One practice's patient satisfaction survey may not generate the anticipated response after it mailed postcard surveys that violated patients' protected health information.

Posted in Risk Management on Thursday, June 23, 2016

Surveying your patients regularly and in a variety of ways is a critical part of running a successful medical practice. Surveys measure satisfaction – or dissatisfaction – with your care, determine critical needs and offer an opportunity to effectively communicate and build relationships with your patients. Selecting the method used to send surveys and survey reminders is a critical decision that you should carefully consider.

For example, one practice’s patient satisfaction survey may not generate the anticipated response after it mailed postcard surveys that violated its patients’ protected health information (PHI). By sending its survey using postcards, each recipient was identified as an individual who used the practice’s services. This led to a HIPAA violation for 59,000 patients.

This is the second example of patient privacy rights being compromised through a postcard mailing. In the first instance, a reminder to complete a survey postcard was sent to a practice’s patients. Again, these postcards indicated that each recipient was an individual who used the practice’s services.  

While postcards can be a less expensive way to reach an audience, when it comes to any patient notification, it’s better to send the information in an enclosed envelope.

In the wake of these incidents, it’s a good time to review the 18 identifiers of PHI:

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:
   • The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people.
   • The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people are 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 fingerprints and voiceprints
17. Full-face photographic images and any comparable images
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)

In situations where PHI is involved, it is better to be safe than sorry.