Shandra was a senior in her final semester of the Health Information Management (HIM) program at Anystate University in Smithville. She was completing her final courses, which included Trends in Health Information Management, Organizational Management Theories, and her Professional Practice Experience. Shandra was engaged to Andre, the Assistant Director of Respiratory Therapy at St. James Medical Center, with plans to marry after her graduation. Shandra was carrying a 4.00 grade point average going into her final semester and had hopes of becoming a Health Insurance Portability and Accountability Act (HIPAA) compliance specialist after graduation because she had heard that a new position was being created. She was excited to be able to complete her Professional Practice Experience at St. James Medical Center, the only hospital in Smithville, so she would be able to complete the rest of her courses that same semester, continue to live near her family and fiancé, and hopefully get her foot in the door with a chance at the new HIPAA compliance specialist position.    Shandra started her Professional Practice Experience by attending two full days of orientation with a group of new employees. The orientation sessions included information about infection control, the Occupational Safety and Health Administration, HIPAA, and quality improvement processes. All students and new employees were required to sign confidentiality statements during orientation.    Shandra did exceptionally well completing all of her assigned tasks during her Professional Practice Experience. She also became close with a number of the staff members in the HIM department and in other areas of the facility. She enjoyed being able to take her breaks and lunches with her fiancé and his friends from the hospital.    During breaks and lunches, Shandra overheard a variety of conversations among hospital staff. Occasionally, they would discuss interdepartmental issues, and sometimes they would gossip about hospital staff and physicians. One conversation was focused on a rumor about Henri Pioche, the Director of Respiratory Therapy. Many of the staff members present for the conversation indicated that they heard Mr. Pioche had been diagnosed with some kind of malignant condition and had been recently worked up to determine the possibility of brain metastasis.    Shandra and Andre took their afternoon break alone together that afternoon. Shandra asked Andre if he had heard any kind of confirmation regarding his director's condition. Andre had only heard rumors, but of course, he was curious because he would be the obvious next in line for the director position.    When Shandra returned to the HIM department after break, she pulled up Henri Pioche's records and saw that he had recently had a series of outpatient tests at the facility. She researched further and found that the most recent tests indicated brain metastasis that appeared significant. That evening, Shandra shared her findi.

1. Shandra was a senior in her final semester of the Health
Information Management (HIM) program at Anystate University
in Smithville. She was completing her final courses, which
included Trends in Health Information Management,
Organizational Management Theories, and her Professional
Practice Experience. Shandra was engaged to Andre, the
Assistant Director of Respiratory Therapy at St. James Medical
Center, with plans to marry after her graduation. Shandra was
carrying a 4.00 grade point average going into her final
semester and had hopes of becoming a Health Insurance
Portability and Accountability Act (HIPAA) compliance
specialist after graduation because she had heard that a new
position was being created. She was excited to be able to
complete her Professional Practice Experience at St. James
Medical Center, the only hospital in Smithville, so she would be
able to complete the rest of her courses that same semester,
continue to live near her family and fiancé, and hopefully get
her foot in the door with a chance at the new HIPAA
compliance specialist position.
Shandra started her Professional Practice Experience by
attending two full days of orientation with a group of new
employees. The orientation sessions included information about
infection control, the Occupational Safety and Health
Administration, HIPAA, and quality improvement processes.
All students and new employees were required to sign
confidentiality statements during orientation.
Shandra did exceptionally well completing all of her assigned
tasks during her Professional Practice Experience. She also
became close with a number of the staff members in the HIM
department and in other areas of the facility. She enjoyed being
able to take her breaks and lunches with her fiancé and his
friends from the hospital.
During breaks and lunches, Shandra overheard a variety of
conversations among hospital staff. Occasionally, they would

2. discuss interdepartmental issues, and sometimes they would
gossip about hospital staff and physicians. One conversation
was focused on a rumor about Henri Pioche, the Director of
Respiratory Therapy. Many of the staff members present for the
conversation indicated that they heard Mr. Pioche had been
diagnosed with some kind of malignant condition and had been
recently worked up to determine the possibility of brain
metastasis.
Shandra and Andre took their afternoon break alone together
that afternoon. Shandra asked Andre if he had heard any kind of
confirmation regarding his director's condition. Andre had only
heard rumors, but of course, he was curious because he would
be the obvious next in line for the director position.
When Shandra returned to the HIM department after break,
she pulled up Henri Pioche's records and saw that he had
recently had a series of outpatient tests at the facility. She
researched further and found that the most recent tests indicated
brain metastasis that appeared significant. That evening,
Shandra shared her findings with Andre.
The following day, Andre decided to approach Henri about
the situation. He simply indicated that he had heard of him
having serious health issues. Andre volunteered to help in any
way possible and stated he was more than willing to cross-train
to expand his duties to be able to cover in case Henri had to be
gone for an extended period of time or if anything should
happen that he might not be able to return, acting as an interim
director until a decision could be made about a replacement.
47 48
Henri denied his health issues to Andre. He did not want
anybody at St. James to know of his condition, at least not this
soon. However, it concerned him that Andre seemed too
confident about his knowledge of his health status, so he
contacted the Director of Health Information Management to
investigate who may have had recent access to his health
information.
A report was run to provide an audit log for access to Henri's

3. records, and the HIM department director questioned Shandra to
determine why she had been in Henri's electronic health record.
Shandra knew immediately that she could not come up with a
verifiable excuse, so she decided that honesty was the best
policy in this case and admitted that she had looked to see
whether what she heard on break was indeed true.
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