It’s Déjà Vu All Over Again

It seems like only yesterday that a new regulation, known as HIPAA (The Health Insurance Portability and Accountability Act), was enacted in the United States. Instead, it was nearly a year ago that this highly complex set of rules was put into motion. The result has been confusion, disruption and serious misinterpretations that have had far-ranging affects - even on healthcare chaplains and clergy.

Simply stated, the regulation is intended to protect the privacy of an individual’s healthcare records. An Emergency Department nurse may not share a patient’s medical information with a TV news reporter, for example, without the patient’s express consent. A similar regulation was enacted in Canada (PIPEDA - Personal Information Protection and Electronic Documents Act ) a year prior to the enactment of HIPAA. While both sets of regulations were intended to promote the privacy of an individual’s records (particularly financial, legal, and/or healthcare related), it remains unclear whether either set of regulations will accomplish their intended goal. What is clear is that the implementation of the regulations, based on the interpretations and counsel of industry consultants, caused unnecessary harm to chaplains and clergy in both countries.

These industry consultants (healthcare and legal), reasoned in both sets of regulations (HIPAA & PIPEDA), that chaplains evidently were not included since they were not mentioned in the regulations. From that line of reasoning, they proceeded to advance the opinion that chaplains were not healthcare workers. The result, in both Canada and the U.S., was the recommendation of the consultants that chaplains should no longer function as part of the interdisciplinary team. Many chaplains were told they could only see patients by request of the patient and had no access to charts or any other patient information. Fortunately, most healthcare administrators in the U.S. decided to employ common sense (as suggested in HIPAA’s Preamble) in applying the regulations. In the end, most of these misinterpretations and overreactions were reversed and chaplains were returned to their rightful place on the healthcare team.

Still, we are mindful that there are chaplains on both sides of the border whose ministries have been seriously affected with no resolution in sight. Regarding local clergy, there are as many interpretations and applications of the regulations as there are healthcare entities. The same consultants, who wanted to eliminate chaplains because they were not mentioned, decided they needed to limit the local clergy’s access to patient information because they were mentioned. The result is ongoing disruption for clergy and a “crazy quilt” of policies. Some hospitals are very user friendly for local clergy while others refuse to give clergy any information on their hospitalized congregants.

One thing is clear. On both sides of the border, healthcare chaplains and clergy must work together to have members of our profession officially recognized by government agencies as healthcare workers. We have been passive for too long, and we are paying a price for our lack of advocacy and action. One piece of good news: the director of the Office of Civil Rights in the U.S. Department of Health and Human Services said recently, “HIPAA does not prevent clergy from getting medical information nor should it affect prayer. A belief persists that HIPAA is hurting the religious community. There is miscommunication and misinterpretation out there.” So, we know that we are now being heard. The next step is to educate our national policy makers.

In recent conversations with several leading faith group representatives, Tommy Thompson, U.S. Secretary of Health & Human Services, indicated that changes to HIPAA, planned to go into effect in August, 2004, will clarify the roles of chaplain and clergy. Our professional and religious communities need to monitor future developments to ensure that the revised regulations correctly represent us and our constituencies.

To read more about these two privacy laws go to:
HIPAA – www.cms.hhs.gov/hipaa/
PIPEDA - http://www.privcom.gc.ca/legislation/02_06_01_01_e.asp?V+Print

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