files without question and get copies. Health providers, plans and hospitals also will have to notify patients about their rights and possible use of medical information, Gray said.
Patients' privacy is balanced with the need to share some information to ensure quality care, prevent fraud and abuse and contain costs, she said.
Gray said the task force addressed the media's concerns and the Maine case and "came up with a balance the Legislature agreed upon."
She said she didn't know the SPJ had asked the governor to veto the bill because it could restrict public information.
"It's an issue that definitely needs to be worked out," she said, adding that she had invited SPJ's attorney to meet with her and the hospitals to work out procedures for a smooth transition.
She said Hawaii's law is more protective than pending federal legislation because it restricts the kind of information that can be shared for treatment, payments and health care operations, and who can look at it.
Before, said Dr. Arleen Jouxson-Meyers, Hawaii Coalition for Health president, "Anybody could access records for patients with relative ease."
For example, if HMSA wanted to look at 100 of her pediatrics records, she had no way to object, she said.
Under the new law, a doctor can ask why the records are wanted, and the insurer can only look for the needed information and at the least number of records to achieve its purpose, she said.
The insurer also must send a suitably qualified person if it wants to examine records to review a doctor's standard of care or decision, she said.
Insurance companies need to watch out for fraud and abuse, Meyers said.
"But patients' privacy has been lost for less than honorable purposes. The bill is very good in correcting those problems."
Phyllis Baumwell Dendle, Kaiser Permanente director of government affairs who was on the task force, noted there are strict civil and criminal penalties for those who violate the law.
"Certainly, it makes all of us who hold information pretty nervous. We don't want to make any mistakes. It reminds us, as holder of the information, that our first obligation is to the protection of the patient."
Dendle said Kaiser has a confidentiality committee and is happy overall with the law.
"It's really important that our members feel confident that their information is kept private -- or as private as we can -- and still provide good care.".
It was the fifth year the bill had been introduced and members of the task force, formed about a year ago, had given it a lot of thought, she said. Still, "It was hard. There were a lot of things to work out, and a lot of personalities there."
Gray said as the task force educated itself, it began to realize the industry's tremendous growth with development of insurance companies and health plans and the need for information.
Large groups seek it for treatment and cost containment, she said.
"And you've got doctors who have both the motivation to treat patients well and ensure their businesses aren't in the red every year."
Government regulations also are involved, she said.
The mixed group was able to achieve consensus, she said, "primarily because everyone ... made a real commitment to work for something practical that protected peoples' interests and didn't harm anybody."
Senior Vice President Cliff Cisco at the Hawaii Medical Service Association said, "The story, from our perspective, is the task force itself."
He said it demonstrated that public and private interests brought together can, with time, work through differences and reach consensus "which in the end developed good legislation."
"It took a lot of work and a lot of compromises to get this through," said Dr. Philip Hellreich, Hawaii Medical Association legislative chairman and Hawaii Federation of Physicians and Dentists president.
Hellreich said a few physicians were upset "because they didn't get everything they wanted."
But the philosophy was if patients want insurance companies to pay their bills, "then third parties have some rights to intrude on medical records to make sure the claim was justified."
The Office of Information Practices is seeking help from businesses and community groups to draft rules to implement the Privacy of Health Care Information law. Help draft privacy rules
One will govern how medical information is kept and protected in paper and electronic form, said OIP Director Moya T.D. Gray. The other concerns how medical information is transmitted electronically, which will tie in with federal rules, she said.
The office also will begin to educate the public on medical privacy issues through an open line newsletter, a Web site, professional associations, health plans and other avenues, she said. She cited these highlights of the law:
Doctors and hospitals must post notices so patients will know their rights and what they can do to protect their rights.
