HIPPA violation?

Mythreeangels · Dec 12, 2005

Ooops, sorry HIPAA

elkpark · Dec 12, 2005

Your best bet may be to check with your hospital HIPAA compliance person (one of the HIPAA requirements is that the organization have a person whose job is to be familiar with all the requirements and assure compliance), but my understanding is that HIPAA requires that patient information be protected even from hospital employees unless they have a "need to know", which a unit secretary clearly wouldn't -- I can't imagine what possible use, except "gossip value," she would have for the information discussed in report.

I have worked at small, rural hospitals over the years, and have always found that the standards related to privacy and confidentiality have been VERY different from city settings :rolleyes: -- but those days are over and have to change!

My background is psych, and I can see that, in a psych setting, the argument could be made that the unit secretary does need to know what's going on with the clients, since they are up and about on the unit and coming up to the desk and s/he is actually interacting with them all day. But certainly not in a regular medical-type setting.

If the manager has not been willing to listen to you, you could check with the HIPAA compliance person and see whether s/he would be willing to approach the manager with this as an "anonymous" report/complaint (not disclose to the manager who brought this up to her/him) -- that way, the manager would know it was someone from the unit, but wouldn't know specifically who. Or, you could go to the HIPAA person as a group.

Best wishes!

flashpoint · Dec 12, 2005

I am guessing this is not a HIPAA violation...she has full access to the charts anyway and it probably can be benficial for her to know things like who is going home, who is transferring, who has a family member that is causing problems, etc. It doesn't sounds like the best use of her time as she could easily be updated after report, but I think it would be OK according to HIPAA...

AuntieRN · Dec 12, 2005

I was a unit secretary for about 4 years. I worked on all the floors except psych and OB including the ER. We always sat in report. The nurses felt it helped them out. We then knew who needed what test done and when they had to be there, we knew who had labs pending so we could be on the look out for them for the nurses, we knew who needed what meds brought up from pharmacy etc. The nurses felt it helped them out in case they got busy and forgot to tell us about something. We helped them remember when a patient's blood was ready for transfusion, or when a patient had to go to the OR. Nurses are extremeley busy on the floors in the hospital. I also helped answer lights when the nurses were busy, this way I also knew what to look out for when a patient rang, I knew who could get out of bed, who was NPO etc. I do not see how it would be a HIPPA violation. Secretaries are the ones who put the orders, d/c orders, meds etc in the computer. They are the ones who place the calls to doctors for nurses when they are busy, they are the ones who call the blood bank, lab or x/r when a test needs to be done,they are the ones who take down x/r and lab results for the nurses. They are just an extra pair of hands. I could be wrong in my thinking, however, the secretaries where I work now also listen to report. They answer the call system when a patient rings and relay messages to the nurses and techs as to what the patient wants or needs. Wouldn't this be a HIPPA violation then? I do not mean to start a debate here I am just wondering as I am almost done with nursing school and do not want to violate any HIPPA laws. Thank you.

BittyBabyGrower, MSN, RN · Dec 12, 2005

I wouldn't think this is a HIPPA violation...our secretaries know everything that is going on....without them, we wouldn't get half the things done we need! They are the ones that put in labs, reqs for procedures, etc....we don't have a full unit report, but the charge nurse fills them in. They also need to know which kids are the sickest, who is a transport, who needs eye exams, etc. Pretty much, the only thing they can't do is take lab results over the phone. We are really lost when we don't have a secretary on...they hold us together!

Mythreeangels · Dec 20, 2005

I wish our unit secretary helped us out. That is one of the main reasons that we are all so aggrevated. She sits in on the whole report, and then we are constantly "riding" her to put in labs, etc. It's always, oh yeah, okay. She absolutely does not answer the call light, and I don't think would even imagine herself doing it. She has a tendency to, literally, go get the mail in the middle of a sick newborn's transport, when she is needed most. We've talked to our manager, but as you could guess, we all wish we had a new secretary, and maybe a manger too, hmmm....Anyways, I guess sitting in isn't such a bad thought, as long as it meant she actually took the iniative to do something. If we had someone, like vlsgrl, we would probably LOVE to have her in report...but unfortunately, we've even asked her to do hearing screens and she's out and out said no...but no backup from our manager..hmmmm sorry so long, just absolutely frustrated

Balder_LPN, LPN · Dec 20, 2005

I am guessing this is not a HIPAA violation...she has full access to the charts anyway and it probably can be benficial for her to know things like who is going home, who is transferring, who has a family member that is causing problems, etc. It doesn't sounds like the best use of her time as she could easily be updated after report, but I think it would be OK according to HIPAA...

Actually the fact that the secretary has access to the charts does not mean reading them is not a HIPAA violation.

HIPAA is clear: A covered entity (Nurses, docs, al other hospital employees in this case) cannot disclose or access confidential information (includes dx,hx,md,tx,rx all those x's, name, dob,ssn etc etc) that is not required to provide the pts service. The covered entity must only access the minimum info neccesary to provide the required services (bedside care, billing, whatever) for the pt.

So the ?? is : Does the secretary require this info to provide her services? hmmmmmm.....seems alot of people think so. I have to disagree. She may need some, but not everything (maybe in psych she does) IMO

What it comes down to is :Can the hospital succesfully defend this decision in court? HIPAA provides no "safe haven". That is, the real determination of a HIPAA violation comes only after the violation. (ie pt in rural area makes complaint of breach to hospital or CMS, issue is investigated (remember hospital must report breaches or suspected breaches to cms) and fines or charges are issued(or not)) All the 200+pages of the regulation still do not provide you with a clearcut way to say, we did A B and C so this is ok.You can only defend yourself after the fact.

Like many govt regs HIPAA started out with good intentions, but is overreaching, and overburdensome in many ways. IMO

Balder_LPN, LPN · Dec 20, 2005

here is how HHS puts it. PHI=Private health information (all that hx,tx,rx, dob ssn, etc etc)

The Privacy Rule

The Privacy Rule permits uses and disclosures for "treatment, payment and health care operations" as well as certain other disclosures without the individual's prior written authorization. Disclosures not otherwise specifically permitted or required by the Privacy Rule must have an authorization that meets certain requirements. With certain exceptions, the Privacy Rule generally requires that uses and disclosures of PHI be the minimum necessary for the intended purpose of the use or disclosure.

LydiaNN · Dec 20, 2005

I have been to several HIPAA trainings, and it doesn't sound like a violation to me. A misuse of the secertary's time, yes (we've got a similar situation where I work, so I can relate). It sounds as if the secretary's attendance at report is a part of standard operating procedures and thus not a violation. She is bound by the same confidentiality rules as the rest of the staff. This question has come up in one form or another at every HIPAA training I've attended, and that's always the answer.

jeirma · Dec 23, 2005

i am LPN student and i have a fellow classmate that she took a picture of a child in a spica cast from a child abuse case on her cell phone. she showed it to several classmates and her husband. it was brought to the attention of the program leader, which is loves this woman, and she told the ones that reported it that they needed to talk to the student and that she did nothing about it. this student just finished yesterday her course and is graduating. the program advisor didnt do anything. the head instructor is a ARNP and she should of known and dealt with it herself instead of the students tell the other student that it wasnt right. doesnt this sound like a HIPPA law violation and shouldnt of the student been suspend from the program? ANY thoughts would help me case cause I am fight this with the school that the program is from. THanks

LydiaNN · Dec 23, 2005

It probably isn't a HIPAA violation because the child herself isn't identified (even though her picture is there, her name and medical information isn't attached). It is a complete violation of her privacy, though. The student who took the picture should be reprimanded, IMHO.