HIPAA violation with chart note?

Specialties NP

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Hi all, I'm an ARNP student and was recently reprimanded by an instructor for what she views as a 'possible HIPAA violation'. This is my last quarter as an ARNP student so this is a bit of a shock!

I learned that in order to share chart notes with instructors/etc that we could either photocopy or e-mail them, as long as all patient identifying data was not on there and/or had been blacked out. Pretty much all you can have is age and sex, not even a birthdate . So I sent a note about a patient to my preceptor the other day--a regular SOAP note with NO identifying information. All it included was a first initial, age, and presumed ethnicity--all of which I thought were ok. I got back a frantic e-mail from her saying she'd shared this with everyone at the clinic and the school and that it was to be investigated. I have sent DOZENS of e-mails just like this to various preceptors/instructors while I've been in school and have never had a problem. What did I miss?

Any advice much appreciated. Ugh. :-(

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Ok..I'm an RN student, but I'll take a shot at this one.

I think she is freaking out over nothing as well as the person that told her that they are investigating it.

Age is important, because it relates to care b/c some diseases/conditions are age-related...the exact birthdate is most likely protected by HIPAA and not necessary.

Race is also important, because there are diseases/conditions that are more prevalent in certain racial groups than others...again, that is part of your care.

Patient's initials, I have seen used in professional studies, on the news, in the paper, you name it...there are millions of combinations of initials.

My question is this: Why is she sharing it with "everyone" at the clinic anyway? Maybe that is what the HIPAA violation is and NOT what you sent her. She had a right to review it b/c that is part of your instruction and that is PROTECTED by HIPAA and not considered a violation...but sharing it with "the entire clinic" probably was not.

You see what I'm saying?

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I'm baffled to by it all and really upset that now I look like a total A$$ to the clinic and what not. I too wondered why *she* forwarded it..um..wouldn't that be an even worse violation? Since those people were not directly involved in patient care? Thanks for your opinions...just wondering what people not involved think. Samarooni

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I dont understand why she shared this with everyone. First, this instructor has not only herself breeched the patient's confidentiality but also your confidentiality as a student. If this was deemed by the instructor to contain private medical information she should never show it around. Also I dont know if it is appropriate for her to show other's your course work.

As far as HIPAA violation, it is complicated. Age and first initial may be identifying information in the context of diagnosis and sex. R is 16 yo female involved in MVA--in a small town everyone may know who that is. Also extremes of age are to be avoided, I forget the exact rule but something like specific years after 90 yoa should not be documented.

But disclosing this information to your instructor in my opinion would not be a HIPAA violation. However, sending it by unsecured email perhaps could place the PHI at risk.

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It totally makes sense that in a small town this might be a challenge, but this is in a huge city in a clinic with well over a thousand patients. Her age was 47 or so, totally 'typical'. I too have heard of not putting extreme ages on notes. I just put "L is a 47 year old Caucasian female"... and then continued on with my note. I'm curious what the instructor will do, but it sure is upsetting in the meantime--you'd think if I done it wrong this entire year someone would have said something!

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I'm an NP student in a metro area and send info as you described all the time. Never had a problem. Can you get a second opinion from your program director or an instructor that you trust? This sounds way overblown.

Check it out, and if necessary set up a meeting between you, the instructor and your program director. Make copies of your correspondence and get some clarification. You don't need this in your last semester.

Good luck.

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I based my answer on the fact that I am in a small town.

We use exact age, race, gender and intials. However, when do my care plans, only the clinical instructor grades them...they don't get passed around to anyone else. That limits who sees the information to me and my instructor---the only two that really need to see it.

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Specializes in RN- Med/surg.

When I was in school they were VERY strict on this as well. THey said BECAUSE we are rural we had to be especially careful. We couldn't use initials or real age. We had to say "male, age 60-70"

Hopefully this will blow over though as I don't think it's truly in violation.

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Thanks for all of your replies, I'm a little stunned. As a working nurse and soon to be ARNP I felt that I had a pretty clear understanding of HIPAA when it comes to what is appropriate and not appropriate to share. I'm super annoyed that the preceptor automatically shared this with at least five other people, none of whom are directly involved in the patient care (or my education). It's an embarassment to me, and for no good reason, in my opinion. If this was wrong then I'm very curious to find out why, because I just don't understand. Thanks for your responses, much appreciated. Here's hoping my blood pressure goes down soon! lol..Samarooni

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Thanks for all of your replies, I'm a little stunned. As a working nurse and soon to be ARNP I felt that I had a pretty clear understanding of HIPAA when it comes to what is appropriate and not appropriate to share. I'm super annoyed that the preceptor automatically shared this with at least five other people, none of whom are directly involved in the patient care (or my education). It's an embarassment to me, and for no good reason, in my opinion. If this was wrong then I'm very curious to find out why, because I just don't understand. Thanks for your responses, much appreciated. Here's hoping my blood pressure goes down soon! lol..Samarooni

I don't understand how an instructor can reprimand you for something that they did. Have you spoken with your university about this. They should have a policy about disciplining students. I am guessing that punishing students for an instructors mistake is not part of this.

David Carpenter, PA-C

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Well I know that she said she was going to forward it to a bunch of people, which would be a pretty obvious offense, since these people aren't in a 'need to know' group. I'm still trying to figure out what I did wrong, it's so frustrating. And I haven't heard back from her or anyone else all day. Sigh!

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Do you know if she's ever done this with anyone else or is known for reporting this kind of stuff? It may be a case of her wanting to look like the "big hero" or something of that nature. (of course at your expense).

When I was in undergrad school I had a class where we had to write this simple little paper and the instructor accused me of plagerizing it, went to the Dean and wanted me kicked out of the program and made a really big stink about it. There was no way I plagerized!

They pretty much just laughed in her face and that one semester was all she ever taught.

To top it all off, I didn't know anything about any of this while it was happening. About a year after the fact a friend of mine was working in a rural clinic and this instructor just happened to be an NP there. This NP proceeded to tell her the story and even used my name! Not knowing that this nurse was a friend of mine. My friend told me what this NP had said and never let on to the NP she knew who she was talking about.

My friend says the NP is about to get fired for inappropriate comments made to patients.

Sorry, got a little off topic. The point I was getting at was maybe this instructor is trying to make a name for herself or something.

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