HIPAA what happened?

[phallusequinas]

---

Members do not see this ad.

HIPAA can be complicated. But let me just make it easy.

Don't look at a chart unless you are a person on the healthcare team with direct responsibility for the patient. There is an exception in HIPAA that permits patients to be listed on the hospital's registry. Thus looking at the list of who is in the ER is not a HIPAA violation.

In addition, there is a limited exception for research purposes. There is no exception for "education" unless it falls within the research exception.

The big concern here is whether a physician on call can look at a patient's chart in the ER if he has not been consulted. HIPAA would not generally allow this conduct, if the physician is not considered part of the healthcare team.

There may be a loophole that I am not 100% sure on. Medicine has become very specialized. Yet before HIPAA, a licensed doctor was a doctor. It did not matter whether he was BC in ER or any other field. If he saw the patient, he was responsible. He was an attending in the eyes the law.

It may be possible to overcome HIPAA by having the hospital give ER privileges to any physican on call. Thus any physician according to the hospital is an "ER physician". Any physician on call is part of the ER team responsible for the care of the patient. HIPAA allows broad exceptions related to medical care.

Of course whether a hospital gives a physician ER privileges does not mean that he will lead the ER. The hospital will still retain rights as to who works in the ER.

On another note, HIPPA has changed. The scienter requirement has been removed. Thus any prosecutor, whether it is the Dept. of HHS or the Office of Civil Rights, no longer needs to prove that you knew what you did was wrong, to hold you responsible. However, this only applies to civil statutory damages, which remain low unless, you really knew what you were doing was wrong or you objectively should have known.

The criminal penalties for HIPAA violations remain the same. Those violations all involve scienter, which may be difficult to prove in run of the mill cases.

In response to other comments in this thread, I would like to discuss that HIPAA says nothing about looking in a chart after you have seen the patient as a physician. Thus as a treating physician, you may access that chart through legal means for the rest of your life. The caveat is that you may only look at everything that you could see before the patient left your care. The underlying legal theory is that a physician owns the records, but he has to maintain confidentiality regardless of whether the patient later withdrew consent for care.

When a hospital is involved, it may claim legal ownership of the records. But ownership does not empower exclusive access. A hospital may make policy as to how you can access that chart (like signing in, looking at it under supervision, etc.). But it cannot deny your rights to view the chart of a patient that you have cared for within the limits previously discussed.

On a final note, this is just an academic discussion and is not legal advice. In general, you should follow the legal advice given to you by hospital sanctioned counsel.

 

[Law2Doc]

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. ...

Um no, it's the EXACT same example. It is NOT unusual for a belly pain patient in L&D to be something other than pregnancy. Pregnant women come in with acute appendicitis, acute cholecystitis, gallstone pancreatitis, kidney stones and other ailments very frequently. They are more of a challenge to diagnose because they have a built in reason to have abdominal pain (and additionally because you try not to run a pregnant person through the CT scanner), but it would be a falsehood to describe it as "unusual" for them to be coming into the hospital for something other than pregnancy. From what I recall, the rates of other things are about the same as other nonpregnant women in that age group.

So yeah, this is the identical example. To say, sure you are a certain specialist more related to patient's underlying problem so you are not at risk for HIPAA is basically making an exception the government and hospital policies don't make. Sorry, but this is the same.

 

[Law2Doc]

...this is just an academic discussion and is not legal advice. In general, you should follow the legal advice given to you by hospital sanctioned counsel.

You never said you were a lawyer and this is an anonymous board, so this disclaimer is pretty unnecessary.

 

[Law2Doc]

I agree, although it's really just the OP who hasn't figured out how to communicated without being unnecessarily rude, condescending, or argumentative.

Yeah, I'm not exactly getting the OP here. He restarted a thread because he thought it useful and educational, and then vehemently attacks those of us who try to disagree with his viewpoint, suggesting we are arrogant and not knowing what we are talking about. I tried to give him the benefit of the doubt by saying he was playing devil's advocate, but he felt that was condescending. Puzzling...

 

[Law2Doc]

...Still, the "greater good" was served and you have in one scenario something to chuckle about with the radiologist before you go home. ...

It's either going to be me chuckling with the radiologist now, or the ED doctor chuckling with the radiologist 8 hours from now, when their condition has worsened. You are acting like I'm going to cause them a lack of dignity by being a doctor reviewing their condition. But the second they come into the ED, there's going to be a loss of dignity with multiple doctors, nurses, PAs, techs, med students, etc. Some consult who maybe can actually help them isn't going to make much difference, in terms of the "chuckling". If it means very sick people get the help they need in a more reasonable time, then there's at least some argument that maybe this is a better approach.

 

[JackADeli]

Um no, it's the EXACT same example. It is NOT unusual for a belly pain patient in L&D to be something other than pregnancy. ...but it would be a falsehood to describe it as "unusual" for them to be coming into the hospital for something other than pregnancy. From what I recall, the rates of other things are about the same as other nonpregnant women in that age group.

So yeah, this is the identical example...

Actually, not exactly the same. But, I will give you the benefit of the doubt in that maybe you didn't fully following my previous explanation:

...It would be unusual for a belly pain patient in L&D to be something other then a pregnant woman. ...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.

...So, while it may be reasonable and easy to establish appropriate protocols in L&D for the limited specialists involved in care...

Yes, the pathology of a woman in L&D may be something other then pregnancy. However, it would be unusual for anyone but a pregnant woman to be going to L&D, as noted earlier. The womans care would be coordinated through the L&D staff/team. I never saw in residency many trawling the L&D board outside of L&D providers which are ~effectively L&D "EM equivalents". So, while the end diagnosis may require more work and complexity, the involvement of other specialists is less likely to be via trawling curiosity as opposed to formal consultation. Can dignity and rights be violated in L&D? Absolutely. But, as noted above, clearer protocols, guidelines, etc can and often are established for L&D. Since there is not a clammering crowd of specialists looking to "peak in just in case" a consult is imminent, L&D often has little problem maintaining confidentiality. Where I see 12 people in an ER walk up and open the same chart unchallenged, I find one non-OB/Gyn lift the chart in L&D and the nurses challenge. In my experience, there is a more reliable "gate keeper" in L&D. I know no GSurgeon that would stand up and try to justify reviewing unconsulted records from L&D by saying, "I just wanted to see if the belly pain might be an appy before I went home".

It's either going to be me chuckling with the radiologist now, or ...You are acting like I'm going to cause them a lack of dignity by being a doctor reviewing their condition. But the second they come into the ED, there's going to be a loss of dignity with multiple doctors, nurses, PAs, techs, med students, etc. Some consult who maybe can actually help them isn't going to make much difference, in terms of the "chuckling"...

The position seems to be that there is no limit. It is an "all or nothing" and patients have no control of their dignity or to what extent. Seeing any physician can involve SOME loss of dignity. It does not require global loss to the entire locker room. And, a patient has the right to these limits... that really is the law. To simply believe they lost some coming in so no big deal to loose the rest, it is not the trawling physicians' call. The patient consents with limits. Almost every hospital gives a pt the HIPAA information on enterring the door. They may not read it thoroughly. But , if it is law, if they are handed was is effectively the hospitals testimony to understanding the law AND promise to abide by it, it is reasonable to believe they can have the expectation to NOT have their records trawled by un-consulted physicians and NOT be the chuckle factor accross specialties. The "maybe" factor does not excuse or supersede their rights.

I have found patients do want some control. They like to keep the circle of people knowing their privacy, seeing their private areas, etc... down to the necessary minimum.

...He restarted a thread because he thought it useful and educational, and then vehemently attacks those of us who try to disagree with his viewpoint...

I do think it important for pre-meds/med-students/residents. I will also try to maintain the integrity of the information and continue to challenge the positions based on feeling and excusal. It is law and there seems to be much confusion. I hope new physicians do not rationalize disregard of patient rights/protections because it may help someone and/or because it is more convenient for the physician. I hope students/etc... do not simply become calouse and excuse their actions with the ~they'are already embarassed so a little more doesn't matter. Yes, I will continue to challenge those positions. It is a mistake for physicians to promote the "I'm a physician...so, that should be enough" position. We have limits and we have restrictions. Two of the most important principle in our doctor-patient convenant are:

1. Informed consent
2. Protection of patient privacy

Neither of those are waived without really good cause. You do not waive them because ~it may allow us to search the ER for the one person that we may help sooner. You do not waive them because ~you're in the ER, vulnerable, needing help, some dignity will be taken so you have no expectation of preserving any dignity.

I actually think there's a lot of stuff ...which is totally reasonable, but probably runs afoul of many hospital HIPAA policies. ...surgical subspecialist who ...doesn't want to get blindsided will scan the ED list and check out the labs, imaging, etc of those patients they think they may be asked to see before they are in fact called (if ever)...

...But honestly the ortho resident scanning the ER board isn't going to want to call the ED to ask about a patient with arm pain. To do that would be suicide -- you buy yourself a consult that you might not have gotten. Your goal when on call is to have fewer consults, not basically "invite" the ED resident to consult you by jumping on the phone with him. ...But I imagine that looking at someone's chart who is not yet on your service is simply problematic under HIPAA and every hospital policy...

...Yes it benefits the physician as well and that is the motivation behind doing it, but so what...

When a debate/position gets premised on the primary motivation for a physician undertaking a patient right violation is... physician convenience, I can get fairly combative. If our debate has come off to strong, then I do apologize to you, Law2.

 

[michaelrack]

On a broader philosophical note, strict interpretation of privacy regs/HiPPA is leading to the breakdown of physician care for the community-

eg, we all hear stories about docs who are fiercely devoted to their own patients but refuse necessary incoming transfers, refuse to go to the ER to see a patient (that is not already their existing patient).

Of course HIPPA doesn't mandate this, but I feel it is contributing to the attitude "It's not my patient, it's not my problem." But I guess Americans have their privacy.

 

[JackADeli]

On a broader philosophical note, strict interpretation of privacy regs/HiPPA is leading to the breakdown of physician care for the community-

...Of course HIPPA doesn't mandate this, but I feel it is contributing to the attitude "It's not my patient, it's not my problem." But I guess Americans have their privacy.

I think this again represents physician failure to step-up. Either laziness or some other reason, physicians choose to not be versed in a fundamental thing that they hold stewardship.... patient rights. As noted earlier, it is ~objective of on-call physicians to get as few consults as possible. So, some may distort and/or hide behind HIPAA as an excuse to not see patients.

It really doesn't work. My answer is clear to such calls, "you need to formally consult". It is not that hard. The issue I see a problem with is the practitioners that fail to consult officially. For one reason or another, they want to run everything "curb-side". There are numerous problems with this that pre-dates HIPAA.

 

[Law2Doc]

Actually, not exactly the same. But, I will give you the benefit of the doubt in that maybe you didn't fully following my previous explanation:
Yes, the pathology of a woman in L&D may be something other then pregnancy. However, it would be unusual for anyone but a pregnant woman to be going to L&D, as noted earlier. The womans care would be coordinated through the L&D staff/team. I never saw in residency many trawling the L&D board outside of L&D providers which are ~effectively L&D "EM equivalents". ...

You are missing the point. It is EXACTLY the same. He is a neonatologist (not the obstetrician) and has not been consulted yet, so he isn't involved in this patient's care, yet. Not all L&D patients will be seen by neonatologists on a particular visit, so he is looking up folks who may not become patients, ever. So under HIPAA he has no business looking through the info, other than that it is advantageous both for his team and for the patient that he be aware of the patient that might make his way onto his service. It's really not different than another specialty looking at patients on the ED board for patients that might need their specialty.

 

[Law2Doc]

...When a debate/position gets premised on the primary motivation for a physician undertaking a patient right violation is... physician convenience, I can get fairly combative. If our debate has come off to strong, then I do apologize to you, Law2.

I think you have to realize that some of your views are not what is common in practice and not necessarily even universally agreed by physicians/hospitals as to what's best for the patient. HIPAA is a congress-made law that was somewhat created in a vacuum without analysis of what needs to happen in practice. So while I see you are vested in your position, which tracks HIPAA fairly well, and that's fine, you probably should acknowledge that your own view isn't necessarily the only rational or non-arrogant view out there. I assumed that was the point of restarting this thread, but your unwillingness to even give credence to any other viewpoints puts this into question.

I'm not looking to wipe out patient rights for my own convenience, I truly think the patient comes to the hospital to get taken care of, rapidly and accurately, and doesn't really care that the doctor who reviews his chart is upstairs in a call room and not yet consulted, rather than an overtaxed ED physician who still won't see him for many hours because other folks who came in that evening are bleeding more. I also find it troubling that you are quick to make an exception for a neonatologist (a consult service) looking at the L&D board as compared to an orthopod or general surgeon (consult services) looking at the ED board. It's the same issue. Which makes me wonder whether your debate varies based on who you are debating, which is a bad approach.

 

[QofQuimica]

In response to other comments in this thread, I would like to discuss that HIPAA says nothing about looking in a chart after you have seen the patient as a physician. Thus as a treating physician, you may access that chart through legal means for the rest of your life. The caveat is that you may only look at everything that you could see before the patient left your care. The underlying legal theory is that a physician owns the records, but he has to maintain confidentiality regardless of whether the patient later withdrew consent for care.

Not sure if you specifically are referring to my comments, but what we were warned about is that we are not allowed to continue to follow the patient through the EMR after we are no longer involved in their care. They didn't specifically say that we couldn't look at the portions of the chart we had available while we were on the rotation, although I for one wouldn't be trying it without written permission. Even with that permission, considering that all subsequent info is available in the EMR and it would be difficult to avoid seeing some of it simply by virtue of opening the chart, I'm not sure how feasible it would be to go back and only look at the portion of the chart that you had access to while caring for the patient. It's also important to note that medical students for sure (and probably residents too) are *not* the "owners" of said charts. I'm no lawyer, but the idea of anyone buying the notion that a trainee owns a chart since it was "their" patient seems like a pretty far reach.

 

[michaelrack]

I think this again represents physician failure to step-up. Either laziness or some other reason, physicians choose to not be versed in a fundamental thing that they hold stewardship.... patient rights. As noted earlier, it is ~objective of on-call physicians to get as few consults as possible. So, some may distort and/or hide behind HIPAA as an excuse to not see patients.
.

There was once a time, long ago, when on-call physicians wanted consults. I am not saying that HIPPA is being used as an excuse to not see patients- only that it (HIPPA) is a small part of a gradually-developing, disturbing trend in the relationship between physicians and society- probably more of a symptom of the dysfunction rather than a major cause.

 

[Law2Doc]

There was once a time, long ago, when on-call physicians wanted consults. I am not saying that HIPPA is being used as an excuse to not see patients- only that it (HIPPA) is a small part of a gradually-developing, disturbing trend in the relationship between physicians and society- probably more of a symptom of the dysfunction rather than a major cause.

Nah, HIPAA isn't the cause of this. (BTW it's HIPAA [Health Insurance Portability and Accountability Act], not HIPPA). As it stands, HIPAA is a defensible way to stay uninformed about consults until they are actually called (as OP has described), but doesn't really affect the number of consults. The issue of trying to minimize consults is a component of defensive medicine at its worst. In many cases in our litigious environment, the ED is afraid of missing something and so they do a battery of tests before even seeing the patient, and then call a host of consults, many of them undeserved. The ability to diagnose, treat and discharge patients without "loading the boat" for liability purposes has more or less disappeared. So the kneejerk response of an ED may be to call in X consult based on a presenting symptom, even if 20 years ago the same patient would have been examined and sent home.

Consult services realize that if you are standing in the ED or calling up an ED physician, your odds of getting consulted on these non-indicated consults increases exponentially, so they try not to put themselves into such positions. Most consult services have no problem seeing a patient where a consult is actually clinically indicated, but eg no surgeon wants to be consulted on a patient simply by virtue of a patient having that particular body part, which is what all too often happens in the days of defensive medicine. This isn't really a HIPAA issue, although chart scanning can expedite the "real" consults getting seen, as I've described above.

 

[shopsteward]

If the people drafting new legislation, such as HIPAA, do their job right, the legislation will be clear and will do what is intended. If the people who formulated the policy behind the new legislation did their job right, what the legislation intends will be a significant improvement on not having the legislation. But whatever either the drafters or the policy formulators do, any new legislation is almost certain to have unanticipated side-effects (the "law of unintended consequences").

People who have the right mindset can exploit the lack of clarity in legislation or its unanticipated side-effects. Very often people who make large amounts of money do so by working on the margins of regulatory provision. Lawyers create business and reputations in the same way. As in the thread which precipitated this one, a technical breach of HIPAA, even if in a situation not intended by its creators, could be exploited by lawyers to their benefit either in a stand-alone case or to bolster a malpractice suit.

Which leaves those subject to HIPAA making an individual choice as to how closely they follow their best guess as to what it means, and living with the consequences. And/or lobbying for improvements in the legislation.

 

[JackADeli]

You are missing the point. It is EXACTLY the same. He is a neonatologist (not the obstetrician) and has not been consulted yet, ...It's really not different than another specialty looking at patients on the ED board for patients that might need their specialty.

Yes, yes, yes... I understand what you are saying. Let me again try to clarify my point and what I did say.

1. yes, in general it is a violation to review patient info/chart/data without appropriate consent/involvement.
2. yes, a situation in L&D can be just as innapropriate as it can be in the general ED.

Now, going back to my points earlier. I don't know the protocols and/or hospital policies/etc.. of the neonatologist posing his query earlier. But, generally speaking, L&D is a fairly streamlined area with limited specialists of regular interest. Thus, as I noted previously, it is possible for the hospital to have very clear set guidelines and policies established as to appropriate interaction. Further, since most pregnant women have interaction through this division or its extensions long before an emergency, many are informed of the services and practices well in advance. I have seen L&D units in which long before delivery day, women sign lots of papers that do also include consent for involvement of neonatology.

Now, as to neonatology, in my experience, there is usually small specific, often single group that services a hospitals neonatology requirements and L&D unit. Some hospitals establish the neonatologists as a pseudo-ER team/group and L&D as the pregnant womens' ER. Also, as noted, the "closed" unit nature of many (if not most) L&D units enables very specific gatekeeper type controls.

Again, I can not speak to what arrangements the earlier poster may or may not have. And, as I noted in my original post, it is very possible to violate patient rights in L&D. So, patient rights can be violated exactly the same way... in the clinic, in the different ERs, on the floor, etc... But, the different locations within differing levels of "closed unit" arrangements do make the situation or setting or environment, if that is the best word, different when comparing general ED to L&D.

I think you have to realize that some of your views are not what is common in practice and not necessarily even universally agreed by physicians/hospitals as to what's best for the patient. ....your position ...tracks HIPAA fairly well...

I do and that is exactly why I thought/think the thread is important. The rationalization/views/personal opinions are all great. Folks can lobby for political change. My purpose in this thread was to make clear what the actual reality is and not what the old school is. We may not like the regs or restrictions or inconvenience. However, our dislike will not keep us from getting fired any more then the argument, "well it happens all the time".

...you probably should acknowledge that your own view isn't necessarily the only rational or non-arrogant view out there. I assumed that was the point of restarting this thread, but your unwillingness to even give credence to any other viewpoints puts this into question...

The thread is not about "my view" or trying to allow free flow interpretation ideas of this or that is OK. The thread was started in relation to a thread deleted. that thread was about someone apparently loosing their job/career for ~innocent/non-injurious violation of HIPAA. Thus, not going to give credence to ideas that global violation of patient confidentiality for the benefit of 1 in 10?, 1 in 20?, 1 in 100? or the idea that a patient in for a penny (of indignity) thus in for a pound. I understand those thoughts/ideas. I get it. The problem is that that does not excuse a HIPAA violation. So, students/residents reading may go beyond simply understanding the sentiment and try to invoke it. That would be wrong. Long and short, trawling patient records in the ER unconsulted in violation of HIPAA is not a defendable point when it comes to your career.

...If you polled patients in the ED and asked them if they'd rather wait for the ED doctor or allow other doctors in the hospital to review their labs/scans you and I both know what they would say. They don't consider this an invasion of privacy. Congress does. Maybe you do, although I'll give you the benefit of the doubt that you are playing devils advocate here...

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...

...you probably should acknowledge that your own view isn't necessarily the only rational or non-arrogant view out there...

Now, as to the arrogance point. My comment was in response to my read of your comment. I read you comment as implying you are right and my position contrary to yours was "playing devils advocate" because .... you are just right.

Do I think other things may come off as arrogant? Sure. I think the thought process of ED visit = complete surrendar of all dignity to any physician that feels justified to peak into your records, the thought process of ED visitor should automatically waive confidentiality to enable physicians to trawl for the needle in the haystack [especially cause it is convenient for the physicians scheduling], the thought process/presumption that every patient would be OK with waiving their rights, or etc... are arrogant positions. Can I be fully misinterpreting you on those? Yes, definately. Can my statements be viewed as arrogant? Sure. As to acknowledge... yes, I will acknowledge other people may have opinions that differs to mine. But, my opinion and their opinion really aren't the issue. The issue is HIPAA and where does the multitude of rationalization fall in relation to HIPAA? In my opinion and understanding of HIPAA, they fall squarely outside of acceptable practices in relation to protecting/safegarding patient rights.

...I'm not looking to wipe out patient rights for my own convenience, I truly think the patient comes to the hospital to get taken care of, rapidly and accurately, and doesn't really care that the doctor who reviews his chart is upstairs in a call room and not yet consulted, rather than an overtaxed ED physician who still won't see him for many hours because other folks who came in that evening are bleeding more...

Your statement again loads up with a number of excuses... the overtaxed ED, bleeding more, etc... But, we are not talking about a specific case. We are talking about just blanket ignoring patient rights. Per your statement earlier, primarily for physician benefit, though with a caveat that maybe one of the violated patients might gain some benefit. We can overdramatize and frontload all day. But the position is based on a troubling primary motive as you originally stated it and depends on the assumption that every patient would be OK therefore no need to actually ask them (i.e. consent). Maybe a patient is bleeding. But, as noted previously, you may be opening the belly pain patient's records improperly for your convenience, patient gaining no benefit, and the patient's rights trampled when you [unconsulted] learn privileged information improperly.

...I also find it troubling that you are quick to make an exception for a neonatologist (a consult service) looking at the L&D board as compared to an orthopod or general surgeon (consult services) looking at the ED board. It's the same issue. Which makes me wonder whether your debate varies based on who you are debating, which is a bad approach.

Don't be troubled cause that is NOT my position. I have tried to explain it several times. To be short, yes, yes, yes it would be improper for any specialist to trawl private records in any hospital location outside of appropriate hospital policies/protocols in-line with HIPAA. My position has not changed on that.

 

[JackADeli]

There was once a time, long ago, when on-call physicians wanted consults. I am not saying that HIPPA is being used as an excuse to not see patients- only that it (HIPPA) is a small part of a gradually-developing, disturbing trend in the relationship between physicians and society- probably more of a symptom of the dysfunction rather than a major cause.

I may be reading you comment wrong. I do not know of any physicians not wanting consults... in general that is how we make money. On the other hand, residents do not want consults... in general that is how they loose sleep and make more work for themselves.

I think the only thing that HIPAA has done in reference to deterring consults is to deter ~non-consults, i.e. curb siding. I have not ever known any physician particulary interested in curbside consults. We tolerated them cause if we didn't we would often not get the true consults. But, the behind the scenes perception of curbside consults are/were:

1. they are an animal generated by the less competent
2. it is being asked to do someone else job for them... i.e. make the diagnosis
3. creates potential liability with little expectation of compensation.

The #3 is particularly important. I have seen too many times where a primary does not formally consult, gets a curb side, the curb side physician leaves, the primary/curbsider screws things up, and then invokes the curb side physicians in the lawsuit.... Or, in a lesser scenario, the curb side physician leaves, the primary then writes a note invoking that un-consulted = unpaid physician into the chart.

 

[Law2Doc]

... I have tried to explain it several times. To be short, yes, yes, yes it would be improper for any specialist to trawl private records in any hospital location outside of appropriate hospital policies/protocols in-line with HIPAA. My position has not changed on that.

It may not have changed, but backpedaling aside, you seem to be working very hard to defend that you okayed a neonatologist consult to do exactly what you wouldn't allow the surgeon consult to do in my example. You can try to distinguish it all you want, but it's a flawed distinction. If you really believe what you wrote when directed at me, you would have to come to the conclusion that anyone looking at a patient's chart who is not yet a treating physician is violating HIPAA. (And that's probably what HIPAA says). That is the argument you started with, but then caved when OBP said he does the same thing as a consult in L&D. Truth of the matter is that neonatology is not involved in every L&D case, many pregnant women come to the hospital and leave without ever seeing a neonatologist, and most pregnant people don't substantially interact with the hospital before they go into labor -- they interface with their OBGYN who may or may not work at the hospital, usually not, but often have never been in L&D before they go into labor. The OBGYN generally will coordinate with the hospital ahead of time, and maybe get forms signed to ease admission, but they likely aren't significantly different forms than folks have to sign when getting processed in the ED (which BTW likely do say that the patient agrees that his care may involve consulting specialists).

As for getting hung up on my comment that reviewing the ED list is a common practice, I again state that I wasn't saying it's okay because everyone does it, but rather that everyone does it because it's the right approach for patient care. The admissions teams do it, the consult teams do it, the neonatologists do it. Why? Not purely for convenience or because everyone else does it, but because there's very real patient care issues, often lifethreatening ones, when a patient sits and waits for the ED physicians to actually see them and call a consult.

So yeah, there's some abrogation of rights that goes on every hour but there are real benefits. Congress passed HIPAA largely in a vacuum, focusing on the rights and no awareness of the downside. And yes, the rights are very important, but not more important than folks who come to the hospital getting the help they need. That's the balancing act that's supposed to take place when deciding whether privacy is more important than other things. Those of us on this board who have experienced hospital life know a bit more about what doesn't happen when you disallow these practices than the typical congressman. Some people leave the ED with fewer physicians having seen their files and their privacy intact, but others leave in a hearse. Which is why the practice I describe is widespread.

Now you can try and spin it however you want, saying blah blah blah you are only talking about convenience, blah blah blah the ED doctors will call you when they get around to it, blah blah blah you are just looking to chuckle with the radiologist, blah blah blah L&D is an exception to this. But I'm sorry, you aren't adding more meat to your argument, you are undermining it. Your strongest argument is that HIPAA is meant to protect these folks privacy. Period. You should stick with that, and say, hey, I agree with congress, there should be no exceptions, even if what you say makes some sense in terms of patient care, because privacy and dignity are the most important thing a patient can leave the hospital with. I won't agree with you, but at least your argument would have some internal consistency to it. Just say, it's the law and you agree with it. But don't try to win your point by trying to create ulterior motives in other posters or making exceptions for certain posters.

 

[Arch Guillotti]

Chart-surfing was commonplace on L & D when I was an anesthesiology resident. I did it, and I would do it again. With a few clicks we could check labs, weight, medical history and other bits of info that could be helpful to us without having to go and see every single patient as soon as they arrived.

All L & D patients had the potential to be under our care though.

 

[JackADeli]

It may not have changed, but backpedaling aside, you seem to be working very hard to defend that you okayed a neonatologist consult to do exactly what you wouldn't allow the surgeon consult to do in my example. You can try to distinguish it all you want, but it's a flawed distinction...

I have not distinguished it and have not "okayed" anything. I don't know if it is somehow critical to your position to continue to say I have "okayed" HIPAA violation in one area or another or what. Maybe you have just not got it, not understood my point on the subject. Call it back pedaling if it makes you feel better. But, that is not my position.

Anybody in any area of the hospital can be in violation of HIPAA via innapropriate trawling of charts and records. I have stated that repeatedly. As I have also stated repeatedly, in reference to neonatology, again not knowing the specifics of the poster, many hospitals do in fact have clear and specific policy and guidelines established as to how the specialists that specifically practice in L&D can conduct themselves. Again, if ANY physician, neonatologist or otherwise engages in chart trawling and chart review/patient confidential data review outside of the appropriate hospital policy they are wrong. It is that clear. There is no "okayed" to that.

...I will give you the benefit of the doubt in that maybe you didn't fully following my previous explanation...

...Can dignity and rights be violated in L&D? Absolutely. But, as noted above, clearer protocols, guidelines, etc can and often are established for L&D...

Yes, yes, yes... I understand what you are saying. Let me again try to clarify ...

1. yes, in general it is a violation to review patient info/chart/data without appropriate consent/involvement.
2. yes, a situation in L&D can be just as innapropriate as it can be in the general ED...

...Again, I can not speak to what arrangements the earlier poster may or may not have. And, as I noted in my original post, it is very possible to violate patient rights in L&D. So, patient rights can be violated exactly the same way... in the clinic, in the different ERs, on the floor, etc...

...I have tried to explain it several times. To be short, yes, yes, yes it would be improper for any specialist to trawl private records in any hospital location outside of appropriate hospital policies/protocols in-line with HIPAA. My position has not changed on that.

...That is the argument you started with, but then caved when OBP said he does the same thing as a consult in L&D. Truth of the matter is that neonatology is not involved in every L&D case...

There was no "cave" in my position. I still hold to my original position. I also tried, apparently to no avail to clarify what I was speaking to with regards to neonatology. Though, it seems to be excessively complicated for you. Again, I am aware neonate is NOT involved in the vast majority of L&D cases. My point on L&D is that :

1. it is generally a closed unit.
2. it (every hospital I have been) usually has set protocols as to patient access
3. In most of the hospitals I have been to, the women do in fact have early and/or regular involvement with L&D from as little as early pregnancy tour and paperwork to multiple evening cervix chekcs in some. The vast majority of women I have seen at hospitals for L&D do not show up completely unfamiliar with the L&D unit.

But, lest you try to twist or confuse the issue, if neonatology has no preset hospital protocols and policies and simply trawls L&D women's records for convenience before checking out, they are in violation.... "exactly like" anyone else in any unit of hospital, ICU, rehab, clinic, etc, etc...

...L&D is an exception to this. But I'm sorry, you aren't adding more meat to your argument, you are undermining it. Your strongest argument is that HIPAA is meant to protect these folks privacy. Period...

Apologies if, after several attempts to explain, you are still confused. I have stuck with my argument. I have not said L&D is an exception. I have not stated rights can be violated because of one area of the hospital or specialty vs another. In fact, as you seem to misunderstand my point, I have repeatedly tried to reiterate my primary position in reference to HIPAA. It seems you means of winning your argument is now simply to redefine and ignore what I have said.If it makes you feel better or enhance your belief in your opinions, call it back pedaling some more. Either way, I stand by my original position.

...Don't be troubled cause that is NOT my position. I have tried to explain it several times. To be short, yes, yes, yes it would be improper for any specialist to trawl private records in any hospital location outside of appropriate hospital policies/protocols in-line with HIPAA. My position has not changed on that.

As to agreeing with congress, not even the point. The point is to assure med-students/residents follow what the law is, agree with it or not, so they don't get fired. I didn't start this thread for a philisophical/political debate. I started it, as noted before, so individuals do not get hung up on alot of feeling and belief and rationalization that will lead them down the road to violating what the law is and loose their carreer.

 

[Slowpoke]

Don't blow off my post because I am not yet in the fray of things. I know this tends to happen a lot. I am naive but I am a human being!

Person A believes in the law and is arguing for it
Person B believes in the law but is arguing that it is not as practical as it can be.

Person B tries to note inefficiencies of the law based on knowledge of how the practice works. Person A refutes inefficiencies as undermining the law.

Who is right?
Both. The problem is that the people who make the law need to integrate actual practice into the mix.

Why did I post this?
I wanted to selfishly be part of a foreseeable historical thread of SDN that is extremely educational to the future of medicine.... And I wanted to help dampen the flames.

 

[reno911]

I remember the initial thread somewhat vaguely, so I'm not clear on the details. One thing I was wondering is if what was done is actually a HIPAA violation. If I remember correctly, the record was accessed and then closed immediately without anything being looked at. Is that correct?

If that is what happened, then I agree that this sort of behavior should be punished by the institution (regardless of whether it is a HIPAA violation or not). However, I think that whether or not it is a HIPAA violation is a different issue.

Is it a HIPAA violation if the chart was never looked at? Is this specified in HIPAA somwhere? It wouldn't surprise me if it was, but I'm curious if anyone knows for sure. It would be the same to me as if someone went an pulled a paper chart and then before looking at anything just put it back on the shelf.

 

[JackADeli]

Don't blow off my post because I am not yet in the fray of things...

Why did I post this?
I wanted to selfishly be part of ...And I wanted to help dampen the flames.

Seriously? IMO you have not dampened anything and just inserted yourself into the thread.... "to selfishly be part of".

...Person A believes in the law and...
Person B believes in the law but...

...The problem is that the people who make the law need to...

This thread is not from my perspective as the OP about believing in or not believing in any law. Such a thread and/or debate is more appropriately placed in the lounge or other political debate forum.

So, while I can appreciate those looking to establish some sort of political debate and or promote continued emotional and rationalization justifications for argument sake, I suspect such conduct [even from a moderator of any level] will only serve to get this thread closed or moved to a political forum. That action may be the intent/goal of some seeking to "win" an argument. As noted, the thread was started to in essence help individuals avoid getting "blindsided" by termination for violating what the current rules/laws are. Closing it or relocating it via changing it into a political science/legal ethics debate will undermine that intent.

...One thing I was wondering is if what was done is actually a HIPAA violation. If I remember correctly, the record was accessed and then closed immediately without anything being looked at...

...I think that whether or not it is a HIPAA violation is a different issue.

Is it a HIPAA violation if the chart was never looked at?...

So, I can not with any authority speak to exact details of the original or any other anecdotal story. But, to the best of my understanding, the original story was of a resident/physician on-call "very tired", looking at some newspaper article of a pending malpractice suit. This FM resident then proceeded to look up the EMR number, plug in the number, open the computer record. He/she did not recall seeing anything protected but.... ~maybe I saw the patient's date of birth.

Is it exactly HIPAA? We would need more clear facts then were given. The thing that is critical to keep in mind is the HIPAA violations can come with major institutional penalties, fines, etc... So, hospitals will often establish rules/guidelines/etc... that supersede and or reach further then HIPAA in a zero tolerance fashion. This in theory assures that any hospital violator is terminated long before they reach a HIPAA violation. It also establishes a ~pro-active appearance for the hospital before any accrediting agency.

 

[theverdict]

Not sure if you specifically are referring to my comments, but what we were warned about is that we are not allowed to continue to follow the patient through the EMR after we are no longer involved in their care. They didn't specifically say that we couldn't look at the portions of the chart we had available while we were on the rotation, although I for one wouldn't be trying it without written permission. Even with that permission, considering that all subsequent info is available in the EMR and it would be difficult to avoid seeing some of it simply by virtue of opening the chart, I'm not sure how feasible it would be to go back and only look at the portion of the chart that you had access to while caring for the patient. It's also important to note that medical students for sure (and probably residents too) are *not* the "owners" of said charts. I'm no lawyer, but the idea of anyone buying the notion that a trainee owns a chart since it was "their" patient seems like a pretty far reach.

I think what horse dick was trying to say is that even though the hospital owns the records, it does not mean it has exclusive access to those records. Therefore, a patient can see his own chart even though he does not own them. Likewise, a doctor who has seen the patient can look at the chart even years after he has finished taking care of the patient.

The advantage of ownership is that a hospital can keep tabs on who is looking at the chart. Hospital lawyers probably have programs that track unusual activity to give them notice of potential lawsuits.

In general, don't look at an old chart unless you have a need. You run the risk of seeing too much information which can get you or the hospital into a HIPAA violation. This is going to be a big problem with EMRs that cannot restrict information within a single medical record.

Also horse dick is not completely right about the education exception.
45 C.F.R. 164.506 states that a hospital can disclose information for healthcare operations paragraph (1) or (2).
45 C.F.R. 164.501 healthcare operations (2) states that a healthcare operation could include "conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to practice or improve their skills as health care providers, training of non-health care professionals . . . ."

There is a lot of fear mongering in this thread. For example, it would be foolish for a hospital to fire an employee over a $100-1000 HIPAA violation. That is just HIPAA hysteria going awry. In addition the Office of Civil Rights does not have the manpower to go after small potatos. It is more concerned with repetitive systemic violations. Therefore, hospital administration needs to look at the big picture, rather than terminating someone for a $100 mistake. A possibility of a wrongful termination suit could easily wipe out the savings for that mistake. For example, why fire this one particular employee versus all the others who have also committed violations.

 

[WeenieRoast]

With regard to HIPAA and protection: what about a hypothetical situation where a medical resident's health record is highly suspected of being viewed by other's who were definitely not given permission - is there any recourse for the resident? In this hypothetical scenario, there would be numerous "overly coincidental" references/jokes by other students and employees to - oh, let's say "treatment of depression", causing the resident to suspect that her health file had been viewed by other residents and medical personnel who definitely did not have permission. Should the resident go to the hospital's IT or "HIPAA Expert" - or get an attorney to investigate with subpoena so that information cannot be conveniently "lost" or removed? Do the large hospital entities typically utilize software that would reliably track those who access? I'm not certain about "damages" but the condition being referred to could very negatively impact the resident with regard to job placement and pre-judgement due to her illness (well-managed BTW) and the associated stigma. What should she do taking into consideration that once she starts down this path there'd likely be no turning back...

 

[hrandani]

You got treated for depression. People found out. Get over yourself. Nobody cares if you don't.

 

[J-Rad]

Keep it civil. Let's try to be constructive with our posting here, please.

 

[J-Rad]

With regard to HIPAA and protection: what about a hypothetical situation where a medical resident's health record is highly suspected of being viewed by other's who were definitely not given permission - is there any recourse for the resident? In this hypothetical scenario, there would be numerous "overly coincidental" references/jokes by other students and employees to - oh, let's say "treatment of depression", causing the resident to suspect that her health file had been viewed by other residents and medical personnel who definitely did not have permission. Should the resident go to the hospital's IT or "HIPAA Expert" - or get an attorney to investigate with subpoena so that information cannot be conveniently "lost" or removed? Do the large hospital entities typically utilize software that would reliably track those who access? I'm not certain about "damages" but the condition being referred to could very negatively impact the resident with regard to job placement and pre-judgement due to her illness (well-managed BTW) and the associated stigma. What should she do taking into consideration that once she starts down this path there'd likely be no turning back...

If you or your friend truly believe that your chart-as a patient-has been accessed inappropriately then you should talk to your patient relations people. If you have a robust EMR it should actually be quite easy to audit who has been accessing your chart. At my institution we have had multiple people fired or disciplined for inappropropriately accessing charts of patients (usually someone who was in the news). It's remarkably easy to track down who has been looking at what and for how long. You/your friend have as much right to feel that your private health info is kept private as any other Joe off the street.

 

[WeenieRoast]

If you or your friend truly believe that your chart-as a patient-has been accessed inappropriately then you should talk to your patient relations people. If you have a robust EMR it should actually be quite easy to audit who has been accessing your chart. At my institution we have had multiple people fired or disciplined for inappropropriately accessing charts of patients (usually someone who was in the news). It's remarkably easy to track down who has been looking at what and for how long. You/your friend have as much right to feel that your private health info is kept private as any other Joe off the street.

Thanks, that makes sense. I should hope our health records are protected "like any Joe" as you said and is not just viewable entertainment and fuel for gossip and rumor. Definitely not a narcissistic thing but it could affect job "potentials". Appreciate the constructive response. Thank you.

 

[hrandani]

I'm sorry if my comment sounded blase or dismissive, I agree completely with J Rad in theory. I just would like to urge you to be careful in pursuing this.

Many conflicts in medical training are pyrrhic victories for students. You have a lot more rights as a patient, in my experience, than as a medical student who happens to be a patient.

 

[StephenMaturin]

Is it a HIPAA violation if you break into the patient's house to search for toxins?

 

[PlutoBoy]

Is it a HIPAA violation if you break into the patient's house to search for toxins?

Not if you don't tell the neighbors.

 

[Doctor Bagel]

With regard to HIPAA and protection: what about a hypothetical situation where a medical resident's health record is highly suspected of being viewed by other's who were definitely not given permission - is there any recourse for the resident? In this hypothetical scenario, there would be numerous "overly coincidental" references/jokes by other students and employees to - oh, let's say "treatment of depression", causing the resident to suspect that her health file had been viewed by other residents and medical personnel who definitely did not have permission. Should the resident go to the hospital's IT or "HIPAA Expert" - or get an attorney to investigate with subpoena so that information cannot be conveniently "lost" or removed? Do the large hospital entities typically utilize software that would reliably track those who access? I'm not certain about "damages" but the condition being referred to could very negatively impact the resident with regard to job placement and pre-judgement due to her illness (well-managed BTW) and the associated stigma. What should she do taking into consideration that once she starts down this path there'd likely be no turning back...

With any EMR system, it should be easy to figure out if anyone has viewed your records. Usually employees (and I think students) have an extra layer of protection where access to EMR records is tracked even more closely. As mentioned above, you certainly have a right to request to see if anyone has accessed your records. If you find that someone has checked it, I don't see how anyone could argue that it was appropriate or that you're in the wrong for pursuing it. That's pretty much a huge deal to look at records of your colleagues. IMO, about one of the most grossly unprofessional things a person can do and should be reported.

 

[sanityonleave]

There was no "cave" in my position. I still hold to my original position. I also tried, apparently to no avail to clarify what I was speaking to with regards to neonatology. Though, it seems to be excessively complicated for you. Again, I am aware neonate is NOT involved in the vast majority of L&D cases. My point on L&D is that :

1. it is generally a closed unit.
2. it (every hospital I have been) usually has set protocols as to patient access
3. In most of the hospitals I have been to, the women do in fact have early and/or regular involvement with L&D from as little as early pregnancy tour and paperwork to multiple evening cervix checks in some. The vast majority of women I have seen at hospitals for L&D do not show up completely unfamiliar with the L&D unit.

I'm not sure that the OP is still looking at this thread, but I thought it was interesting and had a question for the OP. Firstly, I'd like to say that I appreciate that you're trying to clarify the legality for those of us who will soon be medical trainees in the hospital (and I appreciate that) so that we don't make a stupid mistake that could potentially be career-ending.

That said, your defense of the L&D example puzzled me. Why would it make any difference if there were institutional policies in place about patient access for neonatology (for example)? The institution could have a policy that the NICU team could review the charts in L&D to look for potential issues/patients, but since you've repeatedly opined that this is a HIPAA violation, why would it matter what the hospital's policies were? Hospitals can certainly make policies that are more restrictive than HIPAA, but they could not make a policy which offered an exception to HIPAA protections for a certain specialty/class of patients. Perhaps I'm wrong on this (and please feel free to correct me), but this strikes me as equivalent to the hospital making an ED policy that the ER would not see uninsured patients with emergent conditions. They could tout the policy until they were blue in the face, but since it would be in direct contradiction to EMTALA, the policy would be nil and void since Federal law supersedes hospital policy. What am I missing here?

Either way, to all contributors: thank you for this thread. It's a great reminder to be careful. I can easily see myself bored on a call night fishing through the ED census for "interesting" cases and winding up on the wrong end of a dismissal hearing, which would be devastating.

EDIT: Also, JackADeli, out of curiosity -- what's your background? Are you involved with healthcare law/administration? You seem to have a lot of working knowledge with HIPAA-related issues, so I was curious what your perspective is.

 

[Concubine]

5. Pre-emptive chart/record review by definition is a violation. By being pre-emptive, it means you do not have a currently valid reason to be snooping. Once you are consulted/assigned a patient you have a legitimate reason to review the patient's records. Doing so pre-emptively is not defendable.

I don't think this is always true...

For example, pathologists will routinely access the surgical cases ahead of time to try to predict which patients will require frozen sections from the OR. Although by above stated rule this would violate HIPAA, this practice is necessary since consult by the pathologist to the OR as quickly as possible is important for patient care (i.e. sorting through mounds of documentation to find the relevant patient history while the patient is on the operating table is not good).

 

[Buzz Me]

I don't think this is always true...

For example, pathologists will routinely access the surgical cases ahead of time to try to predict which patients will require frozen sections from the OR. Although by above stated rule this would violate HIPAA, this practice is necessary since consult by the pathologist to the OR as quickly as possible is important for patient care (i.e. sorting through mounds of documentation to find the relevant patient history while the patient is on the operating table is not good).

But how long would it take for the pathologists to read through every single H&P for every single case going on that day?!

Seems inefficient.

 

[michaelrack]

That said, your defense of the L&D example puzzled me. Why would it make any difference if there were institutional policies in place about patient access for neonatology (for example)? .

Because HIPAA is vague and generally allows access to records for treatment purposes. HIPAA gives a lot of discretion to health care providers. If an institution such as a hospital has policies allowing a physician that does not have a direct doc-pt relationship to access records of a patient for treatment purposes, that is fine with HIPAA. For example, a hospital could have a policy allowing a medical director of an ICU to look at the charts of patients when the ICU is full, to assist in making decisions (with consent of the patient's attending) regarding transfer of patients to the most suitable level of care.

 

[Concubine]

But how long would it take for the pathologists to read through every single H&P for every single case going on that day?!

Seems inefficient.

You can usually glance through the procedures and predict that way...i.e. brain tumor = likely frozen, gastric biopsy = unlikely frozen...although this method is never for sure. You usually end up reading through more H&Ps than frozens, but again its critical to be familiar with the patients just in case.

 

[Winged Scapula]

You can usually glance through the procedures and predict that way...i.e. brain tumor = likely frozen, gastric biopsy = unlikely frozen...although this method is never for sure. You usually end up reading through more H&Ps than frozens, but again its critical to be familiar with the patients just in case.

Never heard of them reading the H&Ps. During my surgical pathology rotations and now in practice, the pathologists simply look at the OR schedule, and knowing the surgeons and the type of case, can predict with some accuracy who needs a Frozen. YMMV.

 

[Concubine]

Never heard of them reading the H&Ps. During my surgical pathology rotations and now in practice, the pathologists simply look at the OR schedule, and knowing the surgeons and the type of case, can predict with some accuracy who needs a Frozen. YMMV.

A little background info on the patient's condition, as well as relevant information regarding imaging and such to assist with the frozen diagnosis is often important. Very helpful to have seen that ahead of time without scrambling to find the relevant info in the chart after the frozen comes in and the Surgeon is waiting for it in the OR.

 

[Smurfette]

A little background info on the patient's condition, as well as relevant information regarding imaging and such to assist with the frozen diagnosis is often important. Very helpful to have seen that ahead of time without scrambling to find the relevant info in the chart after the frozen comes in and the Surgeon is waiting for it in the OR.

While the pathologists reading the H&Ps IS helpful to them, I agree with WS. I have not found that pathologists do this with any regularity. I suppose some do. In the late afternoons, they'll call into all the GS rooms (regardless of case...even ports) asking if a frozen section is planned and they need to stick around.

 

[Buzz Me]

You can usually glance through the procedures and predict that way...i.e. brain tumor = likely frozen, gastric biopsy = unlikely frozen...although this method is never for sure. You usually end up reading through more H&Ps than frozens, but again its critical to be familiar with the patients just in case.

Agree with WS and Smurfette - they'd be much more likely they just skim through a list of that day's cases. Do you know how long it would take to skim all those H&Ps? An average academic institution would have 20 ORs running, 2-4 cases per OR...40-80 H&Ps every day? No way.

Of course you realize that a "brain tumor" wouldn't necessarily require a frozen section, right? At its simplest level, a frozen section is only obtained if it will change intra-operative management - i.e. if a positive result would mean a bigger resection (or none at all, if you just identified liver mets in a patient that was about to get a Whipple, for example).

 

[Shikima]

So, can I get edumacated on the simple concept of how and why we have strayed from what I understand to be 1-2 lines in a massive government document to an authorian rule in medical systems resulting in perceptions of lawsuits leading to the jeopardy of medical careers?

I recognize that I'm embellishing with extremism, but I just don't get it.

 

[Arcan57]

So, can I get edumacated on the simple concept of how and why we have strayed from what I understand to be 1-2 lines in a massive government document to an authorian rule in medical systems resulting in perceptions of lawsuits leading to the jeopardy of medical careers?

I recognize that I'm embellishing with extremism, but I just don't get it.

In-patient medicine in the US is a wholly owned subsidiary of the federal government. The government had decided that patients deserve protection for their privacy, and enacted laws to insure that. Punishment for breaking those laws are relatively just (it requires repeat offense to rack up large fines), but the consequences can be embarrassing and potentially damaging to the hospital (especially in civil suits). In general, large institutions (and the heads of said institutes) are pretty unforgiving about embarrassment/endangerment of economic opportunities and in order to prevent angering the government (who's cash ensures the hospital stays open) they enact draconian penalties for violating HIPAA. If a tabloid is willing to offer $10k for celebrity baby photos, hospitals have to make the punishment harsh enough to negate that enticement. And because it's a large institution, hospitals have to treat all employees the same. Which means that the dumb-ss resident has no more protection then environmental services.

?'s

 

[Shikima]

Thanks. That puts it in proper perspective.

I was going to type another question but then realized, your answer makes perfect sense in understanding the system. I guess the problem I'm now having is related directly to the management from said hospital systems; Taking the binary approach (Splitting?) in ensuring embarrassment (let's face it, that's really the driving factor) creates a system of labels for which we all know that's the poor management we ultimately all have.

 

[docB]

I don't think this is always true...

For example, pathologists will routinely access the surgical cases ahead of time to try to predict which patients will require frozen sections from the OR. Although by above stated rule this would violate HIPAA, this practice is necessary since consult by the pathologist to the OR as quickly as possible is important for patient care (i.e. sorting through mounds of documentation to find the relevant patient history while the patient is on the operating table is not good).

You're making a mistake in your logic. The fact that there is a good reason for someone to be looking at the record (such as trying to set up path staffing to provide the best coverage) does not matter. All that matters is if the person falls into one of the defined classes of people who are allowed to be in the chart according to HIPAA.

So, can I get edumacated on the simple concept of how and why we have strayed from what I understand to be 1-2 lines in a massive government document to an authorian rule in medical systems resulting in perceptions of lawsuits leading to the jeopardy of medical careers?

I recognize that I'm embellishing with extremism, but I just don't get it.

The government decided to protect privacy by enacting HIPAA. HIPAA is specific about who can access a chart without permission and most of what it demands is pretty common sense. But they also set up some big fines for messing up. Those fines really scare hospital administrators. So they reactively set up a lot of really restrictive policies about written permission for records and so on. Those policies aren't HIPAA but many hospital employees mistakenly say that they are (because they were caused by HIPAA).

 

[Concubine]

Agree with WS and Smurfette - they'd be much more likely they just skim through a list of that day's cases. Do you know how long it would take to skim all those H&Ps? An average academic institution would have 20 ORs running, 2-4 cases per OR...40-80 H&Ps every day? No way.

Of course you realize that a "brain tumor" wouldn't necessarily require a frozen section, right? At its simplest level, a frozen section is only obtained if it will change intra-operative management - i.e. if a positive result would mean a bigger resection (or none at all, if you just identified liver mets in a patient that was about to get a Whipple, for example).

Maybe the institution I'm at is just unique, but I wasn't actually referring to the Attending physicians looking through every H&P, although I know for a fact some do...but actually the residents. And yes, there are a lot of H&Ps every day, but again when you do them a lot you get good at picking out the patients that will require frozen(s) and finding the relevant info on the chart, not to mention the time it takes will also depend on the institutional charting software.

Also, you usually don't need that much info from the chart...mainly finding out what the procedure is, some basic demographics, and a few simple details on why, + any past relevant dx.

 

[Concubine]

You're making a mistake in your logic. The fact that there is a good reason for someone to be looking at the record (such as trying to set up path staffing to provide the best coverage) does not matter. All that matters is if the person falls into one of the defined classes of people who are allowed to be in the chart according to HIPAA.

...I was responding to the op's claim that by definition, "Pre-emptive chart/record review by definition is a HIPAA violation".

 

[michaelrack]

The government decided to protect privacy by enacting HIPAA. HIPAA is specific about who can access a chart without permission.

I am not aware of HIPAA being specific about who can access a chart without permission. In my opinion, HIPAA is quite vague and allows disclosure of PHI to a provider for purposes of treatment

 

[docB]

...I was responding to the op's claim that by definition, "Pre-emptive chart/record review by definition is a HIPAA violation".

I think that it is. It would be nice if it wasn't. And as others have mentioned there are valid reasons why it can be valuable but I still think HIPAA prohibits it.

 

[docB]

I am not aware of HIPAA being specific about who can access a chart without permission. In my opinion, HIPAA is quite vague and allows disclosure of PHI to a provider for purposes of treatment

IIRC HIPAA specifically allows access to PHI by clinicians for purposes of treatment, it allows billers and coders to see it, it allows review for QA/QC. I'll see if I can find some actual info on it.