HIPAA and Communication Challenges in Pediatric Care, Essay Example

In the middle of 2002, a new federal law was implemented and aimed at protecting the privacy of people’s medical records and health information. Predicated on the stipulations included in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this policy typifies significant safeguards for minors, onward with a degree of acquiescence to other federal and state laws pertaining the health care providers. The provisions embody a compromise between competing perceptions regarding whether or not parents should have unadulterated access to their children’s medical records and health information in addition to the confidential healthcare services for minors. Over the past twenty years, adolescent patients have experienced increase opportunities to reap healthcare services that are confidential in nation, especially for endeavors pertaining to sexual activity, HIV, sexually transmitted diseases, pregnancy, mental health issues, and substance abuse. From a public policy and clinical viewpoint, protecting the confidentiality for minors has hitherto been predicated on the admission that some adolescents would not pursue the medical care they require if their confidentiality was not safeguarded. Such reluctance to seek healthcare out of fear of humiliation or parental reprimanding would yield adverse health ramifications not only for the minor but for society at large (Blumenthal & Glaser, 2007). Maintaining strong privacy safeguards if crucial to preserving patients’ trust in their healthcare providers so that they remain willing to seek healthcare services when necessary. These safeguards are particularly significant if sensitive information figures largely. At the same time, there are certain situations in which sharing health information is necessary for the patient to get the most optimal care and treatment.

Two national, representative surveys have been conducting regarding the reluctance of minors seeking healthcare due to confidentiality issues. These surveys revealed that an estimated twenty five percent of middle and high school students self-reported that they decided not to pursue healthcare services they needed for their respective health concerns (Ford & English, 2002). One third of the participants reported that they did not seek medical care because they feared that their parents would find out personal information that was humiliating to them. Moreover, minors who needed particular health services to address sensitive health problems were more preoccupied with privacy concerns conveyed more pronounced reluctance to get the care they required. Sexually active females who are under eighteen years old were surveyed in various family-planning clinics throughout the state of Wisconsin. Results show that if parental notification was required for them to procure birth control, they would stop using the services provided at the clinics or they would delay and halt using specific health services altogether. STD testing and birth control methods are the particular services that these females most frequently sought. While only one percent of the female participants stated that they would practice abstinence if they discontinued using the services at the family planning clinics, the vast majority stated that they would continue having sex despite not being on birth control.

In addition, concerns about privacy also impacted where minors went to obtain healthcare services in addition to deterring open communication between adolescent patients and their healthcare providers, thereby rendering them compunctious to accept any medical services such as STD testing and pelvic examinations. As such, healthcare organizations make a concerted effort to graft in confidentiality safeguards for minors in the ethical guidelines and policies. Moreover, such policies are also included in various federal and state laws that are important for applying the HIPAA privacy policy to the health information of minors. HIPAA grants patients increased access to their own medical records and health information in order to procure copies of it and/or request amendments (Ford & English, ). Furthermore, the policy also itemizes when a the authorization of a patient is mandated for the disclosure of confidential health information, although authorization is usually not stipulated for the utilization of the data and its avowal for treatment purposes, healthcare operations, and payment (English & Morreale, 2001). Clearinghouses, health plans, and providers are all considered to be “covered entities,” so the policy is applicable to them as well. Medical professionals for the most part are required by law to adhere to the privacy rule under HIPAA which states that emancipated minors and adolescents who are considered to be adult by law enjoy autonomy and can exercise their rights as autonomous persons. If minors are not emancipated, then their guardians and/or parents are categorized as personal representatives for their progeny and thus are empowered to make medical decisions on their behalf. As the personal representatives of adolescents, parents or guardians thus are granted access to protected health information and medical records of their kids. Only in very itemized contingencies can parents not be considered the personal representatives of their children under the age of eighteen.

Minors who act as individuals retain the capacity to exercise their rights under the HIPAA law. The most common circumstance is when the adolescent consents to receiving treatment for sexually transmitted diseases under the minor consent law according to which state one lives in. Another circumstance when minors can act as individuals is when they receive medical care legally without their parents’ or guardian’s consent, and the minor, court, or another person has consented to the administration of healthcare such as when the minor asks for and procures court approbation to undergo an abortion legally without the consent of parents of a guardian. The final situation is when parents or a guardian agrees to a confidentiality compact between the minor and the healthcare provider, which usually takes place when a minor receives medical care from a doctor that the family knows and approves of. In these diverse situations, the minor always functions as the individual, and the parents do not automatically have the legal right to access medical records or protected health information of their minor children (Salem, 2003). Specific provisions must be in place for parents to access such information of their unemancipated minors.

While HIPAA protects the rights and privacy of minors, the privacy law also presents various challenges to effective communication between patient and health provider as well as with the parents of minors. HIPAA allows healthcare providers to communicate with a minor’s family and/or individuals involved in the patient’s care because of the critical role friends and families play in patient care. If the patient has the ability to make sound medical decisions, healthcare providers can only communicate with family and friends of the minor if and only if the minor consents to the physician or nurse doing so. Medical personnel can ask the minor permission to share pertinent data with parents or other family members, especially if a family member or friend is present in the treatment room. Disclosure of medical information to family or friends is stringently circumscribed under HIPAA privacy rules, as health providers can only legally share information regard payment for healthcare if minors object to disclosure to parents or friends.

Clinicians treating adolescents and minors are required to implement all of the changes mandated by the privacy rule in HIPAA within all healthcare settings. In addition, they must be cognizant of the components of the policy that are applicable to minors who are not emancipated and also need to fully comprehend how to provide optimal medical care within the context of the HIPAA privacy rule. Primary care physician Erica Yamasaki (2015) noted in a personal interview that it took a protracted period of time to learn and fully understand how to communicate with adolescent patients and involved parties in a way that complied with the new privacy rule (Yamasaki, 2015). This process entailed that they are knowledgeable of state minor consent laws in addition to any and all provisions that circumscribe full disclosure to guardians or parent of a minor as well as the privacy of medical records and health information. If state or federal laws are incoherent and nebulous, medical personnel must be reader to render their professional judgment whether or not to provide medical disclosure when parents request sensitive information about their child’s care for which the minors consented to. Medical personnel need to be cognizant that the privacy rule under HIPAA sanctions legal importance to compacts with parents that grant minors a degree of security regarding their confidentiality when seeking medical care. In these particular scenarios, the privacy rule enables the adolescent patient to assume confidentiality and full control over access to his or her medical records and health information, although this varies on an idiosyncratic basis according to state laws. Unfortunately, the privacy rule fails to adequately address a litany of practice issues that impacts the ability of medical personnel to provide adequate healthcare to adolescents in a confidential manner. They are required to judge whether a minor has the ability to make informed consent while also being able to screen for situations in which minors cannot be granted confidential medical care, such as in the cases of suicide risk or domestic abuse. Moreover, clinicians are also challenged when parents or guardians have procured the right to access medical records or health information. These challenges usually germinate more in primary care settings that provide comprehensive health services rather than in specialized contexts such as in family planning clinics. It is also difficult for health professionals to articulate both the constraints and safeguards of confidentiality to minors as well as their parents or guardians. It remains difficult for them to communicate to minors the importance of effective communication between minors and their parents in a manner that is sensitive to the child’s privacy needs as well as parental support necessary.

References

Blumenthal, D. & Glaser, J.P. (2007). Information technology comes to medicine. New England Journal of Medicine, 356(24), 2527–2534.

English, A. & Morreale, M. (2001). A legal and policy framework for adolescent health care: Past, present, and future. Houston Journal of Health Law & Policy, 2001, 1(1):63-108.

Ford, C.A. & English, A. (2002). Limiting confidentiality of adolescent health services: What are the risks? Journal of the American Medical Association, 288(6),752-753.

Morreale, M.C. & Dowling, E.C. (2004.). Policy compendium on confidential healthsServices for adolescents, second ed. Chapel Hill, NC: Center for Adolescent Health & the Law.

Salem, D. (2003). HIPAA’s privacy regulations: Increased privacy comes at a cost. Medscape. Retrieved December 4, 2015 from http://www.medscape.com/viewarticle/461703_5

Smith, P.C., Araya-Guerra, R., Bublitz, C., Parnes, B., Dickinson, L.M., Van Vorst, R., Westfall, Yamasaki, E. (4 Dec. 2015). Personal Interview.