Inter-Facility Transfer of Patient Information Before and After HIPAA Privacy Measures

Objectives

The study objectives were (1) to test whether interfacility communication of health information at the time of patient transfer changed as a result of implementation of US privacy protection measures (HIPAA) in April 2003, and (2) to examine patient, transfer, and illness characteristics correlated with interfacility transfer document completion.

Design

Observational study.

Participants and Setting

Individuals transferred between a 514-bed urban nursing home and a 1171-bed academic hospital in New York City.

Measurements

Research staff reviewed medical records of patients transferred both ways between nursing home and hospital, examining interfacility transfer documents for 12 items important for continuity of care. Transfer document completeness equaled the percentage of items recorded and legible in transfer documents. Transfers were classified by direction (nursing home-to-hospital [NH-to-H] or hospital-to-nursing home [H-to-NH]), urgency (urgent or not), timing (weekday 9 am to 6 pm or other), and by whether they occurred before 12 am April 14, 2003 (pre-HIPAA), or after (post-HIPAA).

Results

Seventy-eight nursing home residents experienced 100 hospital admissions. NH-to-H transfer documents were more complete than H-to-NH documents (86.7% vs 69.0%; P = .002). There were no significant differences between content of transfer documents between pre- and post-HIPAA transfers in either direction of transfer, with and without controlling for patient and illness characteristics. Older age, female gender, dementia diagnosis, shorter duration of nursing home residence, and off-hours hospital transfer were associated with less complete NH-to-H transfer documents, and shorter hospital length of stay was associated with less complete H-to-NH transfer documents.

Conclusion

There was no change in written health information communicated during patient transfer between an urban nursing home and an academic hospital before and after HIPAA privacy protection measures were implemented. This suggests that the rule’s intent to not restrict the sharing of information needed to treat patients is being followed by providers at these sites in the situation of interfacility patient transfer.

Keywords:  Hospitalization , communication , Health Insurance Portability and Accountability Act