Patients can't have their own labs?

[Just Joshin]

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I read from a resident on the residency forum that as part of HIPPA, a patient can't have a copy of his/her own labs. Is this true? WTF?

 

[FiremedicMike]

I read from a resident on the residency forum that as part of HIPPA, a patient can't have a copy of his/her own labs. Is this true? WTF?

You need to ask yourself if this would be a HIPPA violation, once you answer that question, you'll answer your own question....








(hint, this is obviously not a HIPPA violation)

 

[ArcGurren]

Uh, yes they can. If a patient requests a copy of his labs they absolutely have a right to them.

 

[MilkmanAl]

Uh...actually it is technically a HIPAA violation if you show it to them on the EMR, believe it or not. That's clearly not practical or reasonable, though, so most people ignore that facet of the law in practice.

 

[Perrotfish]

I read from a resident on the residency forum that as part of HIPPA, a patient can't have a copy of his/her own labs. Is this true? WTF?

Under HIPPA a patient always has the right to request a copy of their medical records from their hospital. That would include their labs.

However they do NOT have the right to access EMR directly to get their labs, and I've heard them tell us that showing a patient their labs on EMR is actually a HIPPA violation (though I would love to know if anyone's ever actually been fined for this). You can still tell them their labs, but if they want an official copy it needs to go through whatever your hospital's process for requesting records is.

 

[Just Joshin]

You need to ask yourself if this would be a HIPPA violation, once you answer that question, you'll answer your own question....

(hint, this is obviously not a HIPPA violation)

Don't be a smartass. It's a legitimate question, as evidenced from the answers below.

 

[Just Joshin]

Uh...actually it is technically a HIPAA violation if you show it to them on the EMR, believe it or not. That's clearly not practical or reasonable, though, so most people ignore that facet of the law in practice.

So if a doctor got caught doing it, he could technically be sued under HIPPA? That's so ridiculous.

 

[Long Way to Go]

So if a doctor got caught doing it, he could technically be sued under HIPPA? That's so ridiculous.

Who exactly would have the standing to sue in that circumstance? I doubt the hospital would, although it wouldn't stop them from using it as an excuse to fire the doc if they wanted to I guess.

 

[FiremedicMike]

Don't be a smartass. It's a legitimate question, as evidenced from the answers below.

I re read my post and recognize how it came across poorly, I can assure you I was not trying to come across as an ass. I apologize.


To the others, I would like for you to expand upon your statements. Are you describing a scenario where the patient would be actually looking at the computer, or simply a printout of their emr? Either way, provided you pull up that patient's chart prior to letting them belly up to the computer, and monitored them to ensure they didn't click off their chart, I'm not sure how that is a violation?

 

[ArcGurren]

Uh...actually it is technically a HIPAA violation if you show it to them on the EMR, believe it or not. That's clearly not practical or reasonable, though, so most people ignore that facet of the law in practice.

Right which is why printing them a copy or photocopying a Labcorp document which is theirs is perfectly okay.

 

[red10]

Well then the office I've been shadowing in is up to their eyes in potential lawsuits cause they printed out and gave a copy of lab results to every pt that had them done

 

[Perrotfish]

Who exactly would have the standing to sue in that circumstance? I doubt the hospital would, although it wouldn't stop them from using it as an excuse to fire the doc if they wanted to I guess.

HIPPA is enforced by the federal government and can result in fines and prosecution outside of lawsuits. You don't need to be named in a lawsuit, you just need your local branch of health and human services to get wind of your violation. BTW if you showed a patient their records that would be 'willful neglect', so that's a 10K fine for a first offense.

http://www.ama-assn.org/ama/pub/phy...ability-act/hipaa-violations-enforcement.page

 

[FiremedicMike]

HIPPA is enforced by the federal government and can result in fines and prosecution outside of lawsuits. You don't need to be named in a lawsuit, you just need your local branch of health and human services to get wind of your violation. BTW if you showed a patient their records that would be 'willful neglect', so that's a 10K fine for a first offense.

http://www.ama-assn.org/ama/pub/phy...ability-act/hipaa-violations-enforcement.page

With all due respect, I dont see how showing a patient their own chart is willful neglect?

 

[Perrotfish]

With all due respect, I dont see how showing a patient their own chart is willful neglect?

from my limited understanding, willful neglect just means you neglected your responsibilites on purpose, it doesn't say anything about the severity of what you did. It's 'willful' as opposed to accidents, like printing out files to the wrong printer, faxing a form to the wrong number, or accidentally walking away from a computer without taking a flash drive. It's willful because you took a shortcut you knew could result in a HIPPA violation. Giving a patient a copy of their labs without going through your hospital's requisition process for obtaining medical records is something you did on purpose, so if it's a violation at all it's a willful neglect violation and will cost you at leask 10K. You could even argue that it constituted 'knowing' disclosure (even if the disclosure was to the patient who the labs refered to) and that is, apparently, at least a 50K fine and carries the risk of criminal penalties as well.

 

[docB]

Uh, yes they can. If a patient requests a copy of his labs they absolutely have a right to them.

Right which is why printing them a copy or photocopying a Labcorp document which is theirs is perfectly okay.

Neither of those statements are exactly true. Giving the patient printouts of their labs, or xrays or other reports is covered by the policies of just about every hospital. Most require the patient to go to medical records, sign a form and sometimes pay for the copies or even pay their outstanding bills before they get their records. If you just print out their labs and give them to the patient you will likely be in violation of your hospital's policies and could face consequences.

Under HIPPA a patient always has the right to request a copy of their medical records from their hospital. That would include their labs.

However they do NOT have the right to access EMR directly to get their labs, and I've heard them tell us that showing a patient their labs on EMR is actually a HIPPA violation (though I would love to know if anyone's ever actually been fined for this). You can still tell them their labs, but if they want an official copy it needs to go through whatever your hospital's process for requesting records is.

Agree with above.

HIPPA is enforced by the federal government and can result in fines and prosecution outside of lawsuits. You don't need to be named in a lawsuit, you just need your local branch of health and human services to get wind of your violation. BTW if you showed a patient their records that would be 'willful neglect', so that's a 10K fine for a first offense.

http://www.ama-assn.org/ama/pub/phy...ability-act/hipaa-violations-enforcement.page

Again agree with above. HIPPA is not something you get sued over. It's a regulation of which you can be found in violation. It's the same with EMTALA, Medicare regs, etc. The fines you pay for those violations don't go to the patient you wronged. They go to the government. However, just like EMTALA, if you are found in violation of HIPPA the patient can use that to sue you for damages.

 

[FiremedicMike]

HIPPA is what, 7 years old now? It amazes me that I still learn nuances about it.

Let me ask you this, we use tablets for our field EMRs, and we hand the tablet to the patient to get their signature. Is this HIPPA violation in the same way as it is for them to view their labs on your emr?

 

[MilkmanAl]

Guys, it's HIPAA. Just sayin'.

 

[Perrotfish]

Guys, it's HIPAA. Just sayin'.

Huh. Then why does everyone pronounce it hip-ah rather than hip-ay? It would go better with its spelling the second way.

 

[FiremedicMike]

Guys, it's HIPAA. Just sayin'.

Lol, thanks 🙂

 

[loveoforganic]

Most require the patient to go to medical records, sign a form and sometimes pay for the copies or even pay their outstanding bills before they get their records.

I thought it was a violation of HIPAA to deny own records for any reason?

 

[colbgw02]

I thought it was a violation of HIPAA to deny own records for any reason?

Nope. I know, for example, in Texas, that a physician can deny a copy of records to the patient if he reasonably believes that furnishing such records will result in harm to the patient. (Thank you TX jurisprudence examination)

I mean, you can't deny a copy simply because you don't like the patient, obviously, but there are exceptions - as outlined above.

 

[loveoforganic]

Interesting, thanks

 

[MedStudentWanna]

Nope. I know, for example, in Texas, that a physician can deny a copy of records to the patient if he reasonably believes that furnishing such records will result in harm to the patient. (Thank you TX jurisprudence examination)

I mean, you can't deny a copy simply because you don't like the patient, obviously, but there are exceptions - as outlined above.

That opens the door to abuse. How could one prove that he denied it because the patient may harm himself?

 

[Mattabet]

Oh! I know this one! We just had to sit thru an orientation lecture on this very topic. Here's what I got:

Patients have the right to see their records, with a few exceptions (such as some psych notes). However, at many places (such as mine) the record is owned by the hospital. So, ideally, you would have the patient go to records, pay a dollar or two, and get a copy of his records. There are sometimes online options too ("MyChart", anyone?).

However, your absolute gate in the wall of HIPAA is 'TPO' - activities done for treatment, payment, or operations. So, if you give a patient his lab results in the course of treatment, ie, so he can bring them to another doctor or base some decision off them, you're covered under the 'T' in TPO. Naturally, this line gets a little bit blurry in real life.

So giving results or the like is generally fine, but if a patient wants dozens of pages of material, that's not really your job - they should go get their whole medical record.

 

[RapplixGmed]

Neither of those statements are exactly true. Giving the patient printouts of their labs, or xrays or other reports is covered by the policies of just about every hospital. Most require the patient to go to medical records, sign a form and sometimes pay for the copies or even pay their outstanding bills before they get their records. If you just print out their labs and give them to the patient you will likely be in violation of your hospital's policies and could face consequences.

According to our ethics course, the information contained in the patient's medical record is the property of the patient. However, the physical manifestation and storage of the data (the chart itself or the EMR) is solely the property of the provider.

Thus the patient can request a copy of the data whenever he/she wants since the information itself belongs to them. This info must be freely given and cannot be held hostage because of lack of payment or anything else.

However, since the chart is the property of the provider, the patient cannot ask for the chart itself to take home, they cannot request access to the EMR, and they cannot ask for the chart to be destroyed.

 

[Elbowstoopointy]

I read from a resident on the residency forum that as part of HIPPA, a patient can't have a copy of his/her own labs. Is this true? WTF?

If a doctor ever told me I couldn't see my own chart I would get the law involved...

My mom asked to see her chart, nasty comments the doc wrote and all. They let her see it because its her info.

 

[Elbowstoopointy]

According to our ethics course, the information contained in the patient's medical record is the property of the patient. However, the physical manifestation and storage of the data (the chart itself or the EMR) is solely the property of the provider.

Thus the patient can request a copy of the data whenever he/she wants since the information itself belongs to them. This info must be freely given and cannot be held hostage because of lack of payment or anything else.

However, since the chart is the property of the provider, the patient cannot ask for the chart itself to take home, they cannot request access to the EMR, and they cannot ask for the chart to be destroyed.

Great answer man. This thread is now over

 

[Kevin Baker]

I read from a resident on the residency forum that as part of HIPPA, a patient can't have a copy of his/her own labs. Is this true? WTF?

I keep a copy of my blood labs on hand. It's not the original chart though. My doc sends a copy out to all of his patients with little notes and smiley faces, frowny faces, or a big red OK based on the specific lab result.

I also just learned that using iPads was banned at my old workplace as apparently the way they store information isn't HIPAA compliant, or at least according to the Dean's interpretation. So it wouldn't surprise me if there is some weird nuance about chart copies.

 

[colbgw02]

According to our ethics course, the information contained in the patient's medical record is the property of the patient. However, the physical manifestation and storage of the data (the chart itself or the EMR) is solely the property of the provider.

Thus the patient can request a copy of the data whenever he/she wants since the information itself belongs to them. This info must be freely given and cannot be held hostage because of lack of payment or anything else.

However, since the chart is the property of the provider, the patient cannot ask for the chart itself to take home, they cannot request access to the EMR, and they cannot ask for the chart to be destroyed.

This is all correct. Regarding the bolded phrase, I'd just like to clarify that lack of payment for medical services rendered is not grounds to deny a copy of the records. However, in most states, the physician is entitled to a reasonable fee for furnishing such a copy, and failure to provide this fee is grounds to withhold the record.

In other words, if you don't pay me the $10,000 for your facelift, I can't keep you from getting your record. But if you don't give me the $20 copying/filing fee, then I can withhold the record. Strange, but it has its logic.

 

[xanthomondo]

The primary care office I was at gives you a login/password to access your own labs. You can read them before the doctor even does.

 

[wholeheartedly]

I'm still not getting how it's a violation to show a patient their own EMR ...

At our institution we have official authorization to access our own EMR records if we have access to the charting system and this medical center is pretty anal about HIPAA.

It was my understanding that it was more of an institutional policy how what types of access patients have.

 

[docB]

Oh! I know this one! We just had to sit thru an orientation lecture on this very topic. Here's what I got:

Patients have the right to see their records, with a few exceptions (such as some psych notes). However, at many places (such as mine) the record is owned by the hospital. So, ideally, you would have the patient go to records, pay a dollar or two, and get a copy of his records. There are sometimes online options too ("MyChart", anyone?).

However, your absolute gate in the wall of HIPAA is 'TPO' - activities done for treatment, payment, or operations. So, if you give a patient his lab results in the course of treatment, ie, so he can bring them to another doctor or base some decision off them, you're covered under the 'T' in TPO. Naturally, this line gets a little bit blurry in real life.

So giving results or the like is generally fine, but if a patient wants dozens of pages of material, that's not really your job - they should go get their whole medical record.

We're blurring the lines between the regulatory requirements of HIPAA and the logistics of granting access which is governed by hospital policies. Remember that as someone working in a hospital you are bound by both.

According to our ethics course, the information contained in the patient's medical record is the property of the patient. However, the physical manifestation and storage of the data (the chart itself or the EMR) is solely the property of the provider.

Thus the patient can request a copy of the data whenever he/she wants since the information itself belongs to them. This info must be freely given and cannot be held hostage because of lack of payment or anything else.

However, since the chart is the property of the provider, the patient cannot ask for the chart itself to take home, they cannot request access to the EMR, and they cannot ask for the chart to be destroyed.

Now we're bringing in a third element to the regulatory and policy discussion. Ethically the patient may be entitled to their information but as a physician you are bound by hospital policy if you're in a hospital (if they want your office records do what ever you want). I will guarantee that your hospital policy does not condone you printing out a copy of some portion of the record and giving it to the patient. Practically every policy requires a patient to go to medical records to get what they want.

 

[Impromptu]

I was surprised to learn that as a doctor, if I accessed my own records through the EMR, I am in violation of regulations and the hospital has grounds to fire me. I have to go through the same process in medical records as everyone else.

 

[Mr hawkings]

Who exactly would have the standing to sue in that circumstance? I doubt the hospital would, although it wouldn't stop them from using it as an excuse to fire the doc if they wanted to I guess.

I've heard of residents getting suspended for accessing their own lab reports

 

[ACSurgeon]

I read from a resident on the residency forum that as part of HIPPA, a patient can't have a copy of his/her own labs. Is this true? WTF?

Some (paranoid) hospitals and clinics will have a patient sign a release of information before releasing their medical record (notes or labs, etc). This will ensure that the patient can't accuse the hospital of releasing their info to an unauthorized person.

 

[ACSurgeon]

I was surprised to learn that as a doctor, if I accessed my own records through the EMR, I am in violation of regulations and the hospital has grounds to fire me. I have to go through the same process in medical records as everyone else.

I think once you're an attending you have a lot more leverage and can get away with looking at your own records/ ordering labs for yourself, etc. Even if not, you'll have a lot of attending buddies who can do that for you. For now, we play by the rules, keep our nose to the ground, etc.

 

[docB]

I think once you're an attending you have a lot more leverage and can get away with looking at your own records/ ordering labs for yourself, etc. Even if not, you'll have a lot of attending buddies who can do that for you. For now, we play by the rules, keep our nose to the ground, etc.

Actually we don't. Once the government is in the house investigating everyone in violation, attendings included, gets fired (or more accurately has their staff privileges revoked). It's tough now with EMRs. If you look or if someone else that has no clinical relationship to you looks it's recorded forever and easily assessable to auditors.

 

[cpants]

It is absolutely not a violation of HIPAA to give a copy or display on an EMR screen a patient's own lab results. People throw around the phrase 'HIPAA violation' all the time, but when it comes to a patient accessing his own information, there are almost no limitations to their access. The information your own hospital is giving you may unfortunately be incorrect. I had a hospital wonk tell me in a lecture last week that discussing a patient's care on a cell phone is a HIPAA violation (It's not.).

It's worth reading up on the law a little bit, because misguided attempts to follow HIPAA without understanding it can actually delay or compromise patient care.

 

[docB]

It is absolutely not a violation of HIPAA to give a copy or display on an EMR screen a patient's own lab results. People throw around the phrase 'HIPAA violation' all the time, but when it comes to a patient accessing his own information, there are almost no limitations to their access. The information your own hospital is giving you may unfortunately be incorrect. I had a hospital wonk tell me in a lecture last week that discussing a patient's care on a cell phone is a HIPAA violation (It's not.).

It's worth reading up on the law a little bit, because misguided attempts to follow HIPAA without understanding it can actually delay or compromise patient care.

I agree with you in terms of what HIPAA says but what about hospital policy? You can get into trouble by violating hospital policy too. A good example is that HIPAA does not require written disclosure authorization for two clinicians to discuss a patient they are both caring for. But the vast majority of hospital policies do require such written authorization. Granted it's probably better to get thrown off staff than to get fined by the government but still...

 

[cpants]

I agree with you in terms of what HIPAA says but what about hospital policy? You can get into trouble by violating hospital policy too. A good example is that HIPAA does not require written disclosure authorization for two clinicians to discuss a patient they are both caring for. But the vast majority of hospital policies do require such written authorization. Granted it's probably better to get thrown off staff than to get fined by the government but still...

You are right. Hospital policy can say any idiotic thing as long as it isn't discriminatory and doesn't violate government rules.

 

[FiremedicMike]

Forgive me for bringing us back to the original point, but it seems that most people are now agreeing that this issue is not a HIPAA violation, but rather a violation of hospital policy, is that correct?

 

[docB]

Forgive me for bringing us back to the original point, but it seems that most people are now agreeing that this issue is not a HIPAA violation, but rather a violation of hospital policy, is that correct?

In my view giving a patient their own information is not a HIPAA violation. If it is a violation of anything it would be hospital policy.

 

[cpants]

Forgive me for bringing us back to the original point, but it seems that most people are now agreeing that this issue is not a HIPAA violation, but rather a violation of hospital policy, is that correct?

Honestly, it is probably not a violation of most hospital policies as well. A hospital can't make a policy that patients can't see their lab results, because that is in and of itself a violation of HIPAA. They may have some restriction on letting them see anything in the EMR, but a printout of labs should be fine in most cases.

 

[ArcGurren]

Honestly, it is probably not a violation of most hospital policies as well. A hospital can't make a policy that patients can't see their lab results, because that is in and of itself a violation of HIPAA. They may have some restriction on letting them see anything in the EMR, but a printout of labs should be fine in most cases.

Yeah, well, since when has a hospital always stuck to the letter of the law? 🙄 I always thought it was weird to try and withhold any sort of information from patients.

 

[docB]

The rational for this is that the hospital has policies about how someone has to be identified before they can be given PHI and what forms they need to sign to get it.

For example at my hospital they have to sign two forms, one is a request for the records and the other takes resposibility for that information. No fair taking all of your records and then filing a suit when you lose them and someone else gets them. Remember, we shred everything but most patients lose their discharge paperwork before they reach the door.

There is also a form completed by who ever is giving them the info that documents how the patient was identified. Usually this is a driver's license, social security card, etc.

So while you guys are right, it doesn't violate HIPAA to give infor or print outs to a patient it can go badly for you.

What if a patient is using a stolen identity? You will have given them paperwork with someone else's info. What if they are requesting info from past visits as well? Should you give them that too? What happens if they don't understand what's in their records but someone else does? I have heard of patients handing their ER discharge paperwork over to a boss in lieu of a work note and the boss knew what "substance abuse" menat while the patient didn't (that's why we usually write actual work notes that are devoid of diagnoses). How do you protect yourself from these kinds of problems?