Case Reports and HIPAA Rules

Imagine this scenario:

You are a medical blogger (doctor, nurse, student) and just saw a very interesting patient. You would like to describe the patient as a clinical case on your blog, in order to share it with other health care professionals (some non-medical readers may visit your blog as well).

Question:

Is this case report allowed under HIPAA regulations?

Answer:

Yes, if you observe certain rules. If your opinion differs, please comment in the section below and add the relevant references. It is extremely important to check your employer social media policy which can be more restrictive, and extend or overwrite the general HIPAA rules. HIPAA is a law by the federal government of the United States.

Case Reports and The Health Insurance Portability and Accountability Act (HIPAA) of 1996

Physicians must assure that the case report does not contain any of the 18 health information identifiers noted in the HIPAA regulations, unless authorization from the individual (s) has been obtained. The authorization is not required if neither of the 18 identifiers below are used in the case report.

List of 18 Identifiers:

1. Names;

2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.

3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;

4. Phone numbers;

5. Fax numbers;

6. Electronic mail addresses;

7. Social Security numbers;

8. Medical record numbers;

9. Health plan beneficiary numbers;

10. Account numbers;

11. Certificate/license numbers;

12. Vehicle identifiers and serial numbers, including license plate numbers;

13. Device identifiers and serial numbers;

14. Web Universal Resource Locators (URLs);

15. Internet Protocol (IP) address numbers;

16. Biometric identifiers, including finger and voice prints;

17. Full face photographic images and any comparable images; and

18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

12-Word Social Media Policy by Mayo Clinic: "Don’t Lie, Don’t Pry, Don’t Cheat, Can’t Delete, Don’t Steal, Don’t Reveal" (http://goo.gl/1Jwdo).

References:

The Human Research Protection Program - UCSF.edu.
HIPAA Resources - The Privacy Rule - NIH.gov.
Single Case Report Policy - Johns Hopkins Medicine.
Medical Case Report Policy - Louisville.edu.

Cleveland Clinic Social Media Policy for Employees (PDF), from Association of Pediatric Program Directors, 2009.
The Purpose of this Blog - Dr.Charles.blogspot.
Image source: morguefile.com.

Related reading:

Twitter, HIPAA, Privacy and Freedom of Speech. Phil Baumann, 07/2008.Privacy of Individually Identifiable Health Information. Code of Federal Regulations.
Do you need IRB approval for a Case Report? See for yourself here: http://goo.gl/v3zF3 and http://goo.gl/P1eea
ER nurse blog "impactednurse" back online - reason for taking it offline - a reader identified de-identified X-ray on Facebook http://goo.gl/ey9Up
HIPAA found in Hippocratic Oath: Keep the patients’ secrets a secret. Also: My colleagues will be my brothers and sisters http://bit.ly/pGObLI
Dr. Wes: HIPAA, Case Reports, and the "Small Cell" Problem, 2011.

Comments from Twitter, 2011:

@symtym (Tim Sturgill): What about more restrictive state rules? States may be much more restrictive, e.g., California; also medical societies and organizations, e.g., AMA. There are lots of ways to run foul. For example, this doctor did, without HIPAA being an issue - state law only:

Example: http://www.symtym.com/2011/09/report-reprimand-repercussions.html

Or Rhode Island… medical boards have lots of latitude. RI did not invoke HIPAA, not applicable; they had separate laws to utilize. No info released; shouldn't mix HIPAA specific rules with separate state authority - big point. A key issue is multiple "sovereigns" and their rules are brought into play. There is no doubt synergyy, but the emphasis is multiple authorities and multiple legislative hx, agendas, interests, etc... I think if is very very important (b/c we are so use to and blinded to HIPAA) to be concerned about the many ways...