Disclosure of PHI Obtained From Other Providers

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Patients have the right to request a copy of their medical record, and covered entities must provide it and include any information that was created by, or obtained from other healthcare providers that is contained in the patient record.

The Privacy Rule states:

“A covered entity is required to provide access to protected health information in accordance with the rule regardless of whether the covered entity created such information or not… In order to assure that an individual can exercise his or her access rights, we do not require the individual to make a separate request to each originating provider.

If the individual directs an access request to a covered entity that has the protected health information requested, the covered entity must provide access.”

The inclusion of other providers’ information is not exclusive to patient access rights. For example, if a hospital requests a patient’s full medical record for treatment purposes, then the entire contents of the medical record, including records that were created by other providers, should be included.

Health and Human Services has posted the following question and answer that addresses the issue in a more general manner, rather than only referring to patient requests:

“Question – A provider might have a patient’s medical record that contains older portions of a medical record that were created by another previous provider.  Will the HIPAA Privacy Rule permit a provider who is a covered entity to disclose a complete medical record even though portions of the record were created by other providers?

Answer – Yes, the Privacy Rule permits a provider who is a covered entity to disclose a complete medical record including portions that were created by another provider, assuming that the disclosure is for a purpose permitted by the Privacy Rule, such as treatment.”

While a covered entity may deny access to information that was received from someone under a promise of confidentiality (if access would be reasonably likely to reveal the source of the information), a covered entity may not deny access to PHI when the information has been obtained from a healthcare provider. If a patient authorizes disclosure of his/her PHI, or disclosure is otherwise permitted by the Privacy Rule, a provider may not restrict disclosure of PHI based on who created it.

Acceptable/Responsible Use

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Once a workforce member is granted access to a practice’s information systems (including computer hardware, software, email, voice mail, internet, telephone, cell phone, laptops, or other electronic equipment or service made available to employees or paid for by the practice), it is everyone’s responsibility to ensure that the systems are utilized in an acceptable manner following basic rules of conduct.

Acceptable Use applies to the use and disclosure of proprietary and patient information, computer or other devices (includes mobile and other computing or storage devices), and network resources. Some basic responsibilities include:

  • Protecting proprietary information, such as business practices, financial information and intellectual property of the practice.
  • Using or disclosing business and patient information only as necessary to perform assigned duties.
  • Promptly reporting any theft, loss or unauthorized disclosure of proprietary or patient information.
  • Exercising good judgment in the use of the information system (this includes internet access and the sites visited).
  • Ensuring that local, state, federal, or international law is not violated while utilizing the practice’s information system.

It is helpful if acceptable or responsible use expectations are outlined in an employee handbook, or otherwise clearly communicated to workforce members.  Some organizations may also require users to sign an acknowledgement (often called an “acceptable use policy”) to ensure understanding of the policies.

Sanctions or penalties must be uniformly imposed if anyone should cause harm to the information system, use or disclose information in an unauthorized manner, or violate regulatory requirements. Sanctions may include disciplinary actions up to, and including termination of employment.  Workforce members should also be warned that certain actions that violate privacy requirements might subject them to prosecution and/or monetary penalties by regulatory agencies, such as the Office for Civil Rights.

Communicating compliance responsibilities to workforce members, and informing them of sanctions that will be imposed for failure to meet them, helps ensure the security of your practice’s information system.