Thesis on "HIPAA Privacy and Confidentiality"

Thesis 5 pages (1535 words) Sources: 5 Style: APA

[EXCERPT] . . . .

Health Insurance Portability and Accountability Act (HIPAA) has transformed several aspects of the health care profession. From an institutional perspective, the code creates the risk that employees will fail to adhere to the standards set in the act. If this occurs, the institution is subject to sanction from the Office of Civil Rights (OCR). As such, institutions must ensure that all of their employees are aware of and follow the guidelines set up under HIPAA. However, these guidelines do not cover every specific situation. While in most situations the accurate response or course of action is clear, there will be numerous instances where the nurse is faced with an ethical dilemma. Under such circumstances, professional judgment can be used to "fill in the gaps" (Lo, Dornbrand & Dubler, 2005). For nurses, this judgment can be informed by the Nurse's Code of Ethics.

The Ethical Dilemma

Although HIPAA was intended to ensure consistency with respect to protecting the privacy of patients across the country (HIPAAps.com, 2003) it also leaves much room for interpretation in the course of day-to-day practice. Dilemmas can arise for example, when the nurse must balance the requirements of HIPAA with the best practices for the patient's health. Even without such a situation, the HIPAA rules demand that nurses pay the highest respect to patient's private information. Another potential instance would be if medical identity theft was suspected by a nurse -- a person who is in a good position to uncover such an issue. A nurse may be faced with a situation, for example, where they suspect that a patient is not the person they purport to be (Bendix, 2009). HIPAA compels action on the part of the institution. This can contradict, however, the nurse's code of ethics, including principles of equality, trust, duty to the patient. In addition, the nurse needs to consider the consequences to the patient -- even if they are committing fraud, they may genuinely need the health care and not be able to obtain it through other means. The Nurse's Code of Ethics states that "the nurse's primary commitment is to the patient…." This means that the commitment to HIPAA, the health care provider or any other body is subordinated to the commitment to the patient.

It is precisely the specter of such ethical dilemmas that has caused so much concern within the nursing profession with regards to HIPAA. Certainly when the law first came into effect in 2003 there was fear with respect to the law's punitive aspects (Wielawski, 2009). From the perspective of the government and of health care providers, HIPAA was a necessary step towards improving the management of patient privacy. The patchwork of state laws that preceded HIPAA was inconsistent at best and ineffective at worst. Thus, on one side of the HIPAA debate its proponents insist that the measures taken to protect privacy are worth the additional trouble on institutions and health care staff, including nurses.

From the nurses' perspective, however, the issue was less about patient privacy than it was about the potential for sanctions that could befall nurses for minor privacy violations. It is not that nurses have ever had an ethical dilemma with respect to maintaining privacy -- confidentiality and trust have always been a part of the nursing profession. However, the potential for grey areas, and for areas where HIPAA differs from the Nurse's Code of Ethics caused considerable concern.

Principles Involved

Many of the principles of nursing practice come into play with respect to implementing HIPAA into the daily tasks of the profession. The nursing commitment to care depends on the development of trust between the nurse and the patient. In this regard, HIPAA and the profession are generally in agreement. Confidentiality, however, has proven a stickier issue. Wielawski (2009) relates an anecdote from a maternity nurse, who found that after HIPAA was enacted she was unable to discuss births with extended family members. This caused significant discord between the nurse and the public, the discord coming from the fact that while HIPAA considers such discussions a violation of patient privacy, the patient does not. Another principle that is impacted by HIPAA is that of abiding by a system of rules. With HIPAA introduced into that system, nurses like the maternity nurse above were forced to choose the rules of the system over the benefit to the patient.

Ethical Responsibilities

Despite the ethical dilemmas created by HIPAA, there is some common ground between the law and traditional nursing practice. For example, the third provision of the code outlines nurses' responsibilities with respect to patient privacy and confidentiality (American Nursing Association, 2009). This responsibility is well-captured by the provisions of HIPAA, both in practice and in principle. The nursing profession can reasonably embrace that aspect of the law. Indeed, when a HIPAA-oriented ethical dilemma arises, the nurse can consider Provision 3 and see that while perhaps there are instances when previously acceptable practice would allow for certain disclosures, those disclosures likely violated Provision 3 if they violated HIPAA.

Provision 8 of the code of ethics also appears to support HIPAA. Nurses have a responsibility to contribute to discussions such as those surrounding patient privacy. They have the responsibility to ensure that their inside knowledge of practice is included in legislation. HIPAA, for example, is an evolving piece of legislation to which nurses can make contributions and improvements.

Resolutions

While there are many individual situations that can arise where HIPAA results in an ethical dilemma for nurses, there is a high degree of congruency between the legislation and the Code of Ethics. As such, the best way to resolve any dilemma that does arise is to follow the code of ethics. Provision 3 in particular addresses the same issues that are addressed under HIPAA. Given that the underlying principles of the nursing profession -- including abiding by a system of rules, confidentiality and commitment to the patient, are all in line with the spirit of HIPAA. Dilemmas are more likely to occur where previously accepted nursing practice was not congruent with these principles to the letter. However, it must be accepted that there is a system of rules now, and in general those rules merely reinforce the Code of Ethics and the profession's underlying principles.

My personal moral take on this issue is that maintaining patient privacy is an important issue in nursing today. Steadfastly maintaining privacy is congruent with the Code of Ethics and the underlying principles of nursing, not just HIPAA. Thus, it is my duty as a nurse to make every effort to maintain patient privacy and confidentiality, not just from a legal perspective but from a moral one as well.

In my experience, I have found that ethical dilemmas will occur from time to time. In such situations, I have noticed that if I recall the Code of Ethics and understand the role nurses play in the health care system, the best interests of the patient always guide me. In virtually any situation, advocating and defending the patient will ultimately be in line with not just the Code, but HIPAA as well. Dilemmas often stem from a desire to go beyond the principles of the profession, and every once in a while it is beneficial to return to the basic principles and ethics. In a way, HIPAA helps me to keep those at the front of my mind every day.

Critical thinking can help guide ethical decision making. In my experience, ethical dilemmas can be resolved with a more detached analysis. At times it is easy to become too involved with the patients' lives and this can bring emotions into the job that lead to the desire to do more under the notion that it will be beneficial. A detached analysis can help to understand the degree to… READ MORE

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