Under what circumstance can personal health info be used for purposes unrealted to healthcare under the hipaa?

Answer 1

Good question! People are often amazed at how many different ways their health information or medical records can be used AND abused! I do not know if I can think of twelvecircumstances, but here are some that I know of:

The most common ones are:

1. Decision-making for insurers. Many people are often denied health or life insurance, based on current medical conditions. Often, coverage is denied because of "pre-existing conditions", that is, some condition the person applying already has or had. Many times, this is used by insurance companies very blithely, without really checking to see if it is true. For instance, a person might be denied payment for a doctor's visit for anything that included dizziness (such as a stroke), if in the past, they or a health professional had EVER used the word "dizziness" in a doctor's visit!

2. Joining the Armed Forces or other branches of law enforcement: Most people know of the rating system in the Army, for instance, but anyone wishing to be a police officer or FBI agent, would have to have rigorous medical exams and background checks for other medical problems/conditions.

3. Use in schools: All children in public schools are required to be up-to-date on their immunizations and to provide medical documentation of these, as well as history of yearly physicals, medication required or conditions about which the school should know, in case of emergency. Asthma is a common one.

4. Hiring and even firing. Though this is rarely said, it is also common knowledge that prospective and current employers often check applicants' and employees' medical records, with or without consent, to see if they will be a problem, say, with sick time, or medical claims (if the company offers insurance benefits). Many companies also ask for disclosure of an applicants' disability, if any on their application. This way, if the employee later claims disability, or lack of compliance with such, the company may use this to say they did not know, if the person claimed they had no disability. Responsible companies will use this to PROVIDE compliance for disabled employees (such as ramps).

An example of a GOOD reason to look up a patient's health history, would be in dangerous professions, or ones in which the employee is responsible for many lives, such as an airline pilot, or a doctor!

5. Legal claims: Often, people who sue individuals or companies for conditions due to injury (both on the job and off), are in for a tough road, if the defendant's lawyers uncover a medical condition that could even remotely account for the plaintiff's condition. An example would be: An plaintiff is hit on the head and develops seizures. Head injuries are the most common cause of sudden onset seizures. However, if the plaintiff has a history of alcohol or drug abuse and treatment, a good defense lawyer will almost CERTAINLY claim that this, not the injury, caused the seizures. And a crummy litigator will give up and settle for far less, or so they hope!

6. Information for other doctors. Though reading a patient's COMPLETE medical history is rare these days, with the current state of health care, doctors do use a person's health history to test and diagnose conditions. Dentists often use medical history (such as a heart murmur), to prevent damage to the heart during dental procedures. Other health professionals, such as chiropractors or dentists will often need some of this information.

7. Housing. Though one's medical health is usually not asked for on a lease application, the landlord might very well look it up, using an online service. One might ask why, but it is similar to the employer's reason: not wanting the tenant complaining that their disability was not accommodated (this is against the law) or that they were discriminated against (this is why the landlord would look up medical history secretly, then give another reason for not renting, such as bad references or credit). Also, if the tenant had something that made them prone to injury, such as epilepsy, the landlord might fear being sued if they fell and were hurt).

8. Marriage. It sounds unromantic, but potential spouses often want to know about any history of illness, genetic or otherwise. Also, many partners (wisely) want the other tested for STD's such as HIV and Hepatitis C. In most states, testing for syphilis is mandatory, though there is a cure in the early stages.

9. Conceiving and carrying a child. Most parents are asked if there is a family or personal history of genetic disorders, so that they can prepare for possible outcomes. some people choose not to reproduce, if there is a high risk of passing on a genetic disease, such as Tay-Sach's or Huntington's chorea. There is also the mother's health. Doctors should investigate possible birth problems (Diabetes, hypertension, injuries, malformations of the skeleton or uterus), or anything that could complicate pregnancy and/or delivery.

9. Child custody - This could come under the "legal" category, but many times, individuals make decisions on their own, without legal advice, about who will care for their children (say, if both parents die), based on the potential care-giver's health. Often, grandparents are either not considered, or only given temporary custody, due to age-related issues.

10. Ability to make decisions, legally and otherwise. Many times, families take over decisions about living arrangements, finances and many other aspects of a person's life, if the person's ability to make sound decisions is compromised by a disease such as Alzheimer's or drug/alcohol abuse. This often happens if the person is mentally or emotionally challenged, such as with retardation or mental illness.

11. Marital problems, Separation and/or Divorce - Sadly many spouses who are diagnosed with a lasting, crippling medical condition, such as multiple sclerosis or rheumatoid arthritis, are deserted by their spouses (usually women by their husbands), especially if any personal care may be needed in the future! Men are usually not raised to be caregivers, so possibly, the prospect of caring for a sick or disabled spouse frightens them. Or they may just be callous and want "something better".

12. Driving. Of course, eyesight is tested, but few people know that people with certain conditions, such a seizures, may not be allowed to drive or subject to restrictions (such as being free of seizures for 2 years, after treatment, as certified by a doctor). Obviously, any health condition that impairs a driver's ability would either limit their driving or cause their license to be taken. It is still amazing, however, that such strict rules are imposed on teen drivers, yet not on the elderly (such as yearly eye exams and road tests), when their accident rate is almost the SAME as that of teenage males!

Answer 2

PHI can be utilized for the following purposes: * Delivery of health care (very few limitations) * In order to obtain payment (minimum necessary). * Repricing (minimum necessary). * Covered Entity Operations (minimum necessary) * DE-identified PHI (which is no longer PHI, assuming the de-identification was properly executed). * With the patient's Authorization.