Reviewing Patient EMR After Transfer

[PacoUSA, BSN, RN]

My colleague and I are having a debate: A nurse reviews their former patient's EMR a day after the patient is transferred to a higher level of care, with the intention of knowing how the patient is doing. I argue that this is a HIPAA violation since you as a nurse are no longer the direct caregiver at that moment, while colleague argues it is ok since there is continuum of care within the same admission. Who is right?

Sent from my iPad using allnurses.com

[Pepper The Cat, BSN, RN]

You are. I know the laws are a little different between Canada and the US, but I know first hand of a similar situation. During the SARS epidemic a nurse I worked with went into a pts chart she had seen in ER to see how she was doing. She was reprimanded and nearly lost her job.

[JustBeachyNurse, LPN]

My colleague and I are having a debate: A nurse reviews their former patient's EMR a day after the patient is transferred to a higher level of care with the intention of knowing how the patient is doing. I argue that this is a HIPAA violation since you as a nurse are no longer the direct caregiver at that moment, while colleague argues it is ok since there is continuum of care within the same admission. Who is right? Sent from my iPad using allnurses.com[/quote']

You are correct in most facilities. If the patient was being transferred back to your floor it would be a continuum of care but since that is not the case the nurse has no right to fulfill her curiosity about patient condition. The most we would do is check patient condition in the semi-public data base by checking with the information desk that included inpatient or discharge, good, stable, guarded, critical, etc and sometimes the unit (ICU, med-surg, post ICU). Sometimes patients chose to not be listed and our only source of update was if patient or family came back to update.

Humans are curious but following through on such an action when not actively caring for a patient can result in sanctions, loss of job, and monetary fines.

I believe this is specifically addressed in the HIPAA FAQ online but can't link from phone.

[iluvivt, BSN, RN]

That is not a valid reason to be in the patient's chart just beause you are curious. Now if you forgot to chart something or are doing an audit or are asked to check on something or need some information to write up an incident or unusual occurrence report that would be OK. Even then I make a quick notation of why I am in the chart.

[nurseprnRN, BSN, RN]

You shouldn't even be asking family members, because you are not involved c care of this patient any more. You are correct.

[JustBeachyNurse, LPN]

I meant if family stops by unit and spontaneously says "thanks for taking such good care of Jim Bob. He's going home today!" We would say thanks for the update. It was rare but nice to know care was noticed.

[dudette10, MSN, RN]

You shouldn't even be asking family members, because you are not involved c care of this patient any more. You are correct.

I often see family members of patients I've cared for in the same week, but I'm not assigned to that day. I often ask, "How is she/he doing?" if I developed a good rapport with the family when the patient was mine. I don't think it's a violation of HIPAA in any way. I NEVER reenter the chart, but I do ask the family.

[imintrouble, BSN, RN]

I've done exactly what the OP describes. I've looked at a chart of a pt that was transferred. I considered it might be a HIPAA violation, but ignored it.

I won't do it again.

[psu_213, BSN, RN]

Plus if said nurse does want to learn from the situation, there are avenues to go about this. For example, a pt is slowly going downhill during the shift. Near the end of the shift, the nurse calls an RRT and the pt is transferred to the ICU. The nurse wants to know what he/she could have done differently, if anything, during the shift to prevent the RRT/transfer. In this case the nurse should go to the unit educator who can audit the chart and share certain information with that nurse. The nurse, however, has no "right" to go into the chart on his/her own, even if that nurse has the best of intentions.