When I see HIPAA, my first thought is privacy. Shh... don't say anything. I began to research its history and intent. I can remember years ago when I would go see an optician and decide their prices on glasses were too high, they could refuse to give me my prescription. HIPAA helped with portability. Doctors were now required to give you your records. You had the ability to review and submit corrections for incorrect records. You could take your records to another provider, so your portability was protected so you can transfer care.
This portability also allowed for you to switch jobs and have different insurance. It stopped a person from being job locked because of their work insurance.
It also provided privacy standards for the new technology age of electronic records. Records could be sent by email or fax, but there were no privacy safeguards in place.
You also had new health scares, such as HIV, in the workplace. EMTs would call the hospital and announce HIV status to everyone. This would violate the privacy of a person by giving sensitive information to everyone, not just those related to care. So, at this time, universal precautions became the standard. Basically, assume everyone has some life-threatening disease and you should be okay. It also became illegal to let people know you were a medical provider or caretaker for someone. Well, if you know someone is seeing such and such physician, then you may be able to assume information about them. In our case, if you are seeing a midwife, they may assume you are pregnant.
Another motivation for pushing for the privacy of the patient was research. People were beginning to shy away from their personal history being shared. They were hoping more people would be willing to be involved in research if their privacy was assured.
So, who really cares anyway? Well, we all do in at least small ways. Do you want your doctor sharing with your hairdresser about your colonoscopy? So, that's a little bit of a hyperbole, but you get the picture.
How does HIPAA fit into your care and how does it affect midwives? First and foremost, your care is confidential. We don't share our client list. We do not share your personal information without your permission. I have a disclosure in paperwork that states information will be shared with providers, for collaborative care or insurance. Which means if you are transferring to a hospital, I send records.
Providers can share information without identifiable information, such as your name or birth date. Peer review for midwives is protected in the state of Texas. It allows for midwives to learn and have accountability for care. Because it is protected, midwives participating in peer review are not allowed to share any information and can be held to the same fines as the midwife giving care. I, personally, am very grateful for an awesome group of midwives that are always wanting to learn and improve care.
Times have changed dramatically since the 1990s. Widespread social media has brought some challenges with it. . It has brought a vast amount of information to the point of overload to everyone's fingertips. What happens when things don't go as planned? HIPAA was put in place to protect the privacy of who a client's provider was and their information.
What is not covered under HIPAA? Anything that isn't healthcare. Oftentimes, the midwifery community is small, and midwives and clients' lives intertwine in other areas of life. Conversations, texts, emails, personal contact outside of midwifery, shared classes or church that wasn't part of a client's healthcare or wouldn't be put in a chart and they are not part of HIPAA.
There are times you will see a client or patient come forward and make a public complaint. Providers typically stay silent on the complaint and do not want to be involved in an online debate about a private matter. Hospitals are concerned more about liability than provider reputation. I also believed, as most providers have, that it was illegal to give their side of the story. I recently found out that, when a client posts a public complaint on social media or a search engine, or any public post, or a public video like TikTok, they have voided their HIPAA protections. They took away their own privacy. A provider may give their side of the story. Now, it would be advisable for a provider to do so with the advice of legal counsel.
Then what about writing a "cease-and-desist" letter. Honestly, a cease-and-desist letter has no legal bearing. You cannot write a letter and take away a person's first amendment right of free speech. A cease-and-desist letter has power as a warning if the person, either the client or midwife, is involved in slander. It may be sent by either party. Slander is presenting false, out of context or partial information to damage the reputation of the other person. It intentionally doesn't give the whole story. Libel is more serious and anything that has been written or in a more permanent medium such as video. This doesn't just affect clients and midwife relationships. This also affects other providers. They can be held responsible for false information said about other providers.
This wasn't a feel-good post, but a good one to talk about. These conversations need to be had. There are consequences for everyone when things become public. As a Christian, I feel I need to add this. I sincerely hope anyone that has had a concern with me or any other midwife, that they have taken the opportunity to sit down and talk face to face. Any midwife that has a concern with a client or another provider that they have sat down face to face. Matt 18:15-17, 1 John, Gossip is truth viciously shared and Slander is falsehood shared and both are sin. I have had to self-reflect on my own attitudes and actions.
May the most you ever have to think about HIPAA is this, "Would you like me to forward your records to you or another provider?"