Sorry for the long post, but detailed explanation is required.
I'm not a nurse. I'm a lab technician. I travel between LTC facilities to collect samples. During regular office hours, clients call the special "phlebotomy line" which is a cell phone number, and a live person picks up and dispatches technicians as needed. But, after regular office hours, which is the shift I work, they call the line and leave a message and the on-call person calls the phone, retrieves the messages, and calls them back. The on-call technician is required to check the messages every 15 to 20mins. If we don't return the call within 20 mins, they call again, and if in another 20 mins they don't get a call back, they are to call the supervisor. This process can be problematic for a number of reasons but, in my opinion, it's the potential for HIPAA violations that is the worst. I'll explain why.
Sometimes, that 15-20 min mark comes (and goes) while the on-call person is inside another facility. It's not always "in and out" for many reasons; difficult draw,staff unaware of any needed labs, patient whereabouts is unknown, even just little details like missing ICD codes or DOBs on lab reqs and an authorized staff member not immediately available to remedy that. Some facilities you can expect to be there for 30-45 mins for just one tube just because of a lack of professionalism and organization.
In those instances, I can find myself needing to call and check messages while in the facility. As I'm on a cell phone myself, the potential for others to hear the message or the conversation exist. And, as it's often loud in nursing facilities, I have to turn up the volume so I can hear it. (There's also the times when in the car, using the car blue tooth, with the windows rolled down...I don't do that because of the privacy issue, but others do). Use of facility phones is not always possible, either all phones are in use, or it's not permitted by the facility.
Occasionally, a person leaving a message will include patient identifying information in the message. First, Last, Room #, DOB, medical record number, Even the REASON they need blood work. I, personally, do not need all the information over the phone to do the duties of MY job. I'm not sitting at a computer order this lab work. All I need to know is Where, what unit I'm going to, and what labs need to be drawn so that I(or the person drawing the next day) can be sure to have all the supplies and equipment needed, ie: special tubes, something I might be low on currently as it could be hours between lab drop offs, special handling or return times so I know how to plan my route and manage my time. A person leaving that information is rare, so that's proof enough that I don't need it in a message.
Yes, the lab(processing, hemo, etc.) does need to know all this information, but that information is on the lab requisition. We can't return tubes to the lab without a requisition, and I certainly can't draw the lab without the requisition, so I feel that leaving this information in a message is not only unnecessary, but has the potential to set ME up for a HIPAA violation if someone should happen to hear any part of that message I'm listening to on my cell phone. Nurses, especially DONs in LTC facilities are well-known for filing ridiculous complaints about "lab girls" so I am always minding my P and Qs. Just the fact that I'm using a cell phone at all in nursing home can trigger a complaint, BECAUSE of the potential for overheard background conversations that include patient information. And on that point, I completely agree with the facility.
Well, last night, we had another of those Patient Identifying information messages, and when I called back, the RN that left the message had already left for the day and did not communicate to anyone else that she had called or why. So, when I returned the call, the receptionist could not answer my, "What are we drawing," question. She wanted patient name. Well, I don't have that, I'm in the car, I didn't write any of that down. Actually, she thought I was calling with results and I couldn't get her to understand that was not what I calling for, and besides, she's the receptionist, we can't tell her results anyway because HIPAA, and she was getting "testy" with me about it. So, I asked for RN on duty. When I got her on the line, I told her, "Just BTW, you don't have to leave patient names, date of birth, etc. on the message. If I need it before I get there for some reason, I get that from you when I call back, but because I'm on a cell phone, it's not always secure on my end and I don't want a HIPAA violation. Most of the time, all I need to know is where, when, and what." That nurse said she would leave the other nurse a note. Well, I don't know what that note said, but I got a call from my Supervisor this morning. "Did you tell so-and-so that our phone line is not secure?"
Well, yes, technically, I did. Maybe my choice of "secure" was not the best choice of words. I admit, I should have said something like, "I'm not always in a private place." But, the fact is, it's a cell phone. And, if we aren't allowed to text patient information, or write patient names in our day book (list of facilities that need draws that day), because someone who does not need to know that information to do their job might see it, then I don't think putting the lab tech into a position where she may be in a public setting and need to listen to a message containing patient information over a CELL PHONE is OK, either.
Well, my supervisor is pissed. Now the nursing home thinks they aren't calling a secure line. Well, they aren't. It's a CELL PHONE. They should know that. CELL PHONES are NOT secure. Anyone who thinks they are needs a lesson is technology. No, it's not my fault if they leave the information, but it COULD be if someone who isn't suppose to hear that information, hears it and it could be MY job on the line for it. And, it could be theirs as well.
I do NOT need to know that information to do MY job in that moment. Technically, I don't even need to know the medical record number or dx code, either. As I said, I'm not ordering this on the computer. I'm bringing the information back to the people who do need to know it. All I need to do is to make sure it's on the requisition. But, if it isn't, I don't chase facility staff down for it, because I don't need to know it. When I turn in the lab without the MR or ICDs are missing, it's processing's job to call the facility to get it because THEY need to know it. Not me. Yes, I need to know the patient name, room number, date of birth, to verify I'm drawing the correct person, but I DON'T need to know that until I get to the facility to draw it.
So, my boss is considering a disciplinary action based on what the nursing facility told her about what I said. I do not think I'm wrong here. Especially since, I know, full well, that if I were to get reported for someone overhearing that message, my supervisor and company would NOT stand behind me and say, "Well, she needed to know that information to do her job." That doesn't stand when the person who needs to know that allows or creates a potential for persons who don't need to know that to hear it. It's STILL a HIPAA violation.
Am I right or am I wrong? Any advice on this issue is appreciated.