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Video Surveillance and HIPAA regulations
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Video Surveillance and HIPAA regulations - September 24, 2008 11:12:20 PM
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JDMBBuilder
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From: Long Island
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Does anyone have any information or insight on video surveillance of the physical therapy treatment areas and HIPAA compliance? My employer has instituted video surveillance that will be broadcast over the internet to their home computer. Does anyone else have experience with this in their workplace?
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"Anyone can throw you on a "state of the art" machine and call it physical therapy. The only high-tech equipment I need are my brain and two hands..." -JSDPT
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 5:35:57 AM
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PTupdate.com
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1. If I was a patient there, the last they'd see of me is a Johnny Cash giving-the-finger shot to that camera as I walked out the door with my script in hand.
2. Sounds like you work for a real d_ck
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 6:15:32 AM
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SJBird55
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Video surveillance will probably become more and more common. I can't remember what hospital is having issues with employees breaking confidentiality with celebrities... then there are also employees using their camera phones and taking photos of patients (injuries, surgical procedures) and putting them on facebook/myspace... and then, there are issues with handwashing - employees don't wash their hands. I was reading an article the other day on video surveillance as an option to monitor behavior. What I read and what I followed up on indicated that the surveillance company was the "big brother" and the customer received reports.... http://www.arrowsight.com/public/as/html/medical/overview.asp
And no... no video surveillance where I'm at - I'd just be watching myself. LOL You know though that could be helpful - I'm always losing stuff, maybe if I observed myself, I'd learn my tendencies/habits and that would help my memory!
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 7:03:26 AM
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JDMBBuilder
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From: Long Island
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quote:
ORIGINAL: PTupdate.com
1. If I was a patient there, the last they'd see of me is a Johnny Cash giving-the-finger shot to that camera as I walked out the door with my script in hand.
2. Sounds like you work for a real d_ck
Yep, its real frustrating...who knows how long I'll be working there...
_____________________________
"Anyone can throw you on a "state of the art" machine and call it physical therapy. The only high-tech equipment I need are my brain and two hands..." -JSDPT
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 9:21:01 AM
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Shill
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There are also issues with patients changing their clothes, so if this is in a treatment area, I would strongly advise against any video surveillance, and if it has started already, I would make sure your clinic has a good lawyer. Patients would need to sign an agreement first of all, and second of all it is just plain stalker-creepy, regardless of the intent.
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 6:02:16 PM
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Sebastian Asselbergs
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Yeah, I really do not like giving lawyers even MORE work, but I think you are best off checking with one who knows about the regulations.
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Mundi vult decipi
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 8:29:42 PM
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jma
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Maybe in public areas but there are none in patient rooms or treatments area where I work in the hospital. Sounds way too invasive and invasion of privacy. I wouldn't want to work in an environment that does this.
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RE: Video Surveillance and HIPAA regulations - September 25, 2008 8:36:16 PM
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SJBird55
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I actually think this type of system would be excellent for qualitative studies. We have very little in the way of what happens during patient/clinician interactions.
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 6:04:17 AM
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SJBird55
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No, seriously... think about it... we really don't have any qualitative studies on patient/clinician interactions. What if? What if we could 1) determine "expert" based on outcomes and then 2) really observe the interactions between the patient/clinician? I think I've seen one study on the interactions between therapist/patient - just the verbal aspect that occurred during the sit down, subjective portion. From reading that, I did change my style and stopped my brain (somewhat - I still have a racing brain), listened and really answered the patient's actual question versus being fearful and just responding with another question OR changing the direction of the conversation... What about our body language?... what about the patient's body language? We really don't have anything on that aspect. Combine it with the verbal communication and we might really learn some good stuff!
There might be a way to have something or another written up for patients to sign that isn't too horribly long. With technology now, there may be a way for the surveillance system to be voice driven by voice recognition... that way just the interactions between therapist/patient are captured.
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 6:59:08 AM
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Sebastian Asselbergs
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I think it won't be that easy. If it is voice triggered, a lot of non-verbal interaction in the quiet periods will be lost, reducing the usefulness of the whole thing.
And there is also the "camera" response: there is always the problem of awareness (PT and pt) of observation - especially cameras - which will influence the data collected and thus make any conclusion drawn, less useful.
The only really valuable way to collect such data would be when neither the PT nor the patient would know; and that, in the present confidentiality-sensitive world, ain't happening.
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Mundi vult decipi
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 9:09:53 AM
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SJBird55
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Well... Hmmm... I'd think that technology could be sensitive enough - have the voice activated to trigger for X amount of time? I dunno... Well, no, the patient or the clinician shouldn't know - random samples. If the data is used for clinical improvement, I think it could actually happen.
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 10:21:14 AM
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Sebastian Asselbergs
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But SJ, the PT and the pt both HAVE to sign consent forms - there is NO way it is legal to film either without the benefit of a release/consent - especially in a clinical setting. And as soon as they sign those, they WILL be aware that they may be observed.
I think you are right that it would give valuable information, but making it happen in any really useful way, is not likely - IMO.
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Mundi vult decipi
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 1:14:31 PM
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SJBird55
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Whatever... they sign it. I don't see what the big deal is. If every effort is made to capture the interaction versus undressing, it could be a good thing. Okay, they know they MAY be observed, they don't know when. The cameras can be running for every interaction, but random samples of the interactions between patients would be taken. Casinos have cameras... shopping centers have cameras... video stores have cameras... department stores have cameras.. banks have cameras. We're on cameras everywhere. Does anyone REALLY pay attention to all those cameras? Heck no... we all know they are there, but it doesn't phase us in the least. After awhile, the clinicians wouldn't really be paying attention that there IS a camera or they might be being observed. I'm not talking some big camera that is highly visible - I'm talking some dinky thing that isn't horribly apparent.
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 5:07:16 PM
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Sebastian Asselbergs
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I don't want to flog this horse to death, but you are comparing apples and oranges.
First of all, everybody KNOWS there are security cameras in many areas and what they are for: they are already accepted as a fact of life - in a public area. It is a non-personal thing. Big difference with a place where one-on-one therapeutic interventions occur. Also big difference for the PT who is aware that every aspect of his/her day may be used for study. As I said before - awareness of observation affects the actual activity being observed. How valid will the data be?
Second, they don't know when they will be filmed. There are lots of patients who do not need more than 2 or 3 visits; I can hear them now: "Is it on now? How about now" As if they would forget easily that they just have signed a permission form for being filmed...
Third, you want to make sure not to film any patients who DON"T sign the forms, right? How valid is the data now? You just eliminated a particular group of subjects with a common variable (and what I know of many people, a LARGE group), making whatever data you gather, even less significant.
And finally....yes, whatever.....
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 6:52:04 PM
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SJBird55
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I guess I kind of think if the surveillance were to be used for improving clinical importance, if one were worried about the issue of getting used to it, well, I tend to think it would become similar to living next to a train track that had trains running on it. After a while, one doesn't notice the trains going by. I'd bet after about 2-3 months of time, with no further mention of the potential, random tapings, the therapists would forget. (And even if they didn't, well, for a study, one just communicates the bias/weakness.) Patients... the paperwork could be written so video was buried in the thing. I tend to think that what could be learned from a project like that far outweighs all the issues that you see as barriers.
I also have the attitude that where there's a will, there's a way. I'd be for it. In previous discussions, many of us believed that something relevant and important occurs in patient/clinician relationships - we've never studied it though. What better way to grasp the interaction and developing relationship - the verbal aspect, the body language and visualizing the manual aspect? (What we do is kind of multi-modal and video would be the best way to capture our performance.)
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 8:20:55 PM
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Sebastian Asselbergs
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Well, I disagree - you are now proposing to "bury" the issue of video in the paperwork?!? Yeah, let's fool the client for the sake of improving our therapist/client interaction and outcome.... I'd love to see you write up this part of the protocol for the ethics committee reviewing this research application....
There are many psych and sociological studies that have explored styles of therapist - client interactions: with regards to verbal and non-verbal skills and pitfalls. And there are guidelines and courses addressing this aspect: that should be more than enough to have an individual, effective approach with the wide variety of clients. That's why we took sociology (including: focus on client - therapist relationships, and effective communication and interpersonal skills) in our 3rd and 4th year. And this was in 1982-83.
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Mundi vult decipi
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RE: Video Surveillance and HIPAA regulations - September 26, 2008 9:16:58 PM
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SJBird55
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Patients sign all sorts of forms with regard to HIPAA. Since the video thing would be random and not even actually consistently occurring, the possibility of videotaping sessions wouldn't have to be some big, huge thing as a stand alone statement, hence it could be "buried" within a section of "quality improvement." The rationale for videotaping would be for quality improvement. The patient wouldn't be "fooled."
I never had any class on sociology or interpersonal interactions. I've only seen a few studies with results of transcripts of taped sessions, but what we do is so much more than just a taped session.
We can disagree. I believe there would be value in actually viewing sessions.
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RE: Video Surveillance and HIPAA regulations - September 27, 2008 11:15:55 AM
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kamryn
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I don't think the original question has been answered - is the original scenario a violation of HIPAA? I think it would be, especially if the pt was not aware.
What about how SJ describes it - if the pt signs off, the facility approves, and it will only be analyzed for the purpose of peer review/quality improvement, is this a HIPAA violation? Probably not. I agree with SJ that this could probably be seen in the future in PT clinics for good reason. If you don’t have anything to hide, why would you mind being randomly assessed? Heck, you might get better by improving on areas that you need to improve on.
In the clinic I worked at previously, our clinic supervisor would show up unannounced about 1-2x/quarter to all the PTs for an hour or 2 of clinical supervision - this was specifically done for quality assurance. No one minded it - it was very constructive and the best form of peer review I ever rec'd.
For instance, take a look at the paper below - you could have figured out that providers don't let pts complete their opening statement of concern some other way (direct observation, audiotape) - but I bet there was some interesting body language associated with those providers cutting the pt off that they might not be aware of. And I think we would all agree that letting the pt complete their first sentence is a good thing.
Meuleman JR, Harward MP. Assessing medical interview performance. Effect of interns' gender and month of training. Arch Intern Med. 1992 Aug;152(8):1677-80.
Observation of history taking is commonly used to assess interviewing skills in medical internships, yet specific interviewing problems are infrequently documented. We evaluated videotaped recordings of 83 complete medical histories of new patients for content and questioning technique. Frequent deficiencies were found in history of medication compliance, gynecologic and psychiatric history, use of open questions, and mental status examination. The initial segments of 48 interviews were evaluated, and in 44% the patient was not allowed to complete their opening statement of concerns. Female physicians allowed fewer patients to finish their opening statement, and physicians at the end of the internship permitted the patients less time to express their concerns. Structured evaluation of complete histories reveals frequent interviewing problems as well as possible important effects of physician gender and length of training
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RE: Video Surveillance and HIPAA regulations - September 27, 2008 1:48:13 PM
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SJBird55
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That might have been one of the articles I read, Kam. Right now there happens to be a high frequency of newsfeeds (or whatever you call them) on physicians lacking compassion... physicians blowing off the questions of patients with cancer... physicians lacking basically that emotional connection with their patients.
I've watched other therapists... I've noted whether they squat down to speak to someone in a wheelchair... if they squat down or pull up a stool to speak to someone in a sitting position... if they offer alternative positions (standing, supine, sitting, sidelying) during the subjective portion of the initial visit... do they shake the patient's hand?... how do they introduce themselves?... do they smile? What about on the last visit... a shake of hands? a hug? best wishes? stay in touch? What about those patients that ramble on and on.. cut them off? redirect? What body language is expressed? What about the patients with mild dementia? How does a therapist respect the patient but also tactfully gleen information from a caregiver?
We may transition into electronic health records or electronic medical records (whatever you want to call them)... what happens to the "relationship" or the interaction between the clinician and therapist? Can one maintain a good interaction while being busy clicking on buttons on a computer? What's the patient's perspective? Can one effectively get the documentation done AND have the patient feel important and just as relevant as the computer? Are there body languages that might need to be utilized at a higher frequency to maintain a connection?
A lot of what we do seems to hinge on the relationship we create with patients. Or, maybe I'm wrong and it doesn't really matter.
When I was employed with surgeons, I spent my first 8 weeks doing a lot of observing. One surgeon and one physiatrist were awesome to observe. For the 15 minutes of time, it really felt that time stopped and those two were genuinely focused on the patient in front of them and nothing else mattered. I would sometimes be somewhat deep in thought reflecting on what I was observing that there were times that the surgeon or the physiatrist would have to ask me something twice (usually wanting my input). For example, they sat down when they spoke to the patient. They asked open ended questions and listened to responses. They either had their legs crossed or their feet planted on the floor, but no nervous movement or bored wiggling/tapping of their feet. If there was a woman patient, often times either before leaving or upon entering, they did touch her hand or her knee or her arm/shoulder. Men, they generally tapped the patient's leg or shoulder with the chart as they were walking out of the room. When speaking, they did look the patient in the eyes. They tended to look at radiographs and the chart prior to going into the room. It was very interesting... after awhile, for those two I could pretty much guess what they were going to do next and hand them equipment or write up the beginning of a prescription to assist them. I found it very interesting and intriguing... and I observed 6 other surgeons in the same business and saw WAY different interactions - follow-up visits that I'd call the "grab and go." Walk in with chart in hand, reading/skimming chart, yes/no questions, walk in, keep on moving and walk out... If I blinked, I missed the whole interaction kind of a thing. I would even bet that if I asked those surgeons what color of hair or eyes the patient had, they'd have no clue.
Bas, you do have valid concerns... I do think there could potentially be abuse of surveillance devices - we are human. It always feels to me that as a whole administration has a really low bar for our performance. The meat and potatoes of what we really do isn't observed, tracked or measured.
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