Patients Viewing Nursing Notes In Real Time

TheMoonisMyLantern, ADN, LPN, RN · Mar 4, 2021

On 3/3/2021 at 11:13 PM, MunoRN said:

As to imaging results, all results released to a patient are already interpreted by a provider (a radiologist), there is no reason to suppress this information from patients, particularly since one of the major drivers of making imaging results more accessible to patients is the disturbing number of patients who had incidental findings on imaging that recommended interval follow up which never occurred because it was up to the provider to inform them of that.

A radiologist's interpretation doesn't provide context and ultimately the attending physician has to determine clinical relevance. I think results should be released with the ordering provider's comments providing context for what the radiologist saw.

You are right, there are a disturbing amount of findings where follow up is recommended, and it flat out doesn't happen.

TheMoonisMyLantern, ADN, LPN, RN · Mar 4, 2021

18 hours ago, Tnurse24 said:

Is anyone aware of a new CMS rule that all nursing progress notes are to be made available to patients in real time? This is the default at my hospital, and it is a HUGE safety risk to ER staff who are already vulnerable to erratic and unpredictable behavior as well as wide open to the public. Is anyone else aware of these requirements? What is being done to protect individuals from potential violence or security issues?

I hadn't heard about this new rule. On one hand I have nothing to hide but people are such jerks you know there's a lot of people who will go over them with a fine toothed comb and critique everything mentioned and not mentioned.

I'm fine with patients having access to their information but real time is a bit much.

Wuzzie · Mar 4, 2021

8 hours ago, Susie2310 said:

I don't know your facility's internal process for handling such a call from a family member, but I assumed the patient had not given your facility a documented instruction that their family member could receive the patient's HIPAA information. It seems possible that looking at what went wrong and changing the internal process would avoid situations such as this. The unfortunate situation you described doesn't mean that there is anything wrong with making patient's medical records/nursing notes available to patients in real time or that this not beneficial to the patients.

I very clearly stated that we did not discuss the patient with the family member. HIPAA does not preclude us from listening to what they have to say, especially if the patient is perceived to be in danger. We simply listened and and thanked the person for letting us know. Please tell me how the situation I described was beneficial to the patient? Also, please tell me what changes you think can be made to the internal process? Had the information been suppressed for even 15 minutes we would have had a provider on the phone with the patient assessing the situation at which time he would have been told the nature of the call. I absolutely agree that the patient should have access to their records. I just think there is a more reasonable way to go about this that does not include handing the records over on a silver platter.

TheMoonisMyLantern, ADN, LPN, RN · Mar 4, 2021

Does this rule only apply to narrative notes? On the floors the bulk of charting occurs within various assessment tabs/screens, will those be made available as well? How are hospitals making this available in real time, are there monitors put up in each room that has the notes populated for the patient to see? I'm trying not to be negative or judgmental about this. Everyone better make sure their liability and malpractice premiums are paid up.

I don't think I would want to read my nursing notes if I was a patient, I don't want to read about the episode of explosive diarrhea I had, etc. I think for a lot of patients it's just unnecessary. Now obviously for more complicated patients I could understand how it would be more appealing.

FolksBtrippin, BSN, RN · Mar 4, 2021

I write every single note as if the patient is reading it while I'm writing it. And I work in psych.

Quote the patient or family exactly, don't make value or moral judgments, facts only and leave out everything irrelevant.

Use the word "declined" instead of "refused".

Easy peasy.

Asdf · Mar 4, 2021

On 3/3/2021 at 11:41 PM, Susie2310 said:

As things are now, patients have the right to know the first and last name of the nurse caring for them.

I cover my last name on my badge and I also won’t give it out to pts.

speedynurse, ADN, BSN, RN, EMT-P · Mar 4, 2021

I think patients have always had access to their charts which is OK. I know whatever I documented in the ER was simply the truth and often in direct quotes. My concern when I was in the ER is that patients could see our last names from the notes and that was frightening. For patients with severe psych issues or gave threats to the staff, this was a very real concern.

Susie2310 · Mar 4, 2021

6 hours ago, Wuzzie said:

I very clearly stated that we did not discuss the patient with the family member. HIPAA does not preclude us from listening to what they have to say, especially if the patient is perceived to be in danger. We simply listened and and thanked the person for letting us know. Please tell me how the situation I described was beneficial to the patient? Also, please tell me what changes you think can be made to the internal process? Had the information been suppressed for even 15 minutes we would have had a provider on the phone with the patient assessing the situation at which time he would have been told the nature of the call. I absolutely agree that the patient should have access to their records. I just think there is a more reasonable way to go about this that does not include handing the records over on a silver platter.

I'm aware that HIPAA doesn't preclude a facility/individuals from listening to what a family member has to say (although I have experienced situation/s where it has been made difficult for the family member to provide information on their initial call to the facility due to strict implementation of patient privacy rights) especially if they are stating that the patient could be in danger/expressing concerns for the patient's wellbeing.

I wasn't suggesting that you/your facility didn't follow correct HIPAA practices, but it seemed possible to me from what you had written, since I don't know your facility's privacy practices or the patient's relationship with their family members, or the patient's communication with their providers related to who the patient wished their PHI to be disclosed to, that something could have gone astray in these areas, or that the internal process for dealing with such calls could benefit from being evaluated and possibly adjusted.

Wuzzie · Mar 4, 2021

38 minutes ago, Susie2310 said:

or that the internal process for dealing with such calls could benefit from being evaluated and possibly adjusted.

The problem is if we are to follow the federal guidelines we can't make any adjustments as they are very clear regarding exemptions to the real-time release rules. This particular encounter did not qualify and there is no way, in the EMR, for us to make such adjustments. So the end result was an upset patient who did not get treatment on time and now has a ruined relationship with the one person who was available to help him. Generally I don't care if a patient reads my documentation as it is always objective and thorough even when an encounter has been ugly. If a patient is being a donkey's behind I have no problem with them reading about it in all the glorious details and I don't care if they get mad at me. I'm a big girl, I can take it. This has been my practice throughout my career. I love me some quotation marks. ;-)

The problem is when a group of people, who don't do our job, make a sweeping decision about what's "best" for our patients without allowing for the nuances of communication in the medical setting.

Susie2310 · Mar 4, 2021

6 minutes ago, Wuzzie said:

The problem is if we are to follow the federal guidelines we can't make any adjustments as they are very clear regarding exemptions to the real-time release rules. This particular encounter did not qualify and there is no way, in the EMR, for us to make such adjustments. So the end result was an upset patient who did not get treatment on time and now has a ruined relationship with the one person who was available to help him. Generally I don't care if a patient reads my documentation as it is always objective and thorough even when an encounter has been ugly. If a patient is being a donkey's behind I have no problem with them reading about it in all the glorious details and I don't care if they get mad at me. I'm a big girl, I can take it. This has been my practice throughout my career. I love me some quotation marks. ;-)

The problem is when a group of people, who don't do our job, make a sweeping decision about what's "best" for our patients without allowing for the nuances of communication in the medical setting.

I hear your concern for this situation, and I do think this situation was very unfortunate.

Over the entire population of patients I still believe the benefits of making patient records available to the patient and thus greatly increasing their knowledge of the care they are receiving/their medical conditions without their having to go through the time consuming process of going through medical records to obtain information about each individual patient encounter, far outweighs the disadvantages to patients as a population.

Wuzzie · Mar 4, 2021

Just now, Susie2310 said:

I hear your concern for this situation, and I do think this situation was very unfortunate.

Over the entire population of patients I still believe the benefits of making patient records available to the patient and thus greatly increasing their knowledge of the care they are receiving/their medical conditions without their having to go through the time consuming process of going through medical records to obtain information about each individual patient encounter, far outweighs the disadvantages to patients as a population.

I think I was also clear in my first post that I agree that the ridiculous hoop jumping previously required for a patient to see their record was unacceptable but I do not think that this is the way to fix the problem. For example, another poster suggested that imaging results be held for the ordering provider to add a note providing medical context for the patient. There could be a time limit placed for this to occur and then the results would release. Currently our providers are fined if they don't complete a note within 48 hours. This has curbed their bad behavior and could be implemented here as well. I just think there is a better way to implement this with a harm-reduction rather than risk-mitigation focus.

Daisy4RN · Mar 4, 2021

I cant see how this would turn out good in most cases. But maybe it is just the places I have worked, I guarantee patients would be walking the halls demanding to know why you wrote this and that. I agree with Chickenlady, no way!