Patients Viewing Nursing Notes In Real Time

[Tnurse24]

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?

[Tnurse24, RN]

On 3/5/2021 at 6:49 PM, Closed Account 12345 said:

I think the ability of patients to see the contributions of nurses adds value to our profession.  They'll see that we're more than task robots. We have strong assessment skills that impact their plan of care.  We use critical thinking to identify unsafe orders or determine if a medication should be held.  They'll see documented efforts to improve their comfort and safety. They'll see interdisciplinary communication and advocacy efforts documented. 

I.e. 1430: Dr. Smith notified that patient has additional questions about XYZ procedure. MD states he'll be on the unit at 1700 and will speak with patient then. 1715: Dr. Smith on unit and reminded patient would like to speak with him.

Right now, when Dr. Smith pulls a no show in that patient's room, the nurse gets blamed. Viewing notes would allow the patient to shift misdirected frustrations appropriately.

This is a very good opportunity for many nurses to improve their documentation and communication skills.

Learning to eliminate bias and judgment statements in notes, using objective terms when possible, appropriately using quotation marks, fully and accurately reporting patients' symptoms, etc. are all good things.

I would have no problem explaining to a patient why I wrote "visiting with family member, smiling, eating pancakes and bacon" when they reported 10/10 abdominal pain. "Every patient experiences pain differently. Some patients are smiling and pleasant when they report 10/10 pain, and others are pale, sweaty, and doubled over holding their stomachs when they report 10/10 pain. Using descriptive terms in addition to the numeric pain scale helps team members understand how you experience pain so we can individualize your care and serve you better."  

This is a valuable perspective, I'm skeptical but this is something I'm going to try to keep in mind. Your right this could be a positive. 

[Tnurse24, RN]

5 hours ago, Susie2310 said:

My comments that you are taking issue with were: 

Susie2310   

 Add your Credentials, Experience, etc.

654 Likes   1,974 Posts

17 hours ago

   On 3/4/2021 at 12:46 AM,  TheMoonisMyLantern said: 

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.

My reply to the above poster was:

"A facility can add a note to the released record stating that the ordering provider needs to provide context for the radiology report findings.  I've seen this done."

 

Then I replied to your first reply to me:

Susie2310   

 Add your Credentials, Experience, etc.

654 Likes   1,974 Posts

59 minutes ago

   6 hours ago,  Wuzzie said: 

You can’t really think a generic note like this will make a difference? A personal note from the provider sure but an auto-response? Come on.

My reply to you was:

"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. " 

Then I replied to your second reply to me:

Wuzzie     

9,818 Likes   4,230 Posts

41 minutes ago

   1 hour ago,  Susie2310 said: 

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, 

How is that any different? You still have a patient with a report that they don’t understand and looks to them like their cancer is back or progressing. What is the value in having that report released? How can anyone think this doesn’t result in harm to the patient? What is the risk in delaying it for say 24-48 hours to give the provider time to review and make a notation?

I replied that:

"I said that if the ordering provider has already viewed the report they can use their judgment to send a personal note along with it.  I would also presume that for significant findings the radiologist would contact the ordering provider promptly, so the ordering provider would be able to contact the patient timely if necessary."

My clarifying and adding more information so you can more fully understand my position doesn't signal any negative behavior on my part. 

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.  

 

 

 

 

 

Agreed let's keep it civil folks. 

[Tnurse24, RN]

4 hours 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?

Don't troll on my post or I'll mark it as inappropriate. They agreed to disagree and u gotta write this nonsense? Enough. Who cares. 

[Wuzzie]

4 minutes ago, Tnurse24 said:

Agreed let's keep it civil folks. 

I’m confused. How has this not been civil?

[MunoRN, RN]

1 hour ago, Tnurse24 said:

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. 

The processes for identifying and separating out notes and information that is of higher sensitivity and subject to additional confidentiality has been around for longer than the new rule, since the same information has always been available to patients.  

Current EMRs automatically separate this information so long as it is entered into the correct area of the chart (violence / risk screenings and SW notes that they flag as sensitive).

1 hour ago, Tnurse24 said:

Don't troll on my post or I'll mark it as inappropriate. They agreed to disagree and u gotta write this nonsense? Enough. Who cares. 

?  

Trying to identify where they might have common ground is trolling?  OK then.

[Tnurse24, RN]

1 hour ago, MunoRN said:

The processes for identifying and separating out notes and information that is of higher sensitivity and subject to additional confidentiality has been around for longer than the new rule, since the same information has always been available to patients.  

Current EMRs automatically separate this information so long as it is entered into the correct area of the chart (violence / risk screenings and SW notes that they flag as sensitive).

?  

Trying to identify where they might have common ground is trolling?  OK then.

Yea, I thats what's disturbing, that is pretty reductive and doesn't give the practitioner any way to flag something as potentially sensitive for review outside a few narrow parameters. It's totally dehumanized, that can't be good for anyone. Full disclosure- my nursing education is based on a humanistic framework so others may not feel as strongly about this but it seems like a practical nightmare if your not a robot. 

[MunoRN, RN]

23 minutes ago, Tnurse24 said:

Yea, I thats what's disturbing, that is pretty reductive and doesn't give the practitioner any way to flag something as potentially sensitive for review outside a few narrow parameters. It's totally dehumanized, that can't be good for anyone. Full disclosure- my nursing education is based on a humanistic framework so others may not feel as strongly about this but it seems like a practical nightmare if your not a robot. 

It actually gives multiple ways to flag or designate the documentation of abuse or risk for abuse as a higher level of confidentiality than standard notes.

If your humanistic based nursing education didn't teach you that a patient's right to their own health information shouldn't be taken away just it may take some forethought to keep sensitive information secure then it wasn't all that humanistic.

[Hannahbanana, BSN, MSN]

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.

People often forget that, while HIPAA may prevent you from releasing PHI to people without legal access, it does NOT prevent you from listening to what a family member or other part has to say. If a family member says, “My mother has taken out the side mirrors of her car three times going into the garage” or “My neighbor is out in the back yard all night digging holes and muttering incomprehensible words” or “My dad hasn’t taken his meds for a month and he’s more short of breath than he’s telling you,” those are things that a clinician needs to know. 
 

Agree with “declined” rather than “refused.” Also consider replacing “complained of” with “reported.”  Puts a whole different spin on it, doesn’t it? 

[TheMoonisMyLantern, ADN, LPN, RN]

6 hours ago, Hannahbanana said:

People often forget that, while HIPAA may prevent you from releasing PHI to people without legal access, it does NOT prevent you from listening to what a family member or other part has to say. If a family member says, “My mother has taken out the side mirrors of her car three times going into the garage” or “My neighbor is out in the back yard all night digging holes and muttering incomprehensible words” or “My dad hasn’t taken his meds for a month and he’s more short of breath than he’s telling you,” those are things that a clinician needs to know. 
 

Agree with “declined” rather than “refused.” Also consider replacing “complained of” with “reported.”  Puts a whole different spin on it, doesn’t it? 

I really agree with this. We can get very valuable information from other parties even if we can't release information. Now, sometimes it's a load of bull and the person is just trying to stir the pot but many times they provide a more complete picture to the story. This seems especially true in cases of suspected neglect, failure to thrive, mental capacity, etc. 

[2BS Nurse, BSN]

Am I incorrect in thinking it's only the provider's progress notes available to patients (excluding test results, etc.)? If not, why are we not getting any specific training around this change?

[MunoRN, RN]

9 minutes ago, 2BS Nurse said:

Am I incorrect in thinking it's only the provider's progress notes available to patients (excluding test results, etc.)? If not, why are we not getting any specific training around this change?

There's not really any change to nursing practice involved, it's the same information patients have always had access to, which includes nursing documentation and notes, the only change is that there's less delay and hassle involved in accessing your own medical information.

[2BS Nurse, BSN]

6 minutes ago, MunoRN said:

There's not really any change to nursing practice involved, it's the same information patients have always had access to, which includes nursing documentation and notes, the only change is that there's less delay and hassle involved in accessing your own medical information.

I guess what I'm asking is... will patients be able to login to their online portals and see nursing notes? Currently, I can only see my own PCP's progress note in my own portal. What about telephone encounters that are documented? Will everything be dumped into the portal?