By Mary Butler
The Journal of AHIMA first talked to Sally Beahan, MHA, RHIA, senior director of enterprise records and health information at the University of Washington Medicine (UW Medicine) in Seattle, WA, in early March, when Washington state had the highest number of COVID-19 cases in the country.
Beahan was joined by colleagues Lenny Sanchez, UW Medicine’s HIPAA/privacy director, and Beth DeLair, UW Medicine’s interim chief compliance officer, for a follow-up interview last week to discuss lessons learned in her organization’s HIM department during the first few weeks of its COVID-19 outbreak.
This interview has been lightly edited for clarity.
JAHIMA: What were some of the most frequently asked questions you have been fielding about privacy?
Sanchez: What usually comes our way is questions like “Can we share information with State Department of Health, County Public Health?” or “What types of privacy agreements might be required based on the technology or service?” and “How do I get signatures from patients that are in isolation?”
JAHIMA: Is there a difference in what you can release about patients during a pandemic, an emergency to federal authorities or the CDC versus what’s typically allowed during any other kind of release of information?
Sanchez: I think that we would always oblige what’s required under a government entity’s public health surveillance authority. So in this case the standard is still the same, but the data might be different.
JAHIMA: HIPAA has public health emergency suspensions during emergencies or when they’re declared. Has that happened in your state, and how did it change what you were doing?
Sanchez: Yesterday I received the notification from the Office for Civil Rights making that bulletin declaration about suspending certain provisions of the Privacy Rule. I reviewed them, and I don’t think that at this point in the situation we’re going to change our practices, but they’re certainly on the table if it’s necessary.
JAHIMA: Have you had to think through HIPAA compliance with telehealth? Or have you implemented any telehealth services yet?
Sanchez: We have had telehealth going on for a few years, so not really thinking about anything novel in this sense, but just expanding on the use of it.
DeLair: There have been a lot of questions, because we’re a teaching hospital, about how to utilize teaching physicians and residents both in the provision of a service, whether it’s an outpatient service to initially accept the patient or whether they’re inpatient and in quarantine, how you’re able to bill for that service because of the nuances with the teaching physician role. So that’s been an interesting discussions that many community hospitals do not have to think about or deal with.
JAHIMA: How are you doing with staffing levels? Do you have staff that have become ill since this outbreak started?
Beahan: Out of my 250 staff, I know of three that are sick, but they have yet to be tested [for COVID-19]. But they’re self-quarantined at home. And interestingly the staffing levels, by moving people home, has really helped us to keep up with our workload. And in fact, what I noticed is kind of an unintended consequence is our AR [accounts receivable] stays have gone down since we sent everybody home. And part of that I think is the fact that the whole state is pretty much being told to stay home. When you have staff that are home and don’t have anything else to do, they’re willing to work overtime. So actually our discharge not billed numbers look better today than they did two weeks ago. And I just thought that was an interesting phenomenon that I wouldn’t have expected.
JAHIMA: What have been some other surprises, operationally?
Beahan: I think the other part that we’re seeing impact more is they’ve cancelled all elective surgeries, and so then that impacts my ambulatory coding team as well as my pathology coding team. So it’s just kind of interesting because we’re concerned about running out of work in some of those areas where typically we have more than enough work to do. I noticed this morning that transcription turnaround is quite good, and we don’t have a lot of work sitting in our queue. And I’m assuming that’s partly because we cancelled some of the elective cases where they typically they stay off of the report.
JAHIMA: What advice do you have for other HIM professionals right now?
Beahan: We are prepping old paper disaster charts now for the expected surge in patients. We kept our old charts “just in case” and am glad we did. My advice to my colleagues is to start thinking about surge patients and additional beds. The EHR will not support the care in all the places that they will have to be putting patients, so there needs to be a paper chart contingency plan.
JAHIMA: How does this compare, or does it even compare, to other epidemics or past pandemics? Or is this just completely new and different?
DeLair: What I can tell and you can feel that there are people who are very concerned about this and having quite a bit of anxiety about it, whether it’s for themselves or for their families. But what I can say personally from watching our teams work together, everybody is working so hard and working so collaboratively to provide the best possible care we can, and people support each other as individuals and as a team. It’s really wonderful to watch everyone rise to the occasion and just really support each other.
Beahan: From my opinion, this is new, different, and unlike anything I’ve ever seen in my career. It’s unprecedented, really.
At UW Medicine we have a daily message that comes out where they’re offering resilience support to staff. They have a number of different options for staff that are feeling like they need to talk to somebody or they want, you know, hear what our infectious disease leaders are saying. I mean, it’s really frightening. At the same time, how are we going to survive this if it goes on for months? Which, in reality, it really could. So it’s just, I think, a new thing for all of us to experience. But to Beth’s point, I think people are banding together, and we’re doing what’s right for our patients. There’s a lot of camaraderie right at the moment.
JAHIMA: What have your hours been like in the last couple weeks? And when did things really go from being normal to not normal?
Beahan: For me, from an HIM perspective it was Friday, March 6, when the head leadership at UW Medicine said, “You need to send staff home immediately.” That was really the turning point for us.
JAHIMA: Have there been any silver linings?
Beahan: One thing is we have about 70 staff that have participated in the AHIMA apprenticeship program. And so we have a number of them that haven’t really progressed through the program as quickly as they need to in order to meet the deadline, so that’s been one other silver lining. Since they’ve been stuck at home, they’re working through their modules more quickly.
Mary Butler (firstname.lastname@example.org) is associate editor at the Journal of AHIMA.
Photo credit I-5 Design & Manufacture, available under Creative Commons license, some rights reserved.: https://www.flickr.com/photos/i5design/5118510677/Leave a comment