Litigation? There are gazillion malpractice suits pending, plenty in the pop press/news papers. Farah Fawcett had her records scandalized, a few governors and actors too. I think the entire topic was important for the readers and residents. Plenty of residents getting fired for HIPAA violations. The fact that an FM intern chose to look up the name he/she read in a news paper, obtain the EMR number and enter into the hospital computer system out of curiosity is important for the readers. The fact that others mentioned pre-emptively reviewing EMR of ER patients they had no legitimate clinical involvement with ...yet, is important. We are going to continue to see residents and physicians in trouble. We will continue to see residents and physicians blowing off the multiple HIPAA training sessions and its importance. IMHO the entire thread was important.
agree. I guess the readers deserve an explanation from the moderator.
You need to check with hospital HIPAA person... not just another resident, etc... get direct info from experts.
You are functioning as a care provider, thus reviewing labs and prsumably acting upon them appropriately...
👍 For the most part, this is not that complicated. If your reason for reviewing a patients chart records is to provide care [that you are expected to be providing], you are doing your job. If the reason you are looking is for curiosity, gossip, or just some over-all global sweep of charts (presumably to identify the single patient you might be asked to consult), you are violating patients' rights. Again, it isn't that complicated. If you are thinking of twisted and/or convoluted scenarios of "what if" and "maybe if", you should be thinking several times about what you are considering doing, should be checking with your hospital HIPAA advisors, or are being argumentative for a forum chat.
The first part of this is for the physician benefit, i.e. "doesn't want to get blindsided". The underlined portion is rationalization as to why one thinks it appropriate to globally violate patients' privacy/HIPAA because it may ultimately help some individual patient down the line, i.e. everyone is violated because it may prove to be good patient care for the patient you are actually asked to consult/participate in their care.
It does benefit the patient, thus the EM physician calls a consult immediately in most circumstances. Emergent/time sensitive scenarios like AAA, compartment syndrome, pre-eclampsia, ACS, etc... in most ERs have standard rapid type consult protocols. I don't know of orthos or vasc surgeons just randomly surveying ER charts just in case.... to find that one compartment syndrome or AAA rupture.
First, cool case, interesting image, etc... is not specifically legitimate reason for a patient to have their confidentiality violated. Second, there are very well established ways for teaching institutions to "sanitize" these imagings and such to allow for proper usage in education. If it is for legitimate teaching purposes, it should be handled appropriately. Medical education does not obviate patient rights. I suspect almost every image you can pull from an interesting ER case can be found in textbooks and teaching files.
Education at the expense of patient rights is no more legitimate then review of the random celebrity file. That is simply using education as an excuse. There are volumes and volumes of education materials that make it very easy to NOT violate patient confidentiality for the purpose of teaching. Further, there are plenty of ways to properly use patient materials without violating their confidentiality. To do otherwise smacks of self-serving rationalization to justify laziness.
This is a good litmus test to decide if your action is HIPAA-compliant. 👍
I think this is a pretty gray area. Obviously, you were a part of that patient's care, and oftentimes I hear the ER guys saying they'd be 'checking up on' the patient after they went upstairs (usually an interesting case or patient they made a good connection with). A bit vague (usually they end up asking the admitting doc what happened instead of visiting the patient), but I've seen the ER guys come up to visit a couple times. The patients generally appreciated this and I am sure the patients were ok with them checking the chart after they left the ER.
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👍Yep, educational is OK as long as you follow appropriate rules/policies/protocol. Just claiming "educational" as an excuse does not fly.
Good advice. Also, the dramatic or unique "wow" or "giggle factor" or "patient embarassing" cases, i.e. FB in rectum will not fly for "educational purposes" excuse...
This is explicitly the opposite of what we were told. As in, we do *not* have permission to continue to review the chart just "to see what happened." But if the purpose is to present a patient at conference, that is not the same as accessing the chart just because you want to see what happened, although I'm still not clear on whether it technically violates the rules.
Do you not recognize that the foundation on which you base your premises throughout are not about protecting patients or patient rights but rather physician convenience? Instead of the ortho protecting patients... he/she globally violates patient rights to avoid inviting more work/consults!
You know when you are called. No clinician is entitled to globally preview all ED pts. You are not self consulting. Whio then decides what physician gets to globally review the charts? Heck, psych could then review everyone too... in case the belly pain is in their head. You don't want to be coming back for a late night psych consult.
That is a strawman argument. Many could say excessive physician review of individual patients taxes the healthcare system and clouds the decisions. The answer to urgent/emergent issues is the "first responder", i.e. ER physician recognizing and calling the consult appropriately and promptly. It is not to allow any and every physician within the hospital to peruse patient records "just in case" I may have to do something.... especially if finding it will avoid my being inconvenienced and being called back to the hospital.
It being done everywhere does not make it correct. Further, the basis of your arguments as to why it is legitimate seems to have excessive emphasis on physician convenience/benefit at the expense of the patients rights. The rules are not just to protect patients from "gawking". They are to set basic standards for every patient, to protect from even the smallest breaches of confidentiality. If you have no legitimate justification [beyond those you have suggested], you have no business seeing any piece of the patients confidential information...period.
Perfect example. Nothing on the census list would red-flag you that there might be a "gawking" risk or that you are stepping into deep water. Also, it has been my experience that famous people, "VIP", colleagues, and other "family members" can and often do use aliases at admission. This further increases the risk that your self-serving/pre-emptive inconvenience avoidance tactic snares you into an inexcusable HIPAA violation.
Yep, I got past the arrogant presumption that I was somehow going to scoop the ED in consulting. I know I am not going to do their job except when they call a consult prematurely and request me to do so...but, they are still calling the consult. I am not self-consulting myself in a savior of the world fashion. The realities are that
The key in this scenario is that you are part of the care providing team that has ordered the diagnostic study/procedures. Your team has an obligation to follow up on the studies they have ordered. As a student involved in the patient's specific care, you should also participate in following up on the diagnostic studies/work-ups/procedures/labs [you] ordered. That is sound and expected medical practice. I don't see any "debate" that following up on the studies you ordered is somehow snooping.
Worked in numerous busy hospitals with overworked Eds and/or level I trauma programs.
Been there, done that... I recognize the frustration and what seems to be the under current theme that the resident/potential consultant is going to save the day, be the hero... justifying the generalized violation of patient confidentiality rights; further background theme of...~I'm a doctor, the beurocrats don't understand the real world, let me do my job, I'm saving lives.
I got that too.... The individual patient that the surveying [pre-emptive/self-consulting/snooping/gawking/HIPAA violating] physician MIGHT identify and MIGHT obtain more prompt care stands to POTENTALLY benefit. Of course, this individual patient's benefit comes at the expense of violating confidentiality and/or patient rights protection of all the other patients surveyed improperly to find the single individual patient. Again, a common theme seen often in medicine, ~I can only be concerned about the single patient I am helping. I can't think about the bigger picture or consider if I may be injuring other patients that are not my primary concern.... And of course, as repeated and emphasized throughout, the primary reason for the specific violations is NOT even the benefit of that "potential" individual patient you might find... rather, that "potential" patient is the excuse.
Interesting, although presumptious if not arrogant. This is not about playing devil's advocate. I can appreciate you believe in your position and/or think you are right.
If you violate patient rights, no matter how noble you think you are or how convenient it may be for you, it is still an ~injury, even if the calculable damages are nil, simple example:
That's a wonderfully self serving "survey". Sure, you could poll the average American around the country and ask if they feel healthcare should be "free". Everyone is fine in the generic sense until they individually appreciate what it will cost them and what they must give up. Let us ask the sick/injured/suffering if they are willing to waive their privacy protections to expedite their care! Maybe, we should ask them to waive because, by waiving appropriate protections and privacy rights, we might discover they are about to die sooner? How about, when asking the question we tell them, "well, it will not really help the majority of you, but as a physician it is just far more convenient for me". In moving forward with such a consent, would one be clear and honest that the primary reason is again physician convenience, as noted several times before in this thread. The problem with your premise of "polling" the ED patients, i.e. effectively asking them for ~informed consent/release, is that it violates fundamental principles of getting consent when one is not under excessive stress/duress/situational coercion.
Again, the argument that every patient should surrender their individual rights in exchange for the 1. primary benefit of physician convenience and 2. potential that an individual patient might benefit. The possible individual patient still being used as an excuse. Kind of like airport security strip searches and taking shoes off....
Again, your belief or position that you can speak for all people and/or that you are just correct, i.e. "because the patients would be fine with it if you asked them". The problem is that the patients are fine until they are not fine. You are NOT asking and they are not consenting.
I appreciate that example. It is however, "service specific". It would be unusual for a belly pain patient in L&D to be something other then a pregnant woman. The same as cardiologists aware of who is in the card cath lab. Yes, there are areas in which appropriate respect for patient rights could be lacking. But, given the specific service area, it is distinctly different from the "general store" variety in the ER.
I appreciate your opinion. I guess the perception is in the eye of the beholder and really since the conversation is predominantly between Law2 & I; I am certain Law2 & I can debate and have difference without your concerns. It is unfortunate the quality of your participation/contribution to the discussion.
