Community Confidentiality during COVID-19

As the COVID-19 pandemic continues, new challenges continue to arise for those in transportation. One that has always been of utmost importance, but particularly so now, is the topic of confidentiality.

While medical trips abide by HIPAA (Health Insurance Portability and Accountability Act), typical public transportation trips land in a somewhat grey area. Confidentially is a unique topic as bus drivers and riders often live and work in the same community, with less populated areas making this more likely. Topics of conversation that include local news, updates, events, are common. However, in the wake of COVID-19, discussing personal or local health information is a common discussion topic – which is posing new challenges for drivers and transit systems across the country.

Pandemic focused conversations that happen during transit trips could include personal and/or medical information for the rider or others in the community. This is placing drivers in a challenging position due to the sharing of “confidential” or personal health information (PHI). As the virus spreads and impacts communities, riders, and drivers, here at NCMM we have heard that not surprisingly, these conversations have increased, and sometimes include PHI.

In light of differing practices across the country, NCMM has engaged a few systems including Envida from Colorado Springs, CO and Goldsboro-Wayne Transportation Authority (GWTA) and Macon County Transit from North Carolina in a discussion on their policies and procedures focused on community confidentiality. In particular, we were interested if there were new agency-wide policies implemented regarding confidentiality during this time or if there’s been a “re-setting” of driver expectations to avoid these conversations. Below is a summarized and edited version of the conversations: 

What is your system’s view on addressing confidentiality with your drivers?

Macon County Transit: Confidentiality has always been a serious topic of discussion with our employees. I’m sure you know how small towns and “gossip” are… it’s a constant battle to keep information from spreading.  We even have to keep our dispatching staff on their toes in not saying anything over the radio that would breach confidentiality. Breach of confidentiality is discussed with the employee and, depending on the circumstance, may result in disciplinary action.

Envida: When we onboard a driver we discuss how we as drivers become part of people’s lives.  We are professionals and not their friends. We encourage boundaries. A new driver must sign a Confidentiality Agreement. New drivers are educated about HIPAA through a PowerPoint presentation. And annually there is a review for all drivers about the privacy and security tenets of HIPAA and their accountability to these tenets. A driver is coached if there is any breach of confidentiality, privacy or security. 

Have you used (for lack of a better term) “confidentiality agreements” with your drivers either pre-COVID or in response of the change in expectations during the pandemic?

Envida: In addition to the confidentiality agreement that drivers sign when they are hired, we have a policy with drivers that conversations with riders are not to be shared unless there is a health or safety issue.

Macon County Transit: We use a confidentiality form and have each employee sign it.  We include confidentiality regarding other employees because we have had issues when one is out sick that their information gets shared…not typically out of malice but because the passengers may like a certain driver and notice they are not working and ask about them.

GWTA: We use a confidentiality statement that is signed during pre-employment training. From time to time we will provide a reminder during a monthly meeting, when we notice that there is an issue. 

In response to new challenges that have arisen as part of the pandemic, is your system planning any changes or updates to your policies/practices?

GWTA: We have provided each team member with a reminder memo and have had everyone then sign off again about understanding the issue of confidentiality as a way to heighten awareness right now.

Envida: During all times, we emphasize that drivers do not talk to other riders and not even to staff about a rider’s health unless there is an issue. For example –  two weeks ago we did have a rider share a serious health concern with a driver. The driver notified staff, and we called her back and asked for permission to intervene on her behalf and contact her doctor, which we did. If there is a safety issue, we can report it to Dept. of Human Services, which we have also done on occasion. We advocate on behalf of our riders when we know they need help.  In addition, we train all drivers to respect riders. All drivers should be trained on how to converse and interact with riders appropriately, whether COVID or anything else. If you have a problem with a driver saying too much to others, that isn’t just a COVID issue!