Potential to Violate, Employer says it's ok.

[underabus]

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.

[Julius Seizure]

Am I right or am I wrong? Any advice on this issue is appreciated.

Talk about lecturing.....

This gave me a good chuckle

[underabus]

Qing, I appreciate your non-condescending response and that you took the time to read and understand. Nurses often look down their noses at lab techs, and obviously jump at any opportunity twist what we say and do. I have NO doubt that's what happened in this thread as well. Most of do our best to try to understand the "daily grind" of the nurses we encounter, and treat them with the respect they deserve. All too often, though, we encounter ones like *these*, with ego problems that need to feel better about themselves by treating others like ignobles.

[Kooky Korky, BSN, RN]

I did not admonish the nurse, first of all. You're wrong for admonishing me for something I didn't do. I told her the information wasn't necessary for message. I also didn't lecture. I just said that *I* didn't want a violation. I didn't say it was a violation, or "Section A, article 2 of the HIPAA laws says....." Don't twist it. Don't assume the messaging system isn't HIPAA compliant....I'm not going to assume it IS either. The phone number doesn't go to some landline phone at the brick and mortar lab. It's a cell phone. It's not just that I'm accessing it by cell phone, the number, phone and messaging system IS a cell phone. We don't get to use "company property phones." We are to use our own cell phones. The boss keeps the cell phone to which the number and messaging system is attached. I have an ear piece, when it's too loud where I am, I can't hear, the speaker function isn't facing out towards the general public AND as I CLEARLY stated, I don't use the car blue tooth for that exact reason, AND, as I am not an employee of these facilities, I am NOT allowed in areas that would be considered "Private" unless they are patient rooms and I'm attending the patient. In some, we're not even allowed to move anywhere in the building without a staff escort, except to walk to and from the entrance to and from the office. We are also not allowed to use staff or resident bathrooms, only the public bathrooms, which are by no means private. Pull over.... Um, if I'm supposed to call every 20 mins and I've been in one facility for 45 mins, how do I pull over? I'm not even in a car. I'm inside a facility. Talk about lecturing.....

This angry response leads me to believe that you did come across as something other than you intended.

I think you could probably go behind the desk in facilities more freely than you say, especially on Evening shift. If I'm wrong then I'm wrong.

Do what you can to not violate. But beyond that, it's on your employer, I would think. Since you have pointed out to your boss what difficulties you encounter, what does he/she say?

What do other techs like yourself say and do with regard to the issues you have raised?

[JKL33]

Nurses often look down their noses at lab techs, and obviously jump at any opportunity twist what we say and do. I have NO doubt that's what happened in this thread as well.

I can only speak for myself: You are wrong.

Take care~

[KelRN215, BSN, RN]

We exclusively use cell phones in my work as a visiting nurse. It is not a privacy violation to use a secure messaging service, even if you access it with a cell phone. You do have to ensure you do not take calls/voicemails where others can over hear you to protect privacy.

Same. It's 2018, there's nothing wrong with using cell phones for work. In my last 3 jobs, I have worked off of work cell phones. When I was on call in my home care job, patients or nurses would call the main line which was forwarded to an answering service. The answering service would take their information and text it to me and I would return calls from my cell phone. During the week when I was in the field, I regularly used said cell phone to communicate with patients and MD offices and, yes, people left protected information on my voicemail. It was secure as I was the only person with access to this voicemail.

Same at my last job where I worked 100% off of my cell phone. It was the only means of communication I had and Case Managers regularly called me and left patient information on my voicemail. I also used the phone's email app to communicate with the people in my office but it was A) a secure internal email system and B) everyone I communicated with was involved with the patient in some way.

At the job I just started, same as my last job, my cell phone is my only phone. I left many messages with case workers from CPS this week and if they get my voicemail when they call me back, I fully expect them to leave me messages with patient information included.

[underabus]

Going behind a desk is NOT private. I don't know what kind of desks you're used to, but the one's I see are about waist or less high, are not sound proof, and have facility staff behind them. Maybe you all live where people are less....suspicious maybe, or maybe your state or county laws are less restrictive, I don't know, I'm just throwing possibilities out there...maybe nurses where you are aren't so haughty, rude, and downright abusive sometimes, but around here, outside contractors are just that, outsiders. ESPECIALLY lab techs. I have personally been threatened with physical harm by a nurse for touching the Lab Order....pardon me....."HER lab order," that was sitting on the outside edge of the desk (face up, mind you) without her permission, My ID fully visible and having already told her who I was and what I was there for and been acknowledged by her. And no, nothing was done after I reported it to my supervisor. As per usual. Maybe because there's no state requirement for phlebotomists to be nationally certified, or because it's only a 10 week course, so maybe RNs feel they spent 4 years and a ton of money earning the right to be "superior." I don't know the exact reason. (I spent 5 years and a ton of money to earn my degree, but for my own previously unknown and un-diagnosed health reasons, had to leave that particular occupation. Many of us are in the same boat or have their own reasons why they went another route. Just FYI).

"Other techs" that work my shift/position total 4. We rarely work together or have need to communicate with each other. The rest work days and depend on the supervisor to dispatch them. However, the one I have spoken to about this has had the same concerns as I do, but, like myself, did what our supervisor required us to do, make the call anyway.

MOST facilities do not leave that type of information on the message system because 1) they know it's not necessary, 2) use their heads. We never know when one will drop 2 mins of first, last, date of birth, room #, MR#, dx, ordering physician, insurance.... in fact, the outgoing message says to leave name of facility, name of caller, and extension where they can be reached. If the rest was required, it would say to leave the rest. If, according to my supervisor's answer to me, "We need the information to do our jobs so wouldn't be a violation in any case," why doesn't the outgoing message say to leave all the info? Her answer, was, "Because it isn't necessary. We can get it if we need when we call them back." ............... HELLO?????? I can't the only person to have heard the discrepancy.

If, when that one calls with all that information, if we just stop the message, save it and move on, hang up, whatever, we don't get to hear the rest of it to hear what we DO need to know, ie: call back number, unit, name of person leaving the message. Go on about our business and try to listen to the message again when we get back out to the car, the supervisor has gone in and erased it. As I've said, a few times actually, I could be 45 mins, depending on the situation, inside one facility. She doesn't leave the messages until the end of the shift, or the next morning. She monitors the calls that come in as shown on the caller ID on the cell phone to which the number is attached that she has in her possession vs. the messages we've retrieved. If she has ANY reason to think we've already listened to it, she deletes it. (Now, why would she do that, pray tell?) Micromanaging? Probably. She may have a reason to think she has to. Maybe she was ordered to do so by her bosses.

It's very easy for one who doesn't have live, first hand experience of another's, to judge their actions, re-actions, or "attitude." If it isn't your experience, your reality, then it must not be true, factual, their reality.

Look, I get that long winded posts like mine bore people; they skim, they don't *read*, they look for something they want to speak to, skip/miss/disregard the details and/or context and make assumptions and judgments based on what they want to believe or think in the moment. But, that's not helpful and I can't help but think that it was the fact that I made clear from the start that I wasn't a nurse, but a [blood sucking gnat] that triggered the typical "This person is inferior," mentality. And, as I've already stated, I was correct. It was a valid concern, and a change is being made, because the lab manager didn't jump to a conclusion before she spoke to me and listened.

I thank the person who approached the topic with an open mind. I will not be responding to any more comments, as for me, the subject is now resolved and I no longer have need of advice on this topic from this board.

Have a great day.

[underabus]

And there in, lies the problem. I'm NOT the only person with access to the voice mail. Everyone in the department has been instructed on how to access the voicemails, (in case of call offs and pick-ups). There's rules about accessing when you're not on shift, or have no right at any time to access it, of course, but like all rules, just because they exist, doesn't mean they are impossible to break. And I am NOT going to take a violation for anyone. Why would I? That's a question for corporate. Someone else in the same department, same functional job title, but different assignment and supervisor(yes, you read that right) was suspended for a month for a violation after being given an error notification which contained results that were supposed to have been omitted or redacted by the supervisor before she gave to her. The tech reported it to compliance and she was the one punished. WHY? Because she looked at it. She filed a complaint with the union and her suspension was reduced to one week, instead. Supervisor was not even dinged.

Ok, NOW I'm done responding. Thanks for your input.

[ontnursec]

And there in, lies the problem. I'm NOT the only person with access to the voice mail. Everyone in the department has been instructed on how to access the voicemails, (in case of call offs and pick-ups). There's rules about accessing when you're not on shift, or have no right at any time to access it, of course, but like all rules, just because they exist, doesn't mean they are impossible to break. And I am NOT going to take a violation for anyone. Why would I? That's a question for corporate. Someone else in the same department, same functional job title, but different assignment and supervisor(yes, you read that right) was suspended for a month for a violation after being given an error notification which contained results that were supposed to have been omitted or redacted by the supervisor before she gave to her. The tech reported it to compliance and she was the one punished. WHY? Because she looked at it. She filed a complaint with the union and her suspension was reduced to one week, instead. Supervisor was not even dinged.

Ok, NOW I'm done responding. Thanks for your input.

I think your original post was questioning if you have a potential privacy violation. You have gotten our opinion that no, there isn't really a violation if you take the messages in a secure location (I.e in your car with the windows up- which I personally do every day at work).

It sounds like you've got other issues with your employer's policies and aren't feeling very supported by your supervisor with these challenges. Which may require a different sort of conversation. But again to go back to the original issue at hsnd- receiving messages at your job through a cell phone is not in and of itself a privacy issue if done correctly. You just don't seem to be given the opportunity to do it correctly.