The stakes have been raised. Partly it came about because the internet is a leaky vessel in which to load information. In December 2000, the United States Department of Health and Human Services (HHS) issued comprehensive privacy regulations. These regulations arise from the 1996 Health Insurance Portability and Accountability Act (HIPAA), and will materially affect the practice of orthodontics.

In essence, customary office procedures that have been widely accepted for many years will no longer be permissible. The rules go far beyond the current mandate in Advisory Opinion G to the AAO’s Principles of Ethics and Code of Professional Conduct, which obligates members to "safeguard the confidentiality of patient records."

These rules came about to settle problems with patient information posted on the Web. But the new regulations may apply to any patient records released from the office, orally, in writing, or posted electronically. Our legal counsel at the AAO is reviewing the regulations and the Bush administration’s recent modifications. We hope to publish his advisory document in a future issue.

In the meantime, it is wise to apply some common sense rules:

If a patient makes any request regarding confidentiality, honor it. A mom last week told me of her daughter’s diagnosis of anorexia, and requested that our records not be marked with a health alert, and that we not mention to the patient our knowledge of the situation.

If you want to transmit sensitive information to another professional, discuss it with the responsible person in the patient family first, gain permission, and note it in the chart. If you want written permission, the AAO has a sample document. Electronic transmission is under extreme scrutiny, so perhaps using paper is better.

If a patient family requests copies of their treatment information or patient history, provide it, unless it is for litigation.

Don’t provide false information – An example is the patient family who asks you to fudge to the insurance company on the start date.

Train your staff – here is a sample document for the staff person to sign:

Confidentiality All matters relating to the office, staff members, or to the patients are confidential. Never discuss such matters outside the office or within hearing distance of any patient. Materials relating to patient care (charts, schedules showing patient names, etc.) should never be left in areas where other patients might see them.

This office restricts release of any information about
a patient (name, address, age, sex, nature of the orthodontic problem, general condition, etc.) to members of the public or press, other professionals, pharmacies, families, friends, etc. without the patient’s written authorization. Requests from insurance companies for clinical information or medical histories must always be accompanied by a signed release from the patient or the patient’s guardian.

All subpoenas which require the photocopying of the patient chart should be reviewed by the Doctor before the chart is produced.

Apply discretion when using the telephone. It is important not to leave messages containing patient information on answering machines or with other parties. It is appropriate to leave a message requesting that the patient call "Susie in the doctor’s office" and a number to call.

Divulging any information to anyone outside the office is grounds for immediate dismissal since all information is confidential.

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