Hospice in an ALF and HIPAA

[Race Mom]

Our hospice is moving to EMR and the facilities are given access to our pt electronic chart (until full implementation we print and fax ALL clinical notes from RN, LCSW, and SCP). I feel this could open us up for a HIPAA violation. I could be completely wrong, but the following just doesn't sound like we are protecting our pt's FAMILY (as hospice, our care is for the whole family, not just the patient).

I have a pt that has a dx process that the spouse could no longer manage at home. This is a young pt. This pt also has a young child. The pt was moved to an ALF very recently.

My concerns:

Child has a volunteer from our hospice, that volunteers for HIM, not pt

Social Work and Spiritual Care will split their visits between pt, spouse, and child.

All notes from these disciplines are "available" for the facility to look at through EMR.

I find that this violates the family's HIPAA rights to their privacy of issues they may be working through, whether d/t pt condition or other issues.

For example: let's just pretend...(seriously)

Spouse confides in social worker that he had multiple affairs during his marriage and he is struggling with it....or...he has met someone new now that spouse is in facility...or...he is suicidal....or he has found out he has been diagnosed with (anything).

Son confides in social worker or volunteer that he is being bullied at school, or that he became sexually active, or that he smoked pot...

(seriously, I made all these examples up)

What business is that of the facility? How will that help them accomplish caring for this pt that needs their skilled services?

In my opinion, it violates the family's right to privacy and their right to protected health information. I was told today that the facility should be getting all notes from all disciplines. Because I feel so strongly that I feel the facility has no right to read these notes as it does not help them provide care to the hospice patient but allows them to read the "novel" of the family.

Please let me know what the rule is on this. I would like to make sure I am following HIPAA and that my company is too.

[ktwlpn, LPN]

I certainly meant no offense. I did not feel offended,I was simply responding to your post from my background as a nurse in LTC with a lot of hospice experience,too. I did not use any emoticons, it's unfortunate that you feel like I blasted you out of the water.I did not intentionally do that,I was simply answering your questions.

[MunoRN, RN]

I was pointing out that you seem to be under the mistaken impression that only hospice cares for the patient as part of a family/social/support system and that the SNF nurses don't, a view you seem to be maintaing, which is the offensive part of this conversation.

[Race Mom, ASN, RN]

Where did I ever say that only hospice cares for the whole family, etc? And where did I comment that "maintained" this view? This is the problem with boards. You got offended by something that "I" didn't mean to imply, and for that, I apologize. I was just looking to protect the family's personal information that we may gather and thought I would ask on the hipaa forum if we are following hipaa. That is all. I have tons of respect for the staff at the LTCF. They work hard. We never get the notes from the LCSW or nursing at the facility to assist in our care so I wonder how much of our info from the family is going to aide in caring for this patient by the LTCF. (example...house purchase that needed a letter from our MD...it is a clinical note and went to the facility for their chart too). That is it. Nothing more. I sit here empty, without a clear answer to my original question, but with nurses coming down on me because I want to make sure I'm following hipaa. Why does everyone have to take offense to such a simple question?

[klone, MSN, RN]

I was pointing out that you seem to be under the mistaken impression that only hospice cares for the patient as part of a family/social/support system and that the SNF nurses don't, a view you seem to be maintaing, which is the offensive part of this conversation.

She never said anything about what SNF nurses do and don't do for the patients. She was speaking only about what the role of the hospice is. If you choose to fill in the blank with something offensive or disparaging towards SNF nurses, that's your choice, but don't put that responsibility on her. She did and said nothing wrong or offensive about SNF nurses.

[klone, MSN, RN]

The clear answer is, the SNF or LTCF should not have access to the hospice's EMR. What is to prevent them from accessing other patient records within the EMR?

The hospice should either print out applicable nursing/LSW/chaplain/medical director notes on the patient and give them to the LTCF, or they can write a note in the patient's LTCF chart.

This is per my husband, who is ED of a hospice. I claim no knowledge of hospice doings, other than what I learn via osmosis.

[ktwlpn, LPN]

The clear answer is, the SNF or LTCF should not have access to the hospice's EMR. What is to prevent them from accessing other patient records within the EMR?

The hospice should either print out applicable nursing/LSW/chaplain/medical director notes on the patient and give them to the LTCF, or they can write a note in the patient's LTCF chart.

This is per my husband, who is ED of a hospice. I claim no knowledge of hospice doings, other than what I learn via osmosis.

It's very easy for IT to limit one's access to certain charts or particular areas of a chart-very easy. I think it's a shame you feel so damaged from responses you've received on a web site. You asked questions,you received a number of answers, some comments were misunderstood and then discussed again.When any of us voiced a differing opinion and backed it up you reacted as though you were being attacked.We were just giving you our opinions but I seems you did not really want them.Sorry.

[MunoRN, RN]

Maybe you could clarify; do hospice nurses have access to the same records you're concerned that the SNF nurses have access to?

[Race Mom, ASN, RN]

RNCM do have access to the hospice file, all disciplines, and CoPs require an IDT meeting Q 2 weeks to discuss the patient and family centered care. I am the team leader and therefore play a large role in managing all care provided. The CoPs also require that our team communicate to each other about needs and changes. I do not have access to the facility's SW charting, nor do they send it to us. I have no idea what she discusses with the pt or spouse. If I had a concern, I could go to her (or our LCSW could) to manage the issue together. And what does this clarify?

ktwlpn: I am not "damaged" and I never said you "attacked" me. You are spinning this with your own perception of the actual words that I typed. I also never asked for opinions. I asked for information about if giving all notes was a violation of hipaa. I did read good information about how a LCSW could write their note and I will have to pay more attention to what they type up, I guess. We discuss it in person so I don't usually need to read our SW notes.

Anyways...I was just trying to advocate for my pt's family and find out what HIPAA requires to be given. This whole conversation turned weird and that just baffles me. I love all nurses and I appreciate ALL LTC staff as they do a tremendous, back braking, hard working gift to our loved ones. Lets just drop this. The world needs love, not war.

[MunoRN, RN]

HIPAA requires that those caring for the patient only access information necessary to provide care to the patient, given the holistic nature of nursing, this can often be pretty broad.

In answering your question it needs to be clarified what the role of various caregivers are in order to determine if they have access to appropriate information. If the hospice nurses and the SNF nurses are providing similar nursing care, then there's no reason why information accessible to the hospice nurses wouldn't also be available to the SNF nurses and if it's not appropriate to be accessed by the SNF nurses then it should also be blocked to hospice nurses. This is why the answer to your question hinges on the role of the caregivers; if they serve similar roles the same rules would apply.

The service with which the notes originated makes no difference in terms of HIPAA, they aren't hospice's notes or the SNF's notes, they're the patient's notes and the same privacy principles applies equally.

[klone, MSN, RN]

But like Race explained, the hospice nurses are involved in weekly/biweekly IDG meetings, where they're privy to all aspects of the patient's care. The nurses who work at the SNF are not a part of that. The hospice nurse is taking care of the hospice aspect of the patient's care. The SNF nurse's role may not involve the hospice aspect, but rather the day to day care of the patient.

Surely you understand that the role of the hospice nurse is different from the role of the SNF nurse, even though they may be taking care of the same patient.

And FWIW, care conferences are common among hospices and the SNFs that take care of the patient (if the patient is not at home) - because IDG meetings discuss all patients, it's not exactly appropriate for the SNF nurse(s) to be in attendance there, but it's definitely been done that the SNF nurses taking care of a patient is invited to a care conference, where they are also privy to all aspects of the patient's care.

[MunoRN, RN]

But like Race explained, the hospice nurses are involved in weekly/biweekly IDG meetings, where they're privy to all aspects of the patient's care. The nurses who work at the SNF are not a part of that. The hospice nurse is taking care of the hospice aspect of the patient's care. The SNF nurse's role may not involve the hospice aspect, but rather the day to day care of the patient.

Surely you understand that the role of the hospice nurse is different from the role of the SNF nurse, even though they may be taking care of the same patient.

And FWIW, care conferences are common among hospices and the SNFs that take care of the patient (if the patient is not at home) - because IDG meetings discuss all patients, it's not exactly appropriate for the SNF nurse(s) to be in attendance there, but it's definitely been done that the SNF nurses taking care of a patient is invited to a care conference, where they are also privy to all aspects of the patient's care.

There may very well be more explanation that differentiates the roles of the two, although the previous differentiation was:

Hospice cares for the family, not just the patient...

which is a false understanding of the role of SNF nurses or nurses in general.

[Race Mom, ASN, RN]

OMG, once again... I am explaining the role of HOSPICE not hospice vs SNF! Hospice provides FAMILY CENTERED CARE! Maybe chiropractors and dentists do to, I have no clue! The SNF for the pt made me sit down for an hour and discuss with their nurse educator why I was stating that a feeding tube was not appropriate for this pt. Nevermind her POST stating NO LIFE SUPPORT. Then they blasted her for choosing this and how difficult it was on THEM! There...there is your difference between hospice nursing and general nursing. (disclaimer obviously needed...not all nurses want to go against a POST nor do all SNF not want to honor the wishes of the dying.)