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.
I wasn't replying directly to you, Race Mom. It was actually more towards where the entire thread was heading. Nowhere did I quote you or refer to you or the Agency that you are employed by in my post.
And the "playing nice" comment was geared toward the whole team work issue. We have had Agencies that haven't considered the patient as an individual in the past. Rather they just start with whatever protocols that they have and not consider what the patient actually needs.
Further more, in MY facility, it is more common that the IDT refers to Hospice. We at times, and that is seldom, do we take Respite cases. Or when a patient IS referred to us, the patient is actively dying, and not with us long. In fact the last Residents that we had as referred to us lasted 8 days, 5 days, and 2 days. Coupled with a few more deaths, as well as some family deaths of our Residents, needless to say it was a crappy month.
As for your original post on HIPAA, clinical notes that benefit the patient, including pertinent information on the family SHOULD be shared.
We are in an opposite situation than you, as we go live with EMR very soon. Our Hospice people will have access to the same information that they do now...the ENTIRE medical chart, just as the Hospice files copies of all their clinical notes in the patient's chart under their own section.
I have access to phone numbers to Hospice triage, as well as the Nurse, the Chaplain, and the SW if I have questions or concerns. We don't work with just one Hospice, but a multitude.
A closing thought...we have had one incident with a sister facility where the husband brought a gun into his wife's room and committed a murder-suicide. I don't know the particulars of the case, however, the situation, in my mind, validates the need to know some of the psychosocial aspects of family and a Hospice patient, especially if they are not dealing with the situation well.
One more thing...if you have a SNF that fights a No Tube Feed decision and ignores quality of life and what the Resident wants, maybe it is rime to educate that facility or stop doing business with it. It quite frankly doesn't sound like a facility that I would want to work for. Then again, I love my company that I am with now.
Clear Blue, well written post, thank you for your reply. The third and forth paragraphs in your original post are what I was referring to, as so many on here, for some reason, assumed my original question meant that SNF didn't need to know info or the amount of time that hospice spends with the pt vs SNF. (just because I left the building doesn't mean I'm done with that patient...by far! The visit is usually the quickest part). I want them to know everything they possibly can to provide excellent care to our shared patient.
Anyways, again, well written post. Your patients and staff are blessed to be working with someone that provides compassionate care.
Thank Race Mom, as your compassion and caring for your patients comes through as well. I have always said, and stand by that I am not cut out for Hospice. I would burn out quickly.
As has been pointed out a couple of times in this thread, the answer to your question depends on the roles of various caregivers, their role then determines what information is acceptable to be shared, which is why it's part of your answer, not a side issue.
There is no such thing as the hospice plan of care or the SNF plan of care, there is the patient's plan of care which is comprised of input from various sources, including hospice. The patient's POLST is not hospice's plan of care, it's the patient's. As part of their role, the SNF nurses should be included in the patient's plan of care even the parts derived from hospice assessments, if those include information about family members that in no way contributes to the patient's plan of care then there is no reason to share that information since it wouldn't be identified as the patient's information.
ClearBlueOctoberSky
370 Posts
I wasn't replying directly to you, Race Mom. It was actually more towards where the entire thread was heading. Nowhere did I quote you or refer to you or the Agency that you are employed by in my post.
And the "playing nice" comment was geared toward the whole team work issue. We have had Agencies that haven't considered the patient as an individual in the past. Rather they just start with whatever protocols that they have and not consider what the patient actually needs.
Further more, in MY facility, it is more common that the IDT refers to Hospice. We at times, and that is seldom, do we take Respite cases. Or when a patient IS referred to us, the patient is actively dying, and not with us long. In fact the last Residents that we had as referred to us lasted 8 days, 5 days, and 2 days. Coupled with a few more deaths, as well as some family deaths of our Residents, needless to say it was a crappy month.
As for your original post on HIPAA, clinical notes that benefit the patient, including pertinent information on the family SHOULD be shared.
We are in an opposite situation than you, as we go live with EMR very soon. Our Hospice people will have access to the same information that they do now...the ENTIRE medical chart, just as the Hospice files copies of all their clinical notes in the patient's chart under their own section.
I have access to phone numbers to Hospice triage, as well as the Nurse, the Chaplain, and the SW if I have questions or concerns. We don't work with just one Hospice, but a multitude.
A closing thought...we have had one incident with a sister facility where the husband brought a gun into his wife's room and committed a murder-suicide. I don't know the particulars of the case, however, the situation, in my mind, validates the need to know some of the psychosocial aspects of family and a Hospice patient, especially if they are not dealing with the situation well.
One more thing...if you have a SNF that fights a No Tube Feed decision and ignores quality of life and what the Resident wants, maybe it is rime to educate that facility or stop doing business with it. It quite frankly doesn't sound like a facility that I would want to work for. Then again, I love my company that I am with now.