Hi. Newish RN here.
Today at my facility I was told that speaking with doctors and asking opinions or suggestions from non-consulting docs without mentioning age, gender, name, room number, or admitting dx is considered a HIPAA violation.
I always considered doctors a great resource... especially ones that readily explain in a friendly way. I had already asked pharmacy for suggestions and no feedback given.
I can't ask a doctor anything without them having a direct consult or anything to do with direct patient care?
HIPAA violation or no?
May 4, '12
Stupidity knows no bounds. No, case-study discussion is not a HIPAA violation. Since you don't want any question from Mgmt., however, any discussion I
had would be, "I read about this case where..."
May 8, '12
Welcome to AN! The largest online nursing community.
No HIPAA........with no identifiers there is no violation. Moat facilities don't know HIPAA or are over zealous. There is actually a "clause" including case study and learning.
May 10, '12
and...here are your identifiers and other good info. print it out and post it.
an indispensable source for answers is found here: hipaa - frequently asked questions
this lists the identifiers specifically appearing in the hipaa privacy regulations. the presence of any one of these identifiers renders health information individually identifiable.
hipaa de-identification requires removal of all such identifiers as specifically defined in the regulations. it is not equivalent to the more general concept associated with the term 'anonymous'.
the following identifiers of the individual or of relatives, employers, or household members of the individual the asterisk i* indicates permitted in a limited dataset 164.514(e)(2)):
(a) names (unless specifically released by written permission)
(b)* all geographic subdivisions smaller than a state, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code if, according to the current publicly available data from the bureau of the census:
(1) the geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and
(2) the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.
[limited dataset must exclude postal address information other than town or city, state and zip code]
(c)* all elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;
(d) telephone numbers
(e) fax numbers
(f) electronic mail addresses
(g) social security numbers
(h) medical record numbers
(i) health plan beneficiary numbers
(j) account numbers
(k) certificate/license numbers
(l) vehicle identifiers and serial numbers, including license plate numbers
(m) device identifiers and serial numbers
(n) web universal resource locators (urls)
(o) internet protocol (ip) address numbers
(p) biometric identifiers, including finger and voice prints
(q) full face photographic images and any comparable images (unless written permission obtained)
(r)* any other unique identifying number, characteristic, or code, except as permitted by paragraph (c) of this section; if the algorithm for creating a "code" is disclosed to the recipient of the information, then the code is considered a unique identifier. the code is also considered a unique identifier if it is generated from any of the identifiers, or pieces of the identifiers, listed above.
the privacy rule requires you to "safeguard" phi at your training site. use the following practices to ensure privacy rule compliance.
if you see a medical record in public view where patients or others can see it, cover the file, turn it over, or find another way to protect it.
when you talk about patients as part of your training, try to prevent others from overhearing the conversation. whenever possible, hold conversations about patients in private areas. do not discuss patients while you are in elevators or other public areas.
when medical records are not in use, store them in offices, shelves or filing cabinets.
remove patient documents from faxes and copiers as soon as you can.
when you throw away documents containing phi, follow the facility procedures for disposal of documents with phi.
never remove the patient's official medical record from the training site.
avoid removing copies of phi from the training site; if you must remove copies of phi from the training site, e.g., to complete homework, take appropriate steps to safeguard the phi outside of the training site and properly dispose of the phi when you are done with it. you should not leave phi out where your family members or others may see it. all copies of phi should be shredded when they are no longer needed for your training purposes.
the u.s. department of health and human services has issued another set of hipaa rules (the security rules) regarding safety and security of electronic data files and computer equipment. in the next few months you will be hearing more about electronic safeguards and how the hipaa security rules may affect you at clinical training sites.
use only the minimum necessary information
when you use phi, you must follow the privacy rule's minimum necessary requirement by asking yourself the following question: "am i using or accessing more phi than i need to?" if you are unsure of the phi you may use or access while providing health care for a patient at your training site, please contact your preceptor, supervisor or the hipaa privacy officer at your training site
discussing phi with a patient's family members
before you may discuss a patient's condition, treatment or other phi with his or her family member, it must be determined if the patient would object to such a disclosure. you should confirm with your supervisor that the patient has agreed to allow or in some other way has expressed no objection to such disclosures before you may discuss a patient's condition, treatment, or other phi with his/her family members.
patients' rights under the privacy rule
each training site covered by the hipaa privacy rule will have policies and procedures for implementing the following patient rights under the privacy rule:
the right to request alternative communications. under the privacy rule, patients can ask to be contacted in a certain way. for example, a patient may ask a nurse if she/he can leave a message on the patient's home voicemail instead of contacting the patient at work. if a patient's request is reasonable, as is the previous example, the health care provider or facility must follow it.
the right to look at (and obtain copies of) records. patients can ask to read their medical and billing records, and have copies made.
the right to ask for changes to medical and billing records. each facility must review and consider all requests for changes to medical and billing records.
the right to receive a list of certain disclosures. your training site must make and keep a list of certain disclosures of phi (excluding disclosures for treatment, payment, and health care operations) that are made without patient authorization. patients have the right to see and receive a copy of this list.
the right to request restrictions on how phi is used and disclosed. patients can ask health care providers and facilities to limit the ways they make use of and disclose the patient's phi for treatment, payment, and health care operations. providers and facilities are not required to agree to such requests. you, as a trainee, must never agree to such restrictions on behalf of the training site.
the right to receive a "notice of privacy practices". each health care facility that provides direct patient care must give every patient/client a copy of their notice of privacy practices. the notice describes their privacy practices and the privacy rule. the facility must make reasonable efforts to have each patient sign a form acknowledging he or she received the notice. we recommend that you obtain a copy of the notice of privacy practices from your training site and become familiar with it.
May 11, '12
Are you sure that the objection you received to discussing cases with physicians was related to HIPAA, and not related to the fact that, for multiple reasons, they really don't want to be consulted on cases for which they are not formally "consulted"?
May 11, '12
Way before HIPAA, we were instructed fiercely to never discuss a case or a patient in public, as you never know who might be listening. With the details of a case- even without the PHI- could be recognized by someone related to the patient. (Just a thought).
May 11, '12
To me it sounds like knee jerk reaction based in misinterpretation or ignorance of HIPAA.
There is nothing wrong with having an informal case conference with a medical colleague. Those sort of interdisciplinary interactions enrich the professional delivery of care as they heighten our understanding and knowledge base.
Can we assume that you were not engaging in this discussion in a public area or within earshot of visitors or patients?
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