Would I be breaking HIPPA to look back at old patients?

[Seces]

If I had a patient a few days ago and I'm curious what their dx turned out to be, would I be breaking HIPPA to look it up on the EHR? Im guessing yes since they're not still my patient. It would be helpful for my learning to know how the workup/treatment progressed.

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[VA Hopeful Dr]

So first, its HIPAA (two As, not 2 Ps).

Second, its a grey area. If you want to be totally safe, ask someone currently on the patient's treatment team. You can also ask your attending or resident and see what they say about it.

 

[ACSurgeon]

So first, its HIPAA (two As, not 2 Ps).

Second, its a grey area. If you want to be totally safe, ask someone currently on the patient's treatment team. You can also ask your attending or resident and see what they say about it.

Really from a days prior? I imagine that’s not great at all. If you were looking up a patient from a year ago, maybe grey as a student but probably fine still. Part of taking care of patients is following up on workup and outcomes.

 

[VA Hopeful Dr]

Really from a days prior? I imagine that’s not great at all. If you were looking up a patient from a year ago, maybe grey as a student but probably fine still. Part of taking care of patients is following up on workup and outcomes.

It depends on the situation and how anal your HIPAA people are. That being the case, I'm quite comfortable telling an anonymous person on the internet whose circumstances I know nothing about that its a grey area.

 

[MSTPlease]

I was advised by a fellow classmate who would later be medicine chief to keep a running list in Epic during MS3/4 of all the patients I had so that I could see their diagnosis/management later on. I did, and I really enjoyed being able to follow up on things like how an inpatient’s issue was managed as an outpatient, how a preemie that almost died in delivery was followed over the first year of life, etc.

Highly recommend the same. Even accessed my psych patients’ charts post hoc which included breaking the glass. Never an issue.

 

[Raryn]

There's no clear guidance but I personally have done it ever since I was an M3 and have never run into issues with it. In residency I kept running lists of every patient I saw on each rotation and would periodically go back and take a look at updates with their care - found it to be quite educational.

 

[managedcarefin]

Yes, this a HIPAA violation and yes you can get in trouble but I doubt you will get in trouble unless it's a VIP patient. If your patient at the time is Tom Brady it's cool to look him up but if you were to look him up again after you were finished taking care of him, your HIPAA department would get an alert and you would get in trouble.

 

[MSTPlease]

Yes, this a HIPAA violation and yes you can get in trouble but I doubt you will get in trouble unless it's a VIP patient. If your patient at the time is Tom Brady it's cool to look him up but if you were to look him up again after you were finished taking care of him, your HIPAA department would get an alert and you would get in trouble.

I had patients who were in our fancy pants VIP unit on my list. Still no issues. They consented to having a medical student use their care to learn and in my opinion that includes following the management course after I’m off the rotation.

I’m not saying it definitely isn’t a violation, but it also is not definitely a violation. I think the grey area folks have it right and seeking the input of more superior people would be best.

 

[Merely]

Yes, this a HIPAA violation and yes you can get in trouble but I doubt you will get in trouble unless it's a VIP patient. If your patient at the time is Tom Brady it's cool to look him up but if you were to look him up again after you were finished taking care of him, your HIPAA department would get an alert and you would get in trouble.

Nonsense, it’s not a big deal

 

[Dave1980]

You are allowed to access patient information for treatment and legitimate educational purposes. Definitely not a HIPAA violation.

 

[NicMouse64]

There's no clear guidance but I personally have done it ever since I was an M3 and have never run into issues with it. In residency I kept running lists of every patient I saw on each rotation and would periodically go back and take a look at updates with their care - found it to be quite educational.

I feel like it should almost be a requirement.....but what do I know lol.

 

[NotAProgDirector]

In general, it is allowed. Best practice is for your residency to have a policy. There might be a time limit. You also need to be judicious such that it's educational -- if you manage someone for an IM problem and then they go see psych, you should probably not be looking at the psych note.

 

[MSTPlease]

In general, it is allowed. Best practice is for your residency to have a policy. There might be a time limit. You also need to be judicious such that it's educational -- if you manage someone for an IM problem and then they go see psych, you should probably not be looking at the psych note.

While that’s definitely the safer approach, if the patient is on a lot of medications, it could be educational to see the rationale behind why the psychiatrist chose medicine x over medicine y as that could help you when prescribing meds as an internist to a patient who is on psych meds.

I think I took your approach though. The only past patients whose psych notes I looked at were the ones I saw on psych in the first place.

 

[Donald Juan]

In general, it is allowed. Best practice is for your residency to have a policy. There might be a time limit. You also need to be judicious such that it's educational -- if you manage someone for an IM problem and then they go see psych, you should probably not be looking at the psych note.

I don't know if I agree with this rationale. I feel like we all make mistakes when we try too hard to only work in our own bubble and not consider the global picture of the patient or all of their medical issues. If you are taking care of them you generally have access to all of their PMH. I don't think you should ignore other specialties notes for either educational purposes or in real practice.

 

[NotAProgDirector]

I don't know if I agree with this rationale. I feel like we all make mistakes when we try too hard to only work in our own bubble and not consider the global picture of the patient or all of their medical issues. If you are taking care of them you generally have access to all of their PMH. I don't think you should ignore other specialties notes for either educational purposes or in real practice.

Once you stop caring for a patient (which was the OP's question), your access to their record ends unless you fall under a HIPAA exception. Education is an exception, and following up to look at the outcomes of the issue you were managing is reasonable. I think that psych notes are high risk for seeing things you have no business looking at (unless, as mentioned above, you were treating someone for a psych problem. And even there, I'd be very careful.)

Even when taking care of patients, you should only look at clinical material that would be reasonably required to deliver care. If I admitted a patient for pneumonia and they had psychotherapy notes, I wouldn't look at them without their express permission. If they were completely psychotic, then I would.

 

[Dwight Snoot]

Yes, this a HIPAA violation and yes you can get in trouble but I doubt you will get in trouble unless it's a VIP patient. If your patient at the time is Tom Brady it's cool to look him up but if you were to look him up again after you were finished taking care of him, your HIPAA department would get an alert and you would get in trouble.

Bad example-- it is not possible for Tom Brady to be sick

 

[the shretiology]

Minimum necessary rule. If you’re a scribe/tech, the continuity of care falls outside the necessary knowledge for your job description of typing the note for the physician or whatever else. I am always curious about these things but just avoid it, knowing that soon enough it will be relevant to my position to review outcomes and follow-ups.

Edit: Thought I was in the pre-allo thread. My post should be disregarded.

 

[IlDestriero]

There’s some leeway for educational benefit, and I always follow up on my critically ill patients post op. However beyond a day or two, there’s really no legitimate reason to be going back into their chart unless you’re going to take care of them again, accessing it for a QI presentation, etc. You can always follow up with their surgeon or icu attending for a general “how are they doing”.
People lose their job for these invasions of privacy and EPIC tracks everything forever. One of the nurses I know got an official written warning for accessing her neighbors chart to print lab results at the neighbors request for a 2nd opinion appointment at another facility. It hadn’t moved over into the patient viewable chart yet and they needed it now. One more violation and she’s fired. They, allegedly, pinged it because they lived on the same street.
Think twice, click once.
I’ve never had to break the glass myself.

 

[MSTPlease]

There’s some leeway for educational benefit, and I always follow up on my critically ill patients post op. However beyond a day or two, there’s really no legitimate reason to be going back into their chart unless you’re going to take care of them again, accessing it for a QI presentation, etc. You can always follow up with their surgeon or icu attending for a general “how are they doing”.
People lose their job for these invasions of privacy and EPIC tracks everything forever. One of the nurses I know got an official written warning for accessing her neighbors chart to print lab results at the neighbors request for a 2nd opinion appointment at another facility. It hadn’t moved over into the patient viewable chart yet and they needed it now. One more violation and she’s fired. They, allegedly, pinged it because they lived on the same street.
Think twice, click once.
I’ve never had to break the glass myself.

That's such a wildly different circumstance from medical student/resident education that I personally consider it irrelevant to the discussion.

Sinai must use break the glass a lot more religiously than your institution because even when only accessing the charts of patients I was assigned to and actively involved in their care, I was breaking glass on the regular. Every patient on psych and every employee/student of the institution as well as all of their family members are glass protected.

 

[Premed2295]

I wouldn’t