Testimony: Louis Borgenicht, MD 11/6/02

Thank you for the opportunity to participate in these hearings today on the HIPPA privacy rules.

I have been a general pediatrician for thirty years and have been doing private practice for the past eighteen years in small solo office, 626 square feet in area.

I first heard about HIPPA when I began receiving solicitations to purchase CD's, manuals, and suggestions to participate in special symposia sponsored by various law firms and health related organizations. My first call was to the Utah Medical Association which was helpful in providing some perspective on HIPPA and suggesting that the most constructive thing I could do was file for an extension until the rules and their applicability got clarified, particularly as they might apply to small offices.

Just a comment about the innundation of my office by those looking to profit from my

ignorance about the implications of HIPPA. I passed this information on to the UMA but then wondered whether I should be contacting either state or federal agencies (e.g. FTC) about what seemed to be possibly unscrupulous marketing practices. It is an issue the committee might look into.

In any case I am concerned about the implications of the privacy section of HIPPA for my office. I have been told that "some of the rules will not apply to your office" but doubt this is true. So confusion reigns.

I have read the testimony given by a pediatric group at the hearings in Boston and agree with most of their comments. Since the size of my office is tiny in comparison with theirs other issues arise.

Let me describe my office.

Patients enter my office directly into the waiting room and reception area where my office manager (who literally does everything I don't do) sits. She is a wonder and is able to simultaneously multitask, a necessity in a small office: she greets patients, makes appointments, gives some advice, takes messages, deals with all insurance and billing matters and keeps the general peace in the waiting room.

I have a room used simultaneously for weighing children, storing immunizations in our refrigerator, and a counter for performing the little lab work we do perform (dip urinalyses, quick strep tests, and centrifuged hematocrits). There is a bathroom and two separate examinations rooms and, finally, my consultation room where I talk with patients after the examination and any necessary procedures have been completed. All of this in only 626 square feet.

In this setting some aspects of the privacy requirements are common sense. Charts can be placed backwards in the slots on the exam room doors so that patient identifying information is not visible by anyone walking by. We are already cautious about patient conversations in a small space since most of my discussions take place either in an exam or consultation room and we are aware of the necessity to be similarly discrete with phone calls.

This said one of my concerns about HIPPA is stylistic: the ambiance in my office has always been informal. We do not stand on formality or medical ceremony and I wonder whether the HIPPA privacy regulations will change all this. Will the form of practice dictated by HIPPA change things essential to both the pleasures and efficacy of practice?

While it is clearly important in protect patient privacy in the age of multifaceted transfer of privileged information it is also essential to provide practitioners simple and clear information about the reasonable means to achieve this. What may be applicable to a large clinic may not be applicable to a small office, and while there are fewer and fewer of us left, it is important to preserve them in a way that does not hinder their functional efficacy and care taking ambiance.

Thank you for your consideration.

November 3, 2002