Patients Viewing Nursing Notes In Real Time

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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?

On 3/3/2021 at 11:15 PM, 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.

Often in these situations the family member is in fact on the HIPAA. I for one am completely fine with the patient being able to read that the family member called...one thing I can't stand is the spouse or child who calls with a litany of concerns and wants interventions implemented but then says we have to figure out how to do something about these 10 different things without letting the family member know they called. 

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Specializes in Critical Care.
8 hours ago, morte said:

Untypical of you, you are being obtuse. 

I'm really not being obtuse, I don't see how the number of patients causes entrapment of nurses to write an unprofessional or inappropriate not.

8 hours ago, morte said:

You are persisting in your obtuseness.  And you charting was a lie by omission.

Leaving out the catty remark that the patient was "laughing on the phone" is not a "lie by omission", sorry.

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Specializes in Critical Care.

I'm still not clear if Wuzzie and Susie 2310 are actually just saying the same thing, or if they are debating different views.  Is it being argued that the radiology report shouldn't be released to the patient until the primary MD has released it?

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1 hour ago, MunoRN said:

Is It being argued that the radiology report shouldn't be released to the patient until the primary MD has released it?

Yes, with an expectation that it is done in a timely manner that allows for an intervening plan to be formulated. By and large it doesn’t take an extraordinary amount of time to come up with a reasonable treatment plan. I’m talking 24-48 hours. At this point then the patient could be called (preferred) or a note from the provider could be added to the results. For example “Mr. Smith, we see the slight increase in the right mediastinal lymph node the radiologist mentioned. We have a low suspicion that it is indicating progression but will continue to monitor it. Your chemo plan will remain the same and we’ll see you in clinic in three weeks”. 
If I understand her correctly Susie thinks a generic note saying what amounts to  “your provider needs to explain this more thoroughly to you” will be sufficient to allay their fears. I disagree. 
 

FTR, I don’t care if a patient reads my nursing notes under most circumstances unless I feel they will be put at risk because of them as illustrated in my other example. I just think there should be an option for sensitive documentation to be suppressed long enough to plan on how to minimize harm to the patient as a result of it. 

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1 hour ago, MunoRN said:

I'm still not clear if Wuzzie and Susie 2310 are actually just saying the same thing, or if they are debating different views.  Is it being argued that the radiology report shouldn't be released to the patient until the primary MD has released it?

My understanding from Wuzzie's posts on this thread (Wuzzie, please feel free to correct me if I have misunderstood you) is that Wuzzie believes that the radiology reports should in all cases not be released to the patient until the ordering physician has: 1) reviewed them 2) provided a note along with them to the patient to provide context, so that when the patient receives the radiology reports they also receive the note/context provided by the ordering physician, and 3) that releasing medical records (especially radiology records) in real time is not a good idea because 1) and 2) won't be met and oncology patients will suffer harm because of this.  I also understand that Wuzzie believes that the current situation of the process a patient has to go to to obtain their medical records through Medical Records is unsatisfactory, but that releasing records in real time is not appropriate and can be harmful for patients.

My position is that I believe that the benefits of releasing medical records in real time to patients as a population, thus allowing patients to be significantly better informed about their medical conditions and care they are receiving, is greatly beneficial to patients as a population and overall far outweighs any disadvantages.  I provided examples of how the radiology report can be annotated by the facility when released to the patient to state that the radiology report/results must be given context by the ordering provider, and that the ordering provider should do this timely after the patient receives the report, and that the ordering provider, if they view the radiology report prior to it being sent to the patient, can add their note/comments prior to the report being released to the patient and can contact the patient, and that the radiologist, if the findings are significant, can promptly contact the ordering provider who can contact the patient timely if necessary.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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31 minutes ago, Wuzzie said:


If I understand her correctly Susie thinks a generic note saying what amounts to  “your provider needs to explain this more thoroughly to you” will be sufficient to allay their fears. I disagree. 
 

 

I have already clarified this point for you, and have provided a number of examples, so I'm not sure why you continue to choose to believe this in spite of my extensive clarifications/providing further information about my point of view in my replies to you above.  Can you tell me why you wish insistently to continue to believe that the above is my view, when I have clarified and elaborated on my view in my numerous replies to you?

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26 minutes ago, Susie2310 said:

I have already clarified this point for you, and have provided a number of examples, so I'm not sure why you continue to choose to believe this in spite of my extensive clarifications/providing further information about my point of view in my replies to you above.

I will clarify it for you then. 

4 hours ago, Susie2310 said:

I'm not talking about an auto-response.  I'm talking about a message appended to the radiology results stating that context for the radiology report needs to be provided by the ordering provider, which is followed up timely by the ordering provider interacting with the patient to provide  this context, or, if the ordering provider has already viewed the report when the patient receives it, the ordering provider can use their judgment to include a personal note along with it.  

You gave two options as indicated by the “or” (my bold). The first option (prior to the “or”) does nothing to prevent harm to the patient and, in fact, can cause unnecessary anxiety that they do not need in addition to that which comes from having a potentially life-threatening disease. I have no quibble with the second option as it aligns with what I think is optimal for providing timely results with a necessary explanation. 

 

40 minutes ago, Susie2310 said:

Wuzzie believes that releasing medical records (especially radiology records) in real time is not a good idea. I also understand that Wuzzie believes that the current situation of the process a patient has to go to to obtain their medical records through Medical Records is unsatisfactory, but that releasing records in real time is not appropriate and can be harmful for patients.

What part of the below isn’t clear? I believe that there should be an option for some things to be suppressed for a short period of time in order to formulate at least a rudimentary plan as to how to deal with the contents of the documentation in a way that supports harm reduction for the patient. For example HIV results are an exception and aren’t released. Why are they protected but finding out you have cancer is not?

56 minutes ago, Wuzzie said:

FTR, I don’t care if a patient reads my nursing notes under most circumstances unless I feel they will be put at risk because of them as illustrated in my other example. I just think there should be an option for sensitive documentation to be suppressed long enough to plan on how to minimize harm to the patient as a result of it. 

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3 hours ago, Susie2310 said:

Wuzzie, it's fine with me if you disagree with me - I have no problem with agreeing to disagree, but I don't see any value in both of us continuing to go back and forth, so I'm not going to continue to debate this point with you any further.  

Well, I disagree with this as well. This is a discussion board. Maybe some of the things we discuss can effect change. Maybe we’ll broaden our vision. Maybe we’ll think differently about something. Who knows? I will continue to believe and voice that there must be a better way to improve patient access to their medical records without putting them at risk whether you choose to dialogue with me or not. 

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49 minutes ago, Wuzzie said:

I will clarify it for you then. 

You gave two options as indicated by the “or” (my bold). The first option (prior to the “or”) does nothing to prevent harm to the patient and, in fact, can cause unnecessary anxiety that they do not need in addition to that which comes from having a potentially life-threatening disease. I have no quibble with the second option as it aligns with what I think is optimal for providing timely results with a necessary explanation. 

 

What part of the below isn’t clear? I believe that there should be an option for some things to be suppressed for a short period of time in order to formulate at least a rudimentary plan as to how to deal with the contents of the documentation in a way that supports harm reduction for the patient. For example HIV results are an exception and aren’t released. Why are they protected but finding out you have cancer is not?

   4 hours ago,  Susie2310 said: 

I'm not talking about an auto-response.  I'M TALKING ABOUT A MESSAGE APPENDED TO THE RADIOLOGY RESULTS STATING THAT CONTEXT FOR THE RADIOLOGY REPORT NEEDS TO BE PROVIDED BY THE ORDERING PROVIDER, WHICH IS FOLLOWED UP TIMELY BY THE ORDERING PROVIDER INTERACTING WITH THE PATIENT TO PROVIDE THIS CONTEXT, or, if the ordering provider has already viewed the report when the patient receives it, the ordering provider can use their judgment to include a personal note along with it.  

 

I capitalized the part you are referring to as the bold option wasn't available.  In my view, the ordering provider following up with the patient TIMELY after the report is released to the patient (as I stated above) should serve to minimize harm/anxiety to the patient if the report is released to the patient before the ordering provider is able to view the report and provide their comment/interpretation before it is released to the patient.  I agree that it is preferential for the ordering provider to review the report and provide their comment before it is released to the patient.

 

 

 

 

 

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32 minutes ago, Susie2310 said:

   4 hours ago,  Susie2310 said: 

I'm not talking about an auto-response.  I'M TALKING ABOUT A MESSAGE APPENDED TO THE RADIOLOGY RESULTS STATING THAT CONTEXT FOR THE RADIOLOGY REPORT NEEDS TO BE PROVIDED BY THE ORDERING PROVIDER, WHICH IS FOLLOWED UP TIMELY BY THE ORDERING PROVIDER INTERACTING WITH THE PATIENT TO PROVIDE THIS CONTEXT, or, if the ordering provider has already viewed the report when the patient receives it, the ordering provider can use their judgment to include a personal note along with it.  

 

I capitalized the part you are referring to as the bold option wasn't available.  In my view, the ordering provider following up with the patient TIMELY after the report is released to the patient (as I stated above) should serve to minimize harm/anxiety to the patient if the report is released to the patient before the ordering provider is able to view the report and provide their comment/interpretation before it is released to the patient.  I agree that it is preferable for the ordering provider to review the report and provide their comment before it is released to the patient.

 

 

 

 

 

I added a correction in bold above.

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Specializes in Emergency.
On 3/4/2021 at 9:27 AM, FolksBtrippin said:

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.

That is a really good recommendation- refused is such a trigger for some ppl

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Specializes in Emergency.
On 3/3/2021 at 10:06 PM, MunoRN said:

The CURES act specifically excludes notes that may be used to support an abuse claim, although such notes are still subject to being called into evidence in court, just as they have always been.  

But who- and when and how is doing the filtering of this information? How does it work out in a real and practical way? It just seems so murky and nontransparent. Call me crazy but after this year I really don't trust our government regulations to put safety first. 

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