Paramedics Calling for Pt Info

[nurseby07]

Last night I got a phone call at work from a person saying they were the paramedic who picked up my pt (last week, stable, schedule to go home today) and wanted to know how he was doing and what his clinical diagnosis was. I have never received that kind of a call before but I instantly thought that it didn't sound very hipaa friendly. I put him on hold and asked the charge nurse. She said that no, I couldn't give out pt info as his care for the pt ended at our ER, just as I thought. She said, get his number and tell him you'll give it to the pt and he can tell him himself, if he wants to.

So I did just that but the paramedic got a little agitated with me. I said, "Hey, your in this field too, you understand hipaa and I can't violate it. I'm sorry"

So, I gave the pt the number and told him who it was. He said he didn't want to call the guy. Okay fine. Fast forward to midnight and the paramedic is standing at the nurse's station, again requesting the info. I told him that I had given the pt the note but that he chose not to call. The charge nurse backed me up and said that we cannot give out that info on the pt and please just get on with your job so we can get on with ours.

So as I was giving report this morning to the dayshift RN and another RN who is sometimes charge raked me over the coals. She said that they probably wanted the clinical diagnosis to find out if their care on the field was appropriate for the patient and I should have given him the info. She also pointed out that they were probably making a run to the ER when they stopped by the unit at midnight. (duh)

So my question is obvious, what would any of you do?

Thanks!

[JennRN65]

Last night I got a phone call at work from a person saying they were the paramedic who picked up my pt (last week, stable, schedule to go home today) and wanted to know how he was doing and what his clinical diagnosis was. I have never received that kind of a call before but I instantly thought that it didn't sound very hipaa friendly. I put him on hold and asked the charge nurse. She said that no, I couldn't give out pt info as his care for the pt ended at our ER, just as I thought. She said, get his number and tell him you'll give it to the pt and he can tell him himself, if he wants to.

So I did just that but the paramedic got a little agitated with me. I said, "Hey, your in this field too, you understand hipaa and I can't violate it. I'm sorry"

So, I gave the pt the number and told him who it was. He said he didn't want to call the guy. Okay fine. Fast forward to midnight and the paramedic is standing at the nurse's station, again requesting the info. I told him that I had given the pt the note but that he chose not to call. The charge nurse backed me up and said that we cannot give out that info on the pt and please just get on with your job so we can get on with ours.

So as I was giving report this morning to the dayshift RN and another RN who is sometimes charge raked me over the coals. She said that they probably wanted the clinical diagnosis to find out if their care on the field was appropriate for the patient and I should have given him the info. She also pointed out that they were probably making a run to the ER when they stopped by the unit at midnight. (duh)

So my question is obvious, what would any of you do?

Thanks!

Exactly what you did - the patient obviously did not want to release any information either.

[ohmeowzer RN, RN]

you did the right thing , and the day shift nurses should of backed you up. they know the HIPPA regulations. i wouldn't of given any info to anyone.

[Noryn]

No, I would not have given out the information over the phone. This is one of the lessons you can learn from management. ALWAYS PASS THE BUCK. Say something like, "Our privacy officer will not permit me to give this information but here is their number 222-2222." I actually think it was unprofessional to show up in person after you telling him that on the phone.

Is it a HIPAA violation? I don't think but it could be against hospital policy. Talk with your privacy officer. These HIPAA arguments can go back and forth but per the DHHR website the paramedic would be a covered entity "Reviewing the competence or qualifications of health care professionals,

evaluating provider and health plan performance, training health care and

non-health care professionals, accreditation, certification, licensing, or

credentialing activities;"

Many privacy officers add their own "phrases" or rules to HIPAA such as "need to know."

Ultimately you did the right thing, you cannot verify someone over the phone, you consulted with your charge nurse. But again many privacy officers would consider this a HIPAA violation (which I dont think it is) and since they are in charge of the privacy polices, you have to abide by their rules.

[medic2crna]

As a long time paramedic, you absolutely did the right thing.

Rob

[cpnegrad07]

"Is it a HIPAA violation? I don't think but it could be against hospital policy. Talk with your privacy officer. These HIPAA arguments can go back and forth but per the DHHR website the paramedic would be a covered entity "Reviewing the competence or qualifications of health care professionals, evaluating provider and health plan performance, training health care and non-health care professionals, accreditation, certification, licensing, or credentialing activities;"

I don't know if it meets HIPPA or not--rather than guess, we should research it because what the Paramedic is trying to do is VERY worthwhile. He (she) is trying to learn and reinforce in real life. I couldn't count how many times i did the same thing as a Paramedic. I would get a working diagnosis, treat as such, give it a few days to settle down, and then check to see if i was right. Invaluable.

That was before HIPPA. As a nurse now, i wouldn't do it over the phone because i don't know who i am talking to. I just hope the Paramedic understands my position.

[Noryn]

"Is it a HIPAA violation? I don't think but it could be against hospital policy. Talk with your privacy officer. These HIPAA arguments can go back and forth but per the DHHR website the paramedic would be a covered entity "Reviewing the competence or qualifications of health care professionals, evaluating provider and health plan performance, training health care and non-health care professionals, accreditation, certification, licensing, or credentialing activities;"

I don't know if it meets HIPPA or not--rather than guess, we should research it because what the Paramedic is trying to do is VERY worthwhile. He (she) is trying to learn and reinforce in real life. I couldn't count how many times i did the same thing as a Paramedic. I would get a working diagnosis, treat as such, give it a few days to settle down, and then check to see if i was right. Invaluable.

That was before HIPPA. As a nurse now, i wouldn't do it over the phone because i don't know who i am talking to. I just hope the Paramedic understands my position.

Ultimately it is up to interpretation. The regulations are vague. I dont think anyone can prove it is a HIPAA violation, from the statement I obtained from the DHHR website it seems like it is allowed

BUT in my experience most privacy officers are overly conservative or use misleading statements to confuse people such as "need to know." There is a minimum necessary standard but that does not apply to healthcare providers who are treating the patient.

So a lot of people will argue that this is a HIPAA violation but I don't feel that it is (if the identity is known). Again could be a policy issue though.

[TiredMD]

I think you did everything right, especially given that the patient specifically told you that he didn't want to give his personal information to this person.

Further, I think it would have been reasonable to call the supervisor on duty at dispatch and ask them if this is acceptable behavior for their personnel.

[Cindy-san]

So as I was giving report this morning to the dayshift RN and another RN who is sometimes charge raked me over the coals. She said that they probably wanted the clinical diagnosis to find out if their care on the field was appropriate for the patient and I should have given him the info.

And in terms of this occasional charge nurse's input, I also agree that you shouldn't have given out the info.

If there was an investigation into whether the care was appropriate, I think the company EMTs work for would be looking through appropriate channels for info, which would not be the EMT walking up to you and asking you questions.

I recall having an issue with 2 EMTs not taking appropriate care of a pt, and it was handled with their higher-ups.

[bagladyrn, RN]

It does sound as though it falls within the guideline of HIPAA to me and since you passed the info on to the patient who chose not to call, you did all that was necessary. Passing the buck to higher ups is always appropriate.

I know that we all would like to know how patients do after they leave our care, but it's not necessary to their treatment, so we have no "right to know". When I transfer a high risk OB patient, I usually ask a family member to let us know how she does, explaining that the privacy laws won't allow us to call the other facility for the info. It generally makes a good impression on the family/patient that you continue to be interested in their welfare as well.

[proud2b1]

Trust me,you did do the right thing!!!!!!!!!!!!!!!!!!!!!!!!!!

[EricJRN, MSN, RN]

I agree that you did the right thing.

Hint for next time: If this is a service that transports their patients primarily to your hospital's ER, you might refer the medic to his medical director.

If you are the service's base hospital, the medical director is most likely a staff physician (ER, FP, IM, etc) there and could obtain the information if appropriate. That would take the decision-making off of your back in the matter.