Who can see your records?

June 1, 1998
As providers of dental health care, we have the responsibility to keep detailed and extensive records on our patients. We understand that these records are the written documentation of what has transpired with a patient and what is planned for the future. We understand that it is our job to maintain such records and to keep information about our patients confidential. This is important to us as professionals providing treatment and as private individuals desiring privacy for our own records in a

Carol Tekavec, RDH

As providers of dental health care, we have the responsibility to keep detailed and extensive records on our patients. We understand that these records are the written documentation of what has transpired with a patient and what is planned for the future. We understand that it is our job to maintain such records and to keep information about our patients confidential. This is important to us as professionals providing treatment and as private individuals desiring privacy for our own records in a medical setting.

Who has access?

Currently, there are many "entities" who might have access to medical/dental/drug records:

* Administrators at an HMO or other health plan.

* Staff at a physician`s or dentist`s office.

* Hospital employees who can access a hospital`s computer records.

* Insurance company claims processors.

* The Human Resources employees of an employer.

* An employer.

* Private contractors hired by a health plan to review claims and monitor utilization.

* Workers in firms hired by a health plan to manage mental health and drug benefits.

* Pharmacists.

* Drug companies providing prescription drugs by mail.

* Life insurance companies

* "Case managers" for utilization review groups.

* Law enforcement officials.

Computerization of information has led to the development of many of the problems surrounding confidentiality; however, computers are not the only culprits.

Where medical/dental records used to be available to doctors and a few staff persons, now a vast array of insurance/HMO case managers, managed-care administrators and reviewers have access to records. Once the records are available to these persons, wider, lesser known accessibility is possible.

Human resources employees at most companies can obtain workers` medical and insurance records. According to one Fortune 500 survey, one-third of human resources employees said they had used such records in hiring, promotion or firing decisions.

Drug manufacturers request and receive records from pharmacies and insurers on what drugs people are taking in order to design advertising promotions. Law enforcement officials have access to medical records to investigate insurance fraud.

In the fall of 1997, a new federal law was proposed that would correct some of the problems associated with confidentiality. The law would, among other things:

* Prohibit the use of personal medical information for any nonhealth-care purpose (except the investigation of criminal activity or insurance fraud).

* Prevent employers from using medical records for promotions or firings.

* Require computer records to be confidential and secure.

Some states offer protection

Many state laws already protect patients` confidentiality rights to a certain degree. (FBI and other law-enforcement investigators can obtain medical records without a warrant or court order!) The primary problem lies with the fact that so many people have immediate access to a person`s records via computer.

In the area of mental health, the problem is perceived as dangerous. Many mental-health professionals tell clients not to seek insurance reimbursement if they want to maintain confidentiality.

Use of medical records can have an upside. Last year, in my hometown of Pueblo, Colo. - in a case that was widely reported - bacteria-tainted hamburger meat was discovered as the cause of a rash of serious intestinal problems, evident through the perusal of health records by a public-health official. A nationwide recall of the meat and prevention of further disease was the result of the records review.

The problem of confidentiality is not likely to disappear. Thousands of health-care workers and insurers have access to thousands of records. Your own records and those of your patients are among them.

Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart and a national lecturer. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.

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