After you read the case study below, there are 11 releases of information situations that transpired this

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Question:

After you read the case study below, there are 11 releases of information situations that transpired this day. Read the Situation and the Action and then comment on whether you agree or disagree with how Jill handled each situation and give your reasons for agreeing or disagreeing with her actions. These questions are not asking your opinions - but whether Jill did the right thing legally.

Case Study Situation:

Jill Holmes, RHIA is Assistant Director of the Health Information Department at Minnesota Hospital. As part of her assigned responsibilities, she supervises the release of information function within the department. Until today, she had very little occasion to be involved in the day-to-day operation of release of information, as she had an excellent ROI supervisor who was the expert in this area. However, she has just learned that the ROI supervisor will be out indefinitely because she was injured in an automobile accident the previous evening. They are also down 1 FTE for an ROI clerk position. The department director Georgia Lang has informed Jill that she will have to handle the release of information duties until the supervisor returns or the clerk position is filled. Jill assigned the file room clerk, Bob, to handle walk-in ROI requests in addition to her file room duties. She shows Bob how to have patients complete an "Authorization for Release of Information" form and gives him explicit instructions to refer all special requests back to her. Jill will handle telephone and mail requests. It has been a while since Jill graduated from an HIT program, so she is a little nervous about not being knowledgeable about current ROI standards. She reminds herself that next time there is continuing education money available in the budget, she will request funds for attending an ROI/legal seminar.

Situations and Discussion Questions

1. Situation: An Emergency Room (ER) physician at another hospital requests the immediate transmission of a patient's latest EKG and echocardiography report. The patient is now in his ER with chest pain.

Action: Jill faxed the reports.

2. Situation: Jill opens a letter from Blue Cross/Blue Shield requesting copies of an individual's discharge summary and pathology report in order to review for a specifically identified claim filed for the patient. No patient authorization is attached.

Action: Jill sends back a letter informing BCBS that the hospital cannot release any patient information without first having a properly executed patient authorization.

3. Situation: The department receptionist informs Jill that a gentleman from the State Department of Health has arrived and is requesting to review the entire medical records of three tuberculosis patients.

Action: Jill contacts the file room and has the records brought to her office for the state representative to review.

4. Situation: Jill takes a telephone call from an area high school principal who is requesting information about one of the teachers at his school. He specifically wants to know the reason for her hospitalization.

Action: Jill tells the principal that health information is confidential and cannot be released without the patient's written authorization to do so.

5. Situation: The Medical Examiner's (ME) office calls requesting a copy of an operative report for a patient who recently expired in the operating room at the hospital.

Action: Jill tells them that an authorization is first needed from the deceased patient's estate before she can release any information.

6. Situation: Jill opened a subpoena from an attorney for the widow of the above-mentioned patient.

Action: Jill is unsure of what action to take, so she contacts the hospital's attorney.

7. Situation: Afterwards, Jill notices Bob coming toward her with an anxious expression. He informs Jill that there is a man at the front counter who insists on speaking to the supervisor. Jill learns from the individual that he wants copies of his daughter's last three ER encounters. He is divorced from the patient's mother and is not listed in the patient's chart.

Action: Jill tells the individual that he needs to provide legal documentation, such as a birth certificate, showing that he is the patient's father before she is able to provide him with any records.

8. Situation: After this encounter, Jill opens yet another letter. This time it is from a commercial insurance company requesting copies of a patient's last hospital stay. The letter is accompanied by a standard patient authorization. After Jill retrieves the patient record, she notices that progress notes for this hospital stay indicate that the patient is HIV positive. This diagnosis does not appear on the face sheet or elsewhere on the patient's record.

Action: Jill asks Bob to prepare a copy of the patient's medical record for mailing to the insurance company.

9. Situation: A law enforcement officer shows up at the front desk with a valid, signed authorization from a victim of a crime for an ER encounter from 6 months ago. The officer's name and contact information is in the "Release To" section of the authorization. It is an urgent request as the case is going to court in two days.

Action: Jill takes the authorization from the officer and looks up the date of the ER encounter on the authorization and reviews the volume of information that would need to be released. It is very little so lets the officer know if he can wait 30 minutes, she will have the records ready for him to take with him.

10. Situation: Jill continues to open requests that have come in the mail. In the next request she opens, the requestor is the mother of a patient. It is dated by the mother the same date as the patient's 18th birthday.

Action: Jill sends a denial letter to the requestor that explains the reason for the denial is that the authorization is not signed by someone who has authorization to request the records.

11. Situation: The next request Jill opens, is a request for records to be sent to an attorney, but it is blank where the specific records requested would be.

Action: Jill determines that she will send all the patient's records so the request can get completed.