EXECUTIVE SUMMARY
Patient passports are gaining in popularity, but risk managers should consider legal and documentation issues. The patient passport is a document that covers basic patient data. A key question is whether the passport becomes part of the medical record.
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Passports can benefit patient safety by improving communication between the patient and caregivers.
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The safe strategy is to consider a patient passport part of the medical record.
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Patient passport templates are available to all hospitals.
Risk managers know better communication with patients and family members can reduce errors and improve the overall quality of care, and some hospitals are now adopting “patient passports” to facilitate a better exchange. Proponents laud the benefits of the passports, but risk managers also must consider any potential liability or documentation issues.
The patient passport is a document that covers basic patient data, including some information found in traditional medical records. Patients can write in additional information such as how they deal with certain health conditions, what type of activities they might need help with, and any requests they might have after discharge. They also can update the passport with changes in their conditions or medications prescribed.
The National Quality Forum (NQF) in Washington, DC, has developed a patient passport modeled on one used at the Mattel Children’s Hospital in Los Angeles. It can be customized for specific patient groups, such as cancer patients or palliative care patients. (The passport is available at no charge online at http://www.qualityforum.org/Patient_Passport.aspx.)
Written in the patient’s voice, the patient passport uses pictures and simple language to start conversations and to help providers see their patients as people with stories beyond their illnesses, the NQF explains. The content and style are intended to make frontline staff’s work simpler and more effective by presenting critical information about the patient, such as medications, conditions, and what works or doesn’t work to cope with health conditions, in a concise and meaningful way, the Forum explains.
Mattel developed the passport after leaders there recognized that when children are taken outside the pediatric ward, other physicians and nurses might be unaware of conditions such metabolic issues or weak immune systems. Griffin Hospital in Derby, CT, recently began a similar program for its patients.
One goal with patient passports is to “fill in the gap between best intentions and patient outcomes,” says Jim Kinsey, director of member experience with Planetree, a not-for-profit hospital membership organization that works with the corporate parent of Griffin Hospital.
“There is a disconnect between what providers believe the patients want and what the patient actually wants,” Kinsey say. “The passport helps patients be more active in their care and to have their voices heard more clearly.”
Before signing on to the patient passport idea, Kinsey investigated potential risk management issues with colleagues at Griffin Hospital. He found that by far the most direct risk management effect from patient passports should be positive. Many malpractice cases can be traced back to a misunderstanding between what the patient wanted and what the provider thought, or to mistakes in the patient’s assessment or medications, he notes.
“We think we’re actually avoiding problems by having the patient passport,” Kinsey says. “Researchers have shown that having the patient more involved in their own care improves outcomes and can even reduce costs.”
The legal status of the patient passport is not clear. At Griffin Hospital, administrators do not consider the passport to be part of the medical record, mostly because they encourage patients to continually update it as their wishes or situations change. Medical records are more of a static document that is never altered, Kinsey says.
Patient passports do not have to be incorporated into the medical record, but they probably should be, says Sarah E. Coyne, JD, partner in the Madison, WI, office of the Quarles Brady law firm. The legal community has not yet addressed the issue because patient passports are so new, but Coyne says the safe approach is to consider them part of the record because they are used to determine care.
“My advice is to incorporate it, because otherwise you can have an informational gap if the patient doesn’t bring it back,” Coyne says. “Once you’ve asked the patient to use this as a means of communication, I could see providers being held responsible for not knowing what was in the document or not adhering to it.”
Coyne also wonders about the risk of inconsistency between the passport and the patient’s record. If the patient passport notes an allergy, for example, but that information is not recorded in the patient’s record, the patient then can say the passport is proof that the information was communicated. But what if the patient did not bring the passport to the next visit after noting the allergy on it? Can the hospital claim that its medical record is the official document and that the passport was not provided?
Another concern is that the passport will contain protected health information (PHI) and probably will not be subject to the security precautions in place for electronic or paper medical records, Coyne says. If the patient is responsible for keeping the passport secure, there is still a possibility that the healthcare organization could run afoul of the Health Insurance Portability and Accountability Act (HIPAA.)
“To the extent that it has sensitive information, such as behavioral health treatment or medications, HIPAA can be enforced on that,” she explains. “There also can be additional restraints on a state level, and I would want any hospital I’m working with to have some sort of system that keeps the passport secure.”
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Sarah E. Coyne, JD, Partner, Quarles Brady, Madison, WI. Email: [email protected].
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Jim Kinsey, Director of Member Experience, Planetree, Derby, CT. Telephone: (610) 733-5140. Email: [email protected].
