doctor's office accessing of scripts

Nurses HIPAA

Published

right about now I am ripshoot (george carlinism)....went for a work physical at a doctor's office that I have no prior relationship with and will have no further relationship with, and the MA looks at the screen and says "so, you take x and y meds....." I ask her how she knows this, since I didn't give permission nor a list, and she says if you use insurance to pay for it, we can see it......WITHOUT MY FREAKING CONSENT....! I got copies of the consents i signed, on the way out of the office, don't see it anywhere!!!!!....This seems like a hipaa violation to me, they had no need, hence no right. I am feeling ...angry, hurt, humiliated, stupid.......this on top of no steady job at the moment......really great freaking day I have had.....So, so much for privacy....

Sorry if this has been repeated in prior pages but in my office, we have the ability to access pts medications from their pharmacy ONLY WITH PERMISSION! I will ask patients, new or returns, for their consent. We have an area in the chart to document if we have gotten their consent or not and if yes, we can import. Otherwise we go by what mess they tell us an import them as they tell us. I work in PA so I'm not sure what other states can and cannot do regarding this, but seems wrong to do this with no patient permission.

* go by what meds they tell us. Dang autocorrect.

I use this service too. My patients give consent by signing a form called "Consent to treat." If you signed a consent to treat, you gave consent to access these records.

I cannot safely and effectively evaluate or treat a patient if I do not know every single medication someone may be taking, and as evidenced here, I cannot always rely on patients to be forthcoming with this information. Even if you do not realize it, assessing a patient's fitness for duty does require the provider consider medications they might be taking. This is a significant liability concern for the provider. They are being responsible and thorough to check medication fill history and failure to do so could probably be construed as malpractice.

There is no reason you should be ashamed of your own medical history. Good luck to you.

I am blown away by so many people that have no problem at all with the continued loss of privacy. The thing is= you have 'no' idea, NONE, what may happen in thre future due to anyone having your medical record. Being ashamed is 'not even' relevant to this OP's original dilemna.

Permission to treat does not include access to prior records unless expressly given. your last line was more than a little patronizing.

I use this service too. My patients give consent by signing a form called "Consent to treat." If you signed a consent to treat, you gave consent to access these records.

I cannot safely and effectively evaluate or treat a patient if I do not know every single medication someone may be taking, and as evidenced here, I cannot always rely on patients to be forthcoming with this information. Even if you do not realize it, assessing a patient's fitness for duty does require the provider consider medications they might be taking. This is a significant liability concern for the provider. They are being responsible and thorough to check medication fill history and failure to do so could probably be construed as malpractice.

There is no reason you should be ashamed of your own medical history. Good luck to you.

I've only worked in medical offices and have never heard of anyone getting your scripts through your insurance company. People change insurance companies all the time so it wouldn't be an accurate list. If this was a work-related physical then your insurance wouldn't be filed, it would be handled via your employer, right? I understand your point about not giving permission but I think something's being missed.

Also, as an office nurse, NOTHING bugs me more than pts not giving a complete medication list. I'll have established pts tell me "you've got my chart, you already know what I'm taking" on a daily basis. My reply to that is, "you need to know what you're taking because your medical chart isn't sitting in the ER if you were ever taken there, and other docs could have prescribed new meds since our last visit so I ask everyone for their med list EVERY VISIT." I usually get an eye roll but they start reciting their med list. I then encourage them to type up a list and keep a copy with them.

Specializes in FNP, ONP.
Permission to treat does not include access to prior records unless expressly given. your last line was more than a little patronizing.

It is sad and unfortunate that you find my comment patronizing. It was truly meant to be supportive. Permission to treat absolutely does include access to all medications and diagnoses because we simply cannot effectively evaluate and treat without them. It is clear you can't be objective about this, but I assure you it is true and I have no reason not to be honest with you. I'm merely trying to reassure you that no wrong was done to you; you were treated appropriately. I honestly wish you the best of luck in your health and job search.

Specializes in FNP, ONP.

S/he seems to be hiding something. I don't know why. I guessed it was shame/embarrassment based on comments about being afraid of small town gossip or something to that effect. I could be wrong. It's silly anyway. There is no reason for it. In my experience, most people are far too self absorbed to pay any attention to what someone else has going on anyway!

What the thing REALLY is, is that the medical records are already out there. This is not a new development. They have been there for 15 years. We (providers) just couldn't get them until relatively recently, but they were always there. Insurance companies have had access to these materials for at least 12 years. They have used them to rate you for life insurance, health insurance, etc. Once you fill a prescription or file any insurance claim for medical services carrying an ICD code in the US, there is a permanent record, forever.

The records (ICD codes and medications) need to be in the hands of the people who need them, lol, i.e. those providing treatment (which includes evaluation in this case). There is no point in gathering records in the database in the sky (and they are there) and not using them to ensure patient safety. The only reason they aren't more widely accessed is that providers/hospitals have to pay to access them and many are too cheap to pay for the service. I don't know exactly what it costs, but I think it is several thousand dollars a year. My office subscribes and I cannot tell you how invaluable a tool it is. It literally saves lives by avoiding potentially deadly mistakes. We get a discount on our for using it, but I suspect companies will require providers subscribe eventually.

You don't have to like it, but you will have to adjust to it because it is the way things are and there is no way to opt out. You could use a pseudonym, (i.e. lie) but that of course is illegal. If you get caught you can be prosecuted.

and this will drive person away from getting care, just as the what do you think drove some of the "outside the hospital" birthing? No one showed be able to "see" may record without my explicit consent! By obtaining this information, without my explicit consent, they have decreased any trust in them that I may have had.

S/he seems to be hiding something. I don't know why. I guessed it was shame/embarrassment based on comments about being afraid of small town gossip or something to that effect. I could be wrong. It's silly anyway. There is no reason for it. In my experience, most people are far too self absorbed to pay any attention to what someone else has going on anyway!

What the thing REALLY is, is that the medical records are already out there. This is not a new development. They have been there for 15 years. We (providers) just couldn't get them until relatively recently, but they were always there. Insurance companies have had access to these materials for at least 12 years. They have used them to rate you for life insurance, health insurance, etc. Once you fill a prescription or file any insurance claim for medical services carrying an ICD code in the US, there is a permanent record, forever.

The records (ICD codes and medications) need to be in the hands of the people who need them, lol, i.e. those providing treatment (which includes evaluation in this case). There is no point in gathering records in the database in the sky (and they are there) and not using them to ensure patient safety. The only reason they aren't more widely accessed is that providers/hospitals have to pay to access them and many are too cheap to pay for the service. I don't know exactly what it costs, but I think it is several thousand dollars a year. My office subscribes and I cannot tell you how invaluable a tool it is. It literally saves lives by avoiding potentially deadly mistakes. We get a discount on our liability insurance for using it, but I suspect malpractice insurance companies will require providers subscribe eventually.

You don't have to like it, but you will have to adjust to it because it is the way things are and there is no way to opt out. You could use a pseudonym, (i.e. lie) but that of course is illegal. If you get caught you can be prosecuted.

Specializes in Emergency, Telemetry, Transplant.

This is addressed more so to the group than to the OP:

I am a little confused by people saying that it wrong for a treating practitioner (doctor, etc.) to know the entire medical history before assessing/treating a patient. Perhaps I am missing an obvious argument, but just saying "medical histories are private, therefore they can be withheld from the doctor" makes no sense. The doctor is assuming a lot of liability by accepting a patient...they have the right to know the entire medical history and prescribed meds before they begin their own treatment.

I am not a nurse yet, so I can only comment as a US citizen.

There is nothing wrong with a doctor having access to a complete medical history. There is also nothing wrong with allowing a competent adult to make the decision regarding the release of that information. Do you want the ED to have access to all records in an emergency? I don't think many people would object to that. A specific law can be written to get it done. Concerned that Doc's will get sued when patients refuse access to that information? A specific law can be put in place to cover that, too. Why should we default to a system that takes rights away from competent citizens?

And yes, I know drug seeking is a huge issue. I have a family member who has done so. She lived in a small community and word got around, HIPAA be damned. When she couldn't get a doc to prescribe anymore she just switched to street drugs and is no better off. Really she's worse off. The government is not big enough to fix everybody and everything. It is big enough to make us all miserable if we don't watch it carefully.

Specializes in Med Surg.
There is a difference between giving that info to them yourself vs having them pluck it out of the cyber world. It is a matter of so many having access vs. your having a quiet talk to your doctor and disclosing the info.

I am all for using the technology to prevent doctor shopping/drug seeking, but it is getting intrusive and I bet some people will end up getting burned badly when the information is eventually misused.

Ah well, time will tell.

I agree 100%. In the American mind, THE most profound privilege that the public has come to trust has always been associated with the following: priest or minister/penitent, attorney/client, mental health professional/client and healthcare provider/patient. I daresay that most individuals do not consider this to mean that when you tell one of those individuals, the information can be disseminated to all of the individuals in that category i.e. ALL priests, ALL attorneys, ALL shrinks and therapists and ALL healthcare providers. I think that a REASONABLE person would view it to be his or her prerogative to decide with whom he or she feels comfortable sharing certain information.

And no, I do NOT feel comfortable with all staff at all hcp's and/or hospitals knowing my entire medical history. I will share what I need to share with my physician in private. But I am not "down" with this entire movement towards the lessening of civil privacy rights at large that I currently see occurring in this country (not to get too political about it... ha!)

That said, I DO have medical history that is germane to pretty much any of my health providers. Chronic issues that are ongoing and could affect my health status in many areas, for which I take medication, (and which are also actually quite cumbersome for me to provide over and over again).

I have no issue at all with providers being able to pull this information up (although again, I don't really want everyone in the office seeing everything about me, PARTICULARLY now that I am entering the health industry as an employee myself).

It would be nice to be able to designate certain information that is available in our record for providers at large (such as past surgical procedures, allergies, current health issues and medications we take for those in order not to have to repeat ourselves - because I notice that the enhanced sharing doesn't really cut down on THIS a lot for me).

But we may have other health history that might not be something we would want to share with more than the provider who cared for us during that circumstance.

For instance, and NO, this is not me, just spit-balling here. But does EVERY hcp need to know about a previous sexual assault of many years prior for which someone obtained psychiatric care? Or that a post-menopausal, post-complete hysterectomy woman had an abortion at 17? Or the clap in college? Don't women frequently have gynecologists separate from the pcp BECAUSE they would prefer to share their gynecological issues with just that physician?

I can see that if a pt has a hx of a particular type of illness or incident that is prone to following him or her health wise that this is important to disclose. But fundamentally I still believe that disclosure is up to the patient to decide.

If the sharing of medical info is on a need-to-know in order to treat basis, then why should someone's complete history be accessed without their permission if it is not necessary for their current treatment? Perhaps we think pts are too stupid to know what is relevant. That concept seems a little paternalistic to me. And there is always the option of educating pts about necessary info when they seek help for certain issues and then getting permission to access said info.

When I was accepted to nursing school, I of course had to turn in the requisite physical. I went to a new doctor because I had just moved. I dutifully gave him my med list and any current issues that are chronic and well controlled that i don't mind disclosing (I have very well controlled HTN, for instance).

I suppose he could have pulled up my entire health history and placed it on that form, but he did not (meh, most doctors wouldn't have TIME). And neither would my former physician have done so because much of it is not relevant to the situation at hand. Do I want the entire faculty of the nursing school having access to MY ENTIRE HEALTH HISTORY? Nope. Nothing shameful or inflammatory, just very invasive, unnecessary and PRIVATE. They need to know if I can function to do the job required and that is what this physician assessed for them.

And I do agree with CrunchRN that not only ARE people going to get burned with this unlimited access, but that people have been and do get burned. Hipaa or no hipaa, PEOPLE TALK. It is deplorable but it happens. And I think it's probably not even that uncommon.

THANK YOU ! (OP)

I agree 100%. In the American mind, THE most profound privilege that the public has come to trust has always been associated with the following: priest or minister/penitent, attorney/client, mental health professional/client and healthcare provider/patient. I daresay that most individuals do not consider this to mean that when you tell one of those individuals, the information can be disseminated to all of the individuals in that category i.e. ALL priests, ALL attorneys, ALL shrinks and therapists and ALL healthcare providers. I think that a REASONABLE person would view it to be his or her prerogative to decide with whom he or she feels comfortable sharing certain information.

And no, I do NOT feel comfortable with all staff at all hcp's and/or hospitals knowing my entire medical history. I will share what I need to share with my physician in private. But I am not "down" with this entire movement towards the lessening of civil privacy rights at large that I currently see occurring in this country (not to get too political about it... ha!)

That said, I DO have medical history that is germane to pretty much any of my health providers. Chronic issues that are ongoing and could affect my health status in many areas, for which I take medication, (and which are also actually quite cumbersome for me to provide over and over again).

I have no issue at all with providers being able to pull this information up (although again, I don't really want everyone in the office seeing everything about me, PARTICULARLY now that I am entering the health industry as an employee myself).

It would be nice to be able to designate certain information that is available in our record for providers at large (such as past surgical procedures, allergies, current health issues and medications we take for those in order not to have to repeat ourselves - because I notice that the enhanced sharing doesn't really cut down on THIS a lot for me).

But we may have other health history that might not be something we would want to share with more than the provider who cared for us during that circumstance.

For instance, and NO, this is not me, just spit-balling here. But does EVERY hcp need to know about a previous sexual assault of many years prior for which someone obtained psychiatric care? Or that a post-menopausal, post-complete hysterectomy woman had an abortion at 17? Or the clap in college? Don't women frequently have gynecologists separate from the pcp BECAUSE they would prefer to share their gynecological issues with just that physician?

I can see that if a pt has a hx of a particular type of illness or incident that is prone to following him or her health wise that this is important to disclose. But fundamentally I still believe that disclosure is up to the patient to decide.

If the sharing of medical info is on a need-to-know in order to treat basis, then why should someone's complete history be accessed without their permission if it is not necessary for their current treatment? Perhaps we think pts are too stupid to know what is relevant. That concept seems a little paternalistic to me. And there is always the option of educating pts about necessary info when they seek help for certain issues and then getting permission to access said info.

When I was accepted to nursing school, I of course had to turn in the requisite physical. I went to a new doctor because I had just moved. I dutifully gave him my med list and any current issues that are chronic and well controlled that i don't mind disclosing (I have very well controlled HTN, for instance).

I suppose he could have pulled up my entire health history and placed it on that form, but he did not (meh, most doctors wouldn't have TIME). And neither would my former physician have done so because much of it is not relevant to the situation at hand. Do I want the entire faculty of the nursing school having access to MY ENTIRE HEALTH HISTORY? Nope. Nothing shameful or inflammatory, just very invasive, unnecessary and PRIVATE. They need to know if I can function to do the job required and that is what this physician assessed for them.

And I do agree with CrunchRN that not only ARE people going to get burned with this unlimited access, but that people have been and do get burned. Hipaa or no hipaa, PEOPLE TALK. It is deplorable but it happens. And I think it's probably not even that uncommon.

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