Microscope slide disposal practices in the context of HIPAA
On Monday, I emailed the following question to HHS Office of Civil Rights
that handles HIPAA privacy issues:
Must PHI such as patient names and specimen accession numbers on label ends
of glass microscope slides be removed/de-identified/obliterated/destroyed
before discarding such slides? These slides are considered "sharps" that
are typically hauled away by a licensed medical waste management company and
dumped at a remote site away from public access. It seems to me that
disposing of microscope slides as described constitutes a "reasonable
safeguard" that protects against uses and disclosures not permitted by the
As evidenced by some of the posts on professional laboratory listserves,
some labs are going to expensive extremes (e.g., breaking label ends off
slides, blacking out PHI, crushing slides) to comply with what they believe
HIPAA requires -- adding cost without value. In my view, such measures go
far beyond what HIPAA intends: an individual name out of context has no
value and no potential for abuse. An isolated name is a symbol that might
as well be written in hieroglyphics. Under such circumstances, no one can
discern who the individual is or anything about him or her, what test was
done, what the results were, what meaning they might have, or any way to
gain access to such information.
Explicit guidance will be welcome.
Today, I received a call from David Mayer, Regional HIPAA Specialist (Boy
was I pleasantly surprised!). He confirmed that discarding microscope
slides as sharps, as described above, satisfies HIPAA's intent. There is no
need to make any effort to further de-identify patient-related information
on slide labels. The key point is that there is no realistically
conceivable link between such information per se -- which is not
confidential -- and confidential information about the patient (e.g., test
results, history, treatment, etc.).
David commented that OCR and related entities are criticized for being
either too narrow and restrictive, or too open-ended and subject to a
variety of interpretations. Be practical, not literal or black-and-white.
He also said that what we (i.e., labs) do vis a vis HIPAA-related issues is
way low on their list of priorities.
So, I hope this sets everyone's mind at ease about this question.
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