HIPPAA Family Information Solution

It is pretty much a common understanding that the well-intentioned HIPPAA privacy rules have sown much confusion.  In particular, as discussed here, they are as often used as a shield against people and their families understanding what is going on — critical of course to true partnering —  rather than sword to ensure access to information.  Of course, read carefully the regs, even as currently drafted, actually provide a lot of flexibility to the holders of private health care information.

During a recent fascinating and creative HHS phone call to discuss ways to create useful and accessible online prescription records (of which more in a later blog), someone had a superb idea — to issue a model HIPPAA consent form that includes with the usual insurance company and provider list, language like “any and all family members,”  with, of course the option to check or not check it.

Of course, not everyone will want to check the whole family, and might want rather to list individuals who are to be given access, and that should be made possible with a space for such a list or appropriate general description.

Someone else then suggested that the use of such a form should be mandated by HHS.

What I now personally and routinely do is write that language in myself on the current form, drawing explicit attention to it to the professional staff, and suggesting that it will make their lifes simpler, and encouraging them to put it in their standard form.  So far, one test only, a very positive response to the idea.

So here is an example of a thing we can do to change the culture by popular will, and of an improvement can ultimately be normalized by the system and government.

I would only add that any provider unhappy with such an approach would certainly face questions from me about their value system and philosophy.



Does Anything Ever Change – Queen Elizabeth I Had To Intervene to Protect Against Professional Monopoly Over-Protection By Physicians

I am reading a wonderful book called The Gardens of the British Working Class.  It is one of those books that seems to be about what some would call a “little thing,” but is really about all of life.  The author, Margaret Willes tells a wonderful story (starting at page 38) as to which we would all recognize the issues and circumstances, both for medicine and law:

Towards the end of Henry VIII’s reign, in 1543, an act was passed allowing those experienced in he nature of herbs, roots and waters to practice and use them as a gesture of Christian charity.  This caused much consternation in some quarters. .  .  .  The College of Physicians summoned a series of women before their court for administering medicines and giving advice.  But in one instance, when a poor woman Margaret Kennix, was accused of supplying her friends and neighbors with herbal remedies, the Queen intervened in person.  In a letter sent to the College secretary via Secretary Walsingham, the Queen declared:

“It is her Majesty’s pleasure that the poor woman should be permitted by you quietly to practice and minister to the curing of diseases and wounds, by means of certain simples, in the application whereof it seems God hath given her an especial knowledge.  I shall therefore desire you to take order amongst yourselves for the readmitting of her into the quiet exercise of of her small talent, lest by the renewing of her complaint to her Majesty through your hard dealing towards her, you procure further inconvenience thereby to yourselves.”

How perfect.  I particularly love the subtlety of the implicit threat that the College of Physicians should not take actions by which “you procure further inconvenience thereby to yourselves.”  Something tells the lawyer in me that they had no need of class actions that are now used to obtain compliance for the whole group in such circumstances in those days (although sadly recent Supreme Court rulings have, with some exceptions, made dramatic inroads into the practical availability of the remedy.).

The incident also makes me wonder if, in her day to day administration of the realm, Queen Elizabeth may have been more of a feminist than we realize.  My popular culture impression is that “she had to act as a man to be a queen.”  It would be a great PhD thesis to look through those day to day records, with this incident in mind, to see if the truth may not be much more complicated and interesting.  And, I wonder what Walsingham and others thought about her attitude.

(This is a slightly edited version of a post that appears also in my access to justice blog.