Sharing students' medical info with teachers

mr.brice · Mar 19, 2010

At my school (school of 300, K~12),the parents must call the secretary in the main office for all absences.

Then the secretary posts via email "School Bulletin" every morning to all teachers and staff with announcements and today's school attendance. I've asked the secretary to only tell me the reason why these students are absent.

The teachers often come to me and request to post the reason why these students are sick. Especially during H1N1 outbreak. They said they want to know the details and see who got the diseases.

Personally I don't trust the teachers with student info.

so I don't tell them unless they come see me in my office or ask me by email

about their students. I beleive that teachers who care about their students will

have the initiative to come ask me personally.

What do you all think? Do you think I should go ahead and post it on the School Bulletin who are sick with what?

This is kind of how our school bulletin attendance section looks like:

Attendance: (E= excused absence, U=unexcused absence)

K: (Last name) (First name): (E) family reason

(Last name) (First name): (E) ill

G7: (Last name) (First name): (E) hospitalized (will be gone for a week)

G12: (Last Name) (First name): (U) late

BabyLady, BSN, RN · Mar 19, 2010

Unless it is something that impacts your position as a nursing student, such as, something highly contagious....then it is no business of your instructors...unless it is something that you should not be working around patients with as a student.

You have the same right to privacy as any other patient...absolutely no different.

The school nurse has the SAME obligation to protect students under HIPAA as any other RN in the hospital or physician's office.

bergren · Mar 19, 2010

It is OK to have who is absent, and excused / unexcused, as long as the specific illness is not shared. It would not be OK to put "hospitalized" on a email to the entire staff. It would be a FERPA violation.

hobiehobie · Apr 13, 2010

I have a question and think I know the answer.

I have an issue with teachers and secretaries taking phone calls and notes from home, and emailing the "team" with specific diagnoses and lab results. Sometimes I am not copied on the email, I get it because I am bc. To much info for the "team"?

nursecolley, ASN, BSN, MSN, RN, EMT-P · Apr 13, 2010

Any information that the parents wish to disclose is up to them. Repeating the information to others is a breach of confidentiality. However, any medical conditions, including lab reports, etc. should not be shared with "the team". This is a FERPA violation. The information is only shared on a "need to know" basis. You may want to contact the family and ask that any correspondence might for you arrive in a sealed envelope with your name on it, or they can call the school and ask for you specifically.

Martha, correct me if I'm wrong.

bergren · Apr 15, 2010

hobiehobie - tried to reply the other day and my connection was not working....,

"...telling the team diagnoses / lab results"

That would be your job on the team. Only you as the only health professional would be able to judge what the teachers and staff need to know to provide appropriate accomodations and to keep the child safe. Does the parent know and condone the information being forwarded?

Education professionals should keep medical diagnoses and treatments as confidential as standardized tests and who is on free and reduced lunch. Most of the schools I worked in, the teachers and staff consider that information FAR more confidential than personal health information. (??!!??!)

You cannot keep a parent or child from sharing their own information, but before sharing the detail with the team, I would encourage the staff and teachers to check with you first. If they are reluctant to do that, they should at least contact the parent and ask if they should share it with the team. Teachers and staff most definitely should not assume the information should be shared with anyone except who the information was sent to.

Plus, check your district's policy for sending sensitive information via email. The last district I worked in knew its email system was not secure and barred sharing any sensitive information via email. Other districts have very secure systems and sending information electronically is not risky.

Again, highly recommend this publication about student health privacy:

Schwab, N. C., Rubin, M., Maire, J. A., Gelfman, M. H. B, Bergren, M. D., Mazyck, D. & Hine, B. (2005). Protecting and sharing student health information: Guidelines for developing school district policies and procedures. Kent, OH: ASHA. http://www.nasn.org

mmm333, LVN · Mar 7, 2011

I think that it is important that one get their principal and teachers trained and education on FERPA & HIPAA. Someday you are going to get a kid who is HIV+ or has herpes and takes acyclovir daily, or a child with a bona fide behavioral disorder & the meds for that. You are going to want a compliant system and staff from the moment that kid walks into your school. It will be too late to start changing things ad hoc. You've got to protect your patients from other kids and also the teacher's lounge gossip.

Education professionals are used to being in complete control of the school, and in many respects it is their job to do so. But one must clarify roles and give out information on a "need to know" basis or give out useful but "scrubbed" or "vague" information that is actionable without being overly explicit. No teacher needs lab values, they are not qualified to read lab values. One should stay current enough on both HIPAA & FERPA to field any and all questions from staff about them and so that you can run a compliant health program. There are CE units on privacy and possibly on FERPA itself.

shellfrmmo, ASN, BSN, MSN, CNA, LPN, LVN, RN · Apr 20, 2011

Since we are nurses, confidentiality is assumed " that the information shared with us will not be shared outside that relationship".
Unless the principal is your sub, or the secretary is your sub, they should not have access to this information without going through you. Students will not come to your office if they know these individuals have full access to the raw health information in the record. Make sure that the secretary and principal if they are your subs have the full FERPA /HIPAA training re confidentiality.
The guidance counselors should not have access to raw health records data. There are times when sharing some information with them is appropriate, but it would never be appropriate for them to have access to the record.
Do you have audit capability? Can you tell how has been in the records and what files they have opened?
Schwab, N. C., Rubin, M., Maire, J. A., Gelfman, M. H. B, Bergren, M. D., Mazyck, D. & Hine, B. (2005). Protecting and sharing student health information: Guidelines for developing school district policies and procedures. Kent, OH: ASHA. https://nasn.networkats.com/members_online/members/viewitem.asp?item=S009&catalog=MAN&pn=1&af=NASN

I am having this same concern. Do you know where there is any documentation that supports not giving the counselors free reign to our records? Afterall, we can't see their records.