Question about HIPPA regs...

  1. I know a few of you here on the board are very informed about HIPPA and all the impending changes. I have a question for you about a situation and would it be in violation of HIPPA...

    We have a family practice doctor who is always requesting that we fax to his office any specialist progress notes and consults that are in regards to his pt. For example, Dr. Blowjoe orders a cardiology consult for Mr. Heart in Rm 000. The cardiologist, Dr. Beat comes around later that day and consults on Mr. Heart. He dictates his consult notes and leaves. Dr. Blowjoe calls our unit and requests that the consult note and the progress notes for Mr. Heart be faxed to his office.. Would this be a violation of HIPPA...

    Dr. Blowjoe also wants us to fax the ER reports, labs, xray results and whatever else he deems necessary to his office when one of his patients are admitted through the ER. Is this a violation of HIPPA?

    My last question is, some of the doctors have fax machines in their homes and ask us to fax stuff to them at home in regards to a patient (especially Dr. Blowjoe). Wouldn't this be in violation of HIPPA, since we don't know who else could be on the receiving end of the fax such as a spouse, child, or the family pet.

    Any information you can give me would be greatly appreciated it. Thanks.
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  2. 8 Comments

  3. by   midwestRN
    Sorry, I don't know the answer, but doesn't it just make you tired trying to comply with the government.
  4. by   deespoohbear
    i just love government red tape...., not!!!

    actually, i am hoping that hippa does put an end to some of dr. blowjoe's nonsense. he always calls at the most inopportune time wanting tons of stuff faxed to him. then when you do try to fax to the office, the blanking thing is busy.... our ward clerk and i both have better things to do than to fax all this stuff to his office. my philosophy is if the specialist decides something needs to be brought to dr. blowjoe's attention immediately, he will call him or have us call. and i for one, believe our nursing staff is competent enough to call abnormal labs to the office. plus the er notifies the attending physician when they admit a pt and gives them all the relevant details. i have better things to be doing with my time (and so does the ward clerk) than pulling out multiple pages in a chart and faxing them. one time i got so aggravated about dr. blowjoe wanting stuff faxed on a new admission i faxed the entire chart to the office. i wasn't very busy that day and had time to do it. gave me a little bit of satisfaction. :roll
  5. by   rebelwaclause
    Try this link for good info:

    Compliance.Com

    Hope it answers your ?????
  6. by   hoolahan
    The pt signed a general consent form for info to be shared when he checks into the hosp. If Dr. Blowjoe ordered the consult, I think it is rather conscientious of him to want to keep copies. It takes forever to get info from med recs, and he wants his pt's charts t be complete. Either that or he's a control freak. Personally, I admire his anal-ness, and I don't think it's in violation of hippa.

    Sounds like he needs to hire an assistant to do this secretarial work for him.
  7. by   renerian
    Hoolahan I agree with you. If you have a signed consent you should be fine. I went to get some pre-employment drug screen this week and a sign posted on the window said due to new HIPPA regulations you have to sign in , be seated and do not knock on the window as we may have confidential information by the window and that would be a violation of HIPPA regulations. I thought the knocking on the window was a bit much.....I had to wait 45 mintues for someone to come out. Needless to say by then there were 15 people in the waiting room.......sheezz

    renerian
  8. by   NRSKarenRN
    Resources:

    HIPAAfaq - Privacy
    http://www.hipaadvisory.com/action/faqs/FAQ_Privacy.htm

    HIPAA on the Job: Release of Information under HIPAA
    http://www.ahima.org/journal/feature...e.0111.07.html

    Minimum Necessary
    http://www.hipaadvisory.com/notes/vol2/july02.htm#no26

    No. 31 HIPAA Detail -- Fax Management and Business Associates
    http://www.hipaadvisory.com/notes/vol2/aug02.htm#no31

    Fax Facts
    http://www.hipaadvisory.com/action/faxfacts.htm
    http://www.ahima.org/journal/pb/01.06.2.html


    Several aspects of HIPAA rules come into play in your example.

    I assume you are talking about a hospital seeting where Family doctor/attending/PCP (Dr Blowjoe) has requested a medical consult from Dr Heart.
    Rules from Doctors office to another Dr's office may be slightly different.

    1. What is business relationship of doctord to YOUR facility? Are they on medical staff and employees of the facility or outside consultants??

    Under HIPAA, one may discuss information between physicians and nurses as part of the hospitals treatment, payment and healthcare operations (TPO) ONCE consent has been signed for treatment. DR Heart has access to the patient as his services requested by Attending DR Blowjoe. Dr Blowjoe has a right to patient information under need to treat client.

    This is all covered as long as a BUSINESS ASSOCIATE agreement has been signed between doctors and your facility (covered under granting of facility for hospital provledges).

    2. MINIMUM USE: Dr Blowjoe needs full access to all contents of chart in order to treat patient as attending so he gets access to everything and may have copies but ONLY per facilities RELEASE OF INFORMATION policy.

    Now if Dr. Kidney sees that his patient is in the hospital and decides to come to unit to check on patient he has NO RIGHT to access chart information as consult not requested. Same of nurse on another floor/unit that wants to see patients info--not permitted as not actively caring for patient.


    3. RELEASE OF INFORMATION policy spells out who may send/receive parts of chart. This is where your facilites policy and procedure will guide you in what you should be faxing to doctors.

    You should not be pulling info from floor/unit charts and faxing to attending unless your facility permits that as
    A. too much time wasted away from other duties.
    b. can't determine that info is safe if faxing to doctors home.

    I can see reading part of chart over phone to doc in order to give pertinent info for verbal order for med changes--covered under law (TPO).

    Check with your Medical Records department policies re release of information---should get you off the hook re faxing info. Anyway discuss this with administration as you definately need policy and procedure to allow this to continue under HIPAA.
  9. by   deespoohbear
    hoolahan-The guy is a control freak. One time Dr. Blowjoe ordered a surgical consult for one of his patients. This surgeon is notorious for not consulting for HOURS after the consult is ordered. Anyway, Dr. Scalpel came in and saw the pt but didn't write any notes. One of the office nurses called me wanting the notes from the surgeon faxed to the office. I told her the surgeon didn't write any. 30 minutes later another nurse from the office called and asked for the same information to be faxed. I told her AGAIN that Nurse #1 called not more than 30 minutes ago and there weren't any notes. (This a solo practice too, and Nurse #2 even commented to me that she knew Nurse #1 had called.) An hour later Dr. Blowjoe himself calls me, and I tell him AGAIN that there weren't any notes. (I think the staff was just testing me to see if I would give them the same answer all three times. . At that time Dr. Scalpel just happened to walk up on the floor and I gave him the phone and he and Dr. Blowjoe talked to one another. Dr. Blowjoe acts like to us that he has been sued before because of missing something. He orders every test in the book even for a hangnail. Keeps his patients in the hospital way longer than necessary most of the time. He is anal to a point that it is annoying as he**.

    NRSKarenRN-
    Thank you. I knew you would come through with a ton of links and information. I have no idea where you get all this stuff, but I am glad you do. Sure is helpful. :kiss

    In the situation I described in my original post, it is between the attending physician and a cardiologist who has priviledges at our facility. The consultating physcian's has his own rounding nurse for our facility, and a copy of their licenses are on file for the records. The consultating doctor has all the priviledges of the attending physician: admission, etc. (I work in a rural hospital).

    I will check with medical records when I return to work this week.
    Last edit by deespoohbear on Oct 7, '02
  10. by   NRSKarenRN
    Spent 4 DAYS at HIPAA seminar and spent ~ 100hrs working on homecare agency's HIPAA assessment. Did lot of web surfin---chief privacy officer (off my rocker ) too. Knee deep in remediation plans now.

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