In healthcare privacy and decision-making, two important legal documents come into play: patient directives and HIPAA authorization. While they both relate to the handling and disclosure of patient information, they serve distinct purposes. Understanding the differences between HIPAA authorization and patient directives is vital for safeguarding patient privacy and ensuring that healthcare decisions align with an individual’s preferences.
This article explores the difference between patient directive and HIPAA authorization and how they empower patients in their healthcare journey.
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HIPAA Authorization: Exploring Consent for PHI Use and Disclosure
Considered as legal document, HIPAA authorization allows medical providers, vendors, and records custodians to share patients’ health information with authorized individuals without requiring certification of incompetence from the patient. It is required by the Privacy Rule when using and disclosing protected health information (PHI) go beyond the routine medical procedures of treatment, payment, and health care operations or when there is a need to disclose PHI to a third party specified by the individual.
Russel W. Hall & Associates also states that HIPAA authorization is effective immediately upon the individual’s signing. This way, friends and family can continue assisting with a person’s care, even if the person in question never loses the ability to communicate or make informed decisions pertaining to care.
Key Elements of HIPAA Authorization and Its Role in Protecting Patient Privacy
When creating a HIPAA Authorization, certain essential elements must be specified, including the following:
- A detailed description of the protected health information to be used and disclosed
- The authorized person
- The recipient of the information
- An expiration date
- The purpose of the disclosure.
According to MRA, HIPAA Authorization permits the sharing of protected health information but does not mandate it. There is no specific timeline for disclosing PHI. However, appropriate safeguards must be implemented to ensure secure transmission. Regarding fees for providing PHI copies, the Privacy Rule allows covered entities to impose a cost-based charge, provided that they must disclose the approximate costs and that the individual must agree to it in advance.
Patient Directives: Empowering Individuals to Control Their Healthcare Decision-Making
Patient Directives, on the other hand, empower individuals to retain control over their healthcare decisions even when they cannot make those decisions themselves. These directives come in various formats, following state laws or created by lawyers or patients. State laws and courts determine their validity, so it is crucial to understand the specific requirements for creating legally recognized directives in each state.
Before creating a patient directive, it is highly recommended to engage in open discussions with healthcare providers, loved ones, and potential proxies or agents who would act as substitute decision-makers. These conversations help ensure that the directive accurately reflects the individual’s wishes, fears, and preferences, enabling effective decision-making on their behalf.
Types of Patient Directives
The American Cancer Society identifies the following advanced directives for patients:
Living will
A living will is a type of patient directive that comes into effect when a person becomes incapable of making their own medical decisions, typically in cases of terminal illness or permanent unconsciousness. It outlines the specific medical treatments the person desires or rejects under such circumstances. Examples include preferences regarding life-sustaining measures like dialysis, tube feedings, or breathing machines. Before implementing a living will, two physicians must confirm the person’s incapacity to make medical decisions.
When drafting a living will, considerations may include the use of medical equipment, do not resuscitate (DNR) orders, provisions for fluid and food intake, pain management preferences, and organ donation wishes. It’s essential to be aware that living will laws vary from state to state, including requirements for renewal and updates.
A durable power of attorney
A medical power of attorney, otherwise known as a durable power of attorney for health care, enables individuals to name a proxy or agent to make medical decisions on their behalf in case they are unable to do so themselves. For this designation, a doctor’s certification attesting to the patient’s inability to make medical decisions is necessary.
The proxy or agent acts as the individual’s voice, communicating with the healthcare team and other caregivers to ensure decisions align with the individual’s wishes or, if unknown, are made in their best interest. Thus, choosing a proxy or agent who knows the individual well, understands their decision-making preferences, and is comfortable advocating for their healthcare needs is crucial. It should also be noted that laws governing durable power of attorney for health care vary by state.
POLST (Physician Orders for Life-Sustaining Treatment)
While not technically an advance directive, the Physician Orders for Life-Sustaining Treatment (POLST) form helps individuals specify their preferences for healthcare during emergencies. It consists of specific medical orders that seriously ill individuals can fill out and have signed by a qualified healthcare team member, such as a doctor. POLST forms address preferences for emergency interventions like CPR (cardiopulmonary resuscitation) or the decision to be transferred to a hospital and placed on a breathing machine if necessary.
DNR (Do Not Resuscitate) orders
DNR orders are specific instructions given to healthcare providers regarding the desire of a patient to forgo resuscitation efforts in case of a cardiac or respiratory arrest. In a hospital setting, a DNR order can be added to a patient’s medical record, indicating that no attempts should be made to revive them. However, it’s important to note that a DNR order within a hospital is only applicable during that hospital stay and may need to be renewed upon subsequent admissions.
Outside of a hospital, individuals can obtain DNR documents such as wallet cards or bracelets to inform emergency medical service (EMS) teams about their preferences. State-specific laws govern DNR orders and the associated documentation.
Organ and tissue donation
Advance directives can also include preferences for organ and tissue donation after death. Many states provide organ donor cards or allow individuals to indicate their donation wishes on their driver’s licenses.
HIPAA Authorization vs Patient Directive: Exploring Key Differences
While both HIPAA authorization and patient directives pertain to healthcare decision-making and the protection of patient information, they serve distinct purposes:
- HIPAA authorization primarily focuses on granting consent for the use and disclosure of protected health information beyond routine healthcare operations. It allows healthcare entities to share patient information with authorized individuals, including friends, family, and business agents. Also, it doesn’t require a patient to provide a certification of incompetence to authorize the disclosure of PHI. And while specific elements like expiration dates must be included in the authorization, the disclosure of PHI is not mandatory, and there are no timeliness requirements.
- Patient directives, such as living wills and durable powers of attorney, enable individuals to make decisions about their healthcare in advance or designate a trusted proxy or agent to make decisions on their behalf when they can no longer do so. Patient directives cover a broader range of healthcare decisions, including treatment preferences, end-of-life care, and organ donation. Their implementation requires compliance with state-specific laws, and the designated proxy or agent must act in accordance with the individual’s wishes or best interests.
HIPAA authorization and patient directives are essential legal tools that play distinctive roles in healthcare decision-making and the protection of patient privacy. While HIPAA authorization focuses on granting consent for the use and disclosure of protected health information, patient directives empower individuals to control their healthcare decisions in advance or delegate decision-making authority to trusted proxies.
Thus, clearly understanding the HIPAA authorization and patient directive differences is vital. It allows individuals, healthcare providers, and institutions to ensure patient privacy, honor preferences, and promote effective healthcare decision-making.
