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Chevron Medical Center is a 300 bed trauma hospital in La Porte, Indiana. Chevron Medical Center is a Joint Commission approved Medicare, Medicaid facility and houses a separate large outpatient surgery center adjacent to the main hospital. (You) Sandy Marshall is the Director of Health Information Management, and manage all of the records for both the main hospital and the outpatient surgery center.

Ten months ago, Chevron Medical Center moved totally away from paper medical records and implemented an electronic health record (EHR) system. The move was completed in three phases over an eighteen month time span. The majority of your 16 employees were ecstatic about the move to an EHR and were fully onboard with the change. One of your employees, Donna Hartford is frustrated over all of the security features associated with the new EHR. Donna is very vocal about wanting some of the security features disabled so she can get faster access to patient records and not have to sign in multiple times a day due to the systems auto shut down if idle for 10 minutes. The current process in place for all hospital employees is to first log on to Chevron Medical Center’s main system with a user name (assigned by the hospital IT department) and password (selected by the employee); second, then log on to the electronic health record using the main user name but a different password along with an access code (again assigned by the hospital IT department).

Donna wants to sign on one time and access anything she wants within the main system and electronic health record for as long as she wants with no additional logons or lock outs. She has assured you and the hospitals risk management department she will sign off completely when she goes on breaks, lunch, and at the end of her shift.

Donna has been extremely negative in regards to the new EHR sign on process and has made it a daily goal of hers to complain to anyone and everyone she comes in contact with. This includes co-workers, physician’s, department heads, other employees within the facility, and etc. Once a week, you have a brief department meeting with your staff just to touch base on how things are going, new items you need to share with them, productivity levels, concerns, and etc. During these meetings, Donna exhibits severe negative behavior emphasizing the need to eliminate the security features within the EHR. She becomes very verbally aggressive when one or more of her co-workers do not agree with her and say they have no issues with the process currently in place. There have been one or two times she has hit her fist on the table and shook her finger at everyone. Donna’s behavior is very disruptive and has all your other employee’s fearful she may become physically violent at any given moment. You have consulted Donna on her behavior in the past and she manages to tone it down for several weeks. But within two to three weeks she is back to her aggressive behavior again. You have had quite a number of complaints from other employee’s throughout the facility and know you must take action to control this situation.

Due to the State and Federal rules and regulations in regards to confidentiality and security of patient health information, you are at a loss as to how to possibly accommodate Donna’s request. You have reviewed:

1. Chevron Medical Center’s internal policy and procedures on confidentiality, security, and access to patient health records. It clearly states due to HIPAA and Joint Commission regulations, all EHR systems must be equipped with confidentiality, security, and access controls for protecting patient health records.

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