HIPAA Compliance Strategies

Patient Privacy Goals Are Driving Hospital Construction Projects

Reprinted from the August 2006 issue of REPORT ON PATIENT PRIVACY, the industry's most practical source of news on HIPAA patient privacy provisions.

There's a sort of parallel universe for visitors to the new facility built by Deaconess Hospital in Evansville, Ind. Visitors are moved throughout the new hospital in a configuration that blocks their access to patient-care areas, says HIPAA Team Leader Candace Foster. This new floor plan takes patient privacy to a new level.

"It's a whole different design where the main working guts are off-limits to the public," Foster says. "There is much tighter control over channeling where the public can go. Patients will travel through a set of corridors that are entirely separate from what the public travels. It enables the patients to be transported from rooms without sharing elevators with strangers or the general public." For example, once patients come into radiology, they use a different elevator than do visitors. "It's truly separate. The public has no access," Foster says.

Patient privacy and security have become important considerations in hospital construction, renovation and design, privacy officers say. And even when projects are not big overhauls, hospitals reorganize departments and make other small physical and structural changes to maximize privacy. And often it is privacy as a patient satisfaction issue, more than HIPAA compliance per se, that is driving the changes. "It is patient satisfaction motivated," Foster says. "It's more for privacy in the human sense than in the HIPAA sense."

Deaconess' strategy was developed by its architect with input from the hospital. The second hospital - which is an additional facility, not a replacement — will have only three entrances for the public: the emergency department, the heart building and the main entrance, Foster says. The strategy cuts down on noise and enhances safety and security. "It wasn't generated out of concern for HIPAA itself so much as based on a general awareness that we needed to make things more private [for patients]," she says. "We use patient satisfaction surveys quite a bit in planning."

Some hospitals are also building new towers with single-occupancy rooms, another major approach to heightening patient privacy. For example, Lutheran General Hospital, part of Advocate Healthcare in Oak Brook, Ill., is building a new tower that will house single occupancy rooms, says Privacy Officer Donna Siemons. Privacy wasn't the only motivation - there were medical reasons as well, such as the need for isolation rooms - but privacy "was one of the compelling reasons" to go the single-occupancy route in the tower. The hospital breaks ground this summer, she says.

Soundproofing Proves Crucial

At Cambridge Medical Center in Cambridge, Minn., Jeff Pray, respiratory care services coordinator, and Laura Niemela, sleep services coordinator, were overseeing the remodeling of regular rooms for sleep studies in the sleep lab. The policy of their parent health system, Allina Hospitals & Clinics in Minneapolis, requires the assessment of construction projects from a privacy standpoint, so they were careful to ensure that the remodeling incorporated privacy protections.

Of paramount concern was making sure that voices didn't carry from room to room. So Pray and Niemela looked into soundproofing. A local company that specialized in soundproofing, evaluated the lab. "The company went into the room with a sound meter to tell decibel levels with different levels of talking. I was surprised it was better than I expected," Niemela says. But sound carried through the gap under doors and through the ductwork.

The company came up with several recommendations. One solution: door jam seals that seal the door when it's closed. "When you open the door, the latch is deactivated," Niemela says. There are also mufflers for the ductwork because it turned out that conversations in one room could be heard in another room through ducts.

The Cambridge sleep lab also had acoustical panels put on the walls to stop noise from traveling. In terms of the ceiling, half of the rooms were Sheetrock, and half were ceiling tiles, Pray and Niemela say. So the company dropped out the ceiling tiles and put in more soundproof tiles.

In addition to the soundproofing, the sleep lab had to find some way to protect the giant TV monitors that are part and parcel of sleep labs. Because the sleep lab is not completely isolated — it's at the end of a medical wing — visitors and outpatients wander by and sometimes, out of curiosity, try to sneak a glimpse at the oversize monitors. "People come back here looking for a bathroom or waiting room," Niemela says. So they had to find a way to protect the privacy of patient PHI on the computer screens.

Screen protectors were considered sub-optimal for the various monitors being used in the lab. "People walking by could see the screens, so as part of our remodeling we wanted to get them all turned," Niemela says.

To accomplish this, Cambridge designed a desk that sits in the middle of the room so the monitors face away from traffic flow. Additionally, "we ordered a tall back splash" for the desk "so there is no way someone could peek over the desk wall" at a computer or TV monitor. And the desk was set up in an L shape to block the point of entry. "We didn't want it to be easy for the public to get around to the tech area and see the information on the computer screens. So I limited the traffic flow to one point of entry," Niemela says. "Now with the layout, people would have a hard time getting into the technician area."

Some of the privacy improvements at the sleep lab were also simpler. For example:

(1) Technicians were instructed to close patients' doors. Each technician handles two patients a night, so "if you're with one patient, and you don't close the other patient's door, you can hear everything," Niemela says. "It was a simple fix but it made a big difference in privacy."

(2) Staff was educated on turning patients' charts upside down or facing them away, Pray says. Niemela bought fluorescent poster board to cover PHI anytime it's on the desk. That reminds techs to cover the charts. "It's hard to ignore," Pray says.

New Room Configuration for Privacy's Sake

Privacy was an important consideration for the Seattle Cancer Center Alliance when it expanded its women's health clinic. "The goal is to design rooms to maximize privacy," says Julie Hamilton, corporate integrity officer.

For example, the center wanted to have private rooms where patients could get results from clinicians after having mammograms. "They used to have waiting areas after tests - with curtains. We don't think that's the best way to approach it from a privacy perspective," she says.

To address this, long rooms were constructed and split in two, with doors on both ends. Patients have the mammogram elsewhere, and then go to one side of the room for the clinical exam and consultation, and to the other side to dress and wait for the nurse to come and discuss the results. A new patient is cycled to the first part of the room. With doors at opposite rooms, privacy is maintained. "In the design process, we discussed how to use space in a way to be operationally efficient but also provide patients with the most privacy," Hamilton says.

DCH Health System in Tuscaloosa, Ala., is remodeling parts of its emergency room to improve patient privacy, says Chris Jones, senior counsel and privacy officer. The hospital got its share of "negative feedback" from patients when registration and triage were located together in an open room. "They were a distance away from where people sat, but if the waiting room was full, you could hear what was going on," he says.

So the hospital told its architect to up the privacy quotient. Now triage and registration are behind closed doors, Jones says, and the sound of silence — an absence of complaints from patients — is welcome.

Advertise With AIS

Privacy

Site Map