Q: We recently had a complaint from a patient who told us that, as she was filling out forms at the registration desk, she overheard a clerk on the telephone discussing the medical condition of another patient with a physician. Shes concerned that others might overhear medical information about her. What can we do and what do we have to do?
A: Providing privacy for such patient encounters is included in the HIPAA provisions. Most labs and offices are designed to provide privacy for files and for patient examination, but have often overlooked the chances for breaches of privacy that modern technology has produced. Although HIPAA provides no clear guidelines for ensuring privacy of telephone conversations, it is wise to take stock of the risks of eavesdropping and reduce them.
There is a variety of ways you can restructure your work areas to reduce the chances of eavesdropping. You may wish to consult a sound engineer to assess the physical arrangement of your workstations. If theres not room in the budget for a formal consultation, a little common-sense analysis can help improve the situation.
Sound control is generally based on three principles: absorbing sound, blocking sound, and masking sound. Often, simple changes can make a significant difference in the quality of sound management.
Sound absorption is the result of providing surfaces that will not deflect sound waves and that dull the transmission of sound throughout the space. Carpeted floors, dropped acoustic ceilings, and sound-absorbing wall coverings either carpet or special wallpaper help absorb sound and reduce the opportunity for eavesdropping. Installation of sound-absorbing coverings is generally inexpensive and can often be incorporated into routine maintenance budgets.
Sound blocking requires imposing a physical barrier to reduce the chance for transmission of sound. Breaking up a workspace with sound-absorbing cubicle walls will block sound, but may not be an option because of cost and physical restrictions of space. However, simple changes can provide a measure of sound blocking that may be very effective: ensuring that oral transactions take place in spaces that are directed away from each other. For example, lining up check-in stations side-by-side at a single desk almost ensures that a person in one area will overhear whats going on next door. The simple expedient of turning the workstations 45 degrees or 90 degrees from parallel will reduce sound transmission. Similarly, ensuring that the telephone stations in the rear are situated so that a person on the phone faces away from the patient area will also help. If possible, provide sufficient telephone and workspace in other areas of the office so that when sensitive conversations are occurring, a clerk can relocate to a quiet area.
Sound masking is perhaps the best, but most expensive, way to ensure audio privacy. Sound-masking technology involves providing low-level coverage of sound that makes it difficult to interpret conversations a few feet away because the covering sound interferes with the ears and brains ability to hear and interpret consonants, without which speech becomes unintelligible. Although sound masking adds to the background noise in an area, it is generally well tolerated by those working in the space and provides an effective way to reduce eavesdropping without large-scale remodeling. It can also be adapted to provide different amounts of sound reduction in different areas, depending on changing needs.
Barbara Harty-Golder is a pathologist-attorney in Sarasota, FL. She directs the clinical laboratory at Health South Rehabilitation Hospital in Sarasota, and maintains a law practice with a special interest in medical law. She writes and lectures extensively on healthcare law, risk management, and human resources management.
December 2002: Vol. 34, No. 12
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2002 Nelson Publishing, Inc. All rights reserved.
