The discharge planning process always moved quickly, but today it’s on steroids! Case managers face intense pressure to quickly transition patients to that next level of care, or home. Whether you case manage for a hospital, an MCO, or a community-based agency, you need information when you need it! That means you need a space to ask questions that provide responses “in the moment” and that is often not the workplace! Social media has become the fastest way for case managers and other healthcare professionals to quickly get information on what resource to use, and when!
More and more new case managers are entering the workforce than ever before, and their onboarding happens at warp speed. They commonly ping “friends” or tag “connections” for discharge planning and other resources, from treatment and provider recommendations to specific home health agencies and skilled nursing homes. Complex patient circumstances become an opportunity for colleagues to weigh in on the management of everything from addiction and family dynamics to those “tough to place” patients, prescription drug access, and other psychosocial circumstances. After all, there’s no harm in asking for this information, right? WRONG!
HIPAA Breaches, Penalties, and Professional Sanctions
There’s an ethical and often legal pitfall of these requests. Despite one’s best intent to seek information or recommendations, posts can easily and unintentionally become HIPAA breaches. This can mean financial penalties for the case manager and their employer or potential sanctions or reprimands against one’s professional licensure and case management credential.
It can be common to see these posts within professional groups or communities. You know how it plays out. Limited information may be posted about the patient, but then questions are posed by connections or group members. For each answer provided, more ePHI is inadvertently released, and ultimately just enough for the patient or their family to be identified. It may not be one piece of information that leads to a HIPAA breach, but the collective discussion. This might include:
- Posting the names and locations of potential facilities for transfer
- Posting the age, psychosocial information about family demographics, or unique characteristics.
- Posting the name of the health plan for the patient
- A case manager’s social media profile may include information about their current employer.
- The patient may reside in a community of under 20,000 persons.
What’s the best way to handle obtaining these recommendations?
There are a series of ways that case managers can consult with colleagues and heed HIPAA and other ethical and legal requirements for patient privacy and confidentiality:
- Use the least information possible about the person (or their family members) to obtain needed guidance and be mindful of the amount of detail provided (e.g., use obesity vs. a specific weight).
- Make sure all necessary permissions for the release of information documentation are clearly signed.
- Move recommendation dialogues offline (e.g., emails, telephone calls)
- Remember, all disciplines have unique privacy and confidentiality guidelines listed in their standards of practice and codes of ethics. All professionals are beholden to those requirements.
More detailed information about this topic can be found in Chapter 7: Ethics is What You Do While Everyone Watches: Health Information Technology, in The Ethical Case Manager: Tools and Tactics, published through Blue Bayou Press and available on Amazon.
Dr. Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM is an award-winning industry entrepreneur whose focus is on interprofessional ethics, holistic health equity quality, trauma-informed leadership, and competency-based case management. She is a content developer, professional speaker, author, and educator with academic appointments at Cummings Graduate Institute of Behavioral Health Studies, George Mason University, and the University of Buffalo School of Social Work. More information can be found on her website and LinkedIn profile