Sharing students' medical info with teachers

bergren · Jan 28, 2006

Are you in a public school?

If yes, you are covered by FERPA, not HIPAA. FERPA allows you to share information with anyone in the school who has a "legitimate educational interest" in the child, but only the amount of information needed to provide a safe environment and those aspects that affect learning. FERPA allows you to do this, but does not obligate you to share and many districts ask the parents to sign an authorization to release information internally. The Pediatrician is asking because if affects their ability to share information with you. You should be using a HIPAA Compliant release form to get information form any HIPAA covered entity and many providers are reluctant to share information with schools as the level of security and confidentiality in some schools is far below HIPAA standards, and often far below FERPA standards. HIPAA was modeled after FERPA, but many who handle sensitive information in schools never heard of FERPA until HIPAA came along. They are very similar laws.

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.ashaweb.org

Bergren, M. D. (2004). Privacy questions from practicing school nurses. Journal of School Nursing, 20, 296 - 301

Bergren, M. D. (2004). HIPAA - FERPA revisited. Journal of School Nursing, 20(2), 107 - 112.

Bergren, M. D. (2003). National Conference on HIPAA Privacy Rule, NASNewsletter, 18 (4), 20 - 22.

Bergren, M. D. (2001). HIPAA hoopla? Journal of School Nursing, 17, 336 - 340.

Bergren, M. D. (2001). The facts about faxing. Journal of School Nursing, 17, 274 - 275.

Bergren, M. D. (2001). The facts about email. Journal of School Nursing, 17, 210 - 212.

National Forum on Education Statistics. (2004). Forum Guide to Protecting the Privacy of Student Information: State and Local Education Agencies, NCES 2004-330. Washington, DC: National Center for Education Statistics http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2004330 (FREE)

Schwab, N. & Pohlman, K. J. (2004). Records: The Achilles heel of school nurses. Answers to some bothersome questions. Journal of School Nursing, 20, 236 - 241.

Schwab, N. (2003). School nurses role in education privacy standards for student health records. National Association of School Nurses, http://www.nasn.org

lcprnc · Jan 28, 2006

Hi Bergren,

No, I am not in Public School. I am actually a Nurse Educator at a local community hospital and am also the CME coordinator for the medical staff. One of our pediatricians asked me to research the issue so I thought I'd ask here first. After I posted last night, I did a little "google" research and found the links and explanations regarding FERPA - of which I didn't know about. Wow! You have certainly given me lots of information! I am also learning a great deal, not only sharing info with the teachers but also bus drivers, coaches, etc. I will retrieve the journal articles that you cited (and wrote). Thank you very much!

LCP

Jeanine · Feb 8, 2006

We have a release on every student, signed by the parent. I got about 98%"yes" responses, one or two limiting the information to share, and a few that downright said "no". The release encompasses the school career in our town. The releases are in a binder, by grade, and get passed from school to school. It is part of the papers parents complete when a new student transfers into district as well.

Home Health Columnist / Guide · Mar 25, 2006

powerpoint: privacy standards for student health records

privacy in education

state-by-state confidentiality

chrissy51 · Nov 19, 2006

As a school nurse in a miloitary community , sharing of information is a real bugbear as we are covered by the Nurses Act but come under military law too

In terms of child protection , the military unit , a named individual within the school , the GP and social worker are part of the child protection plan and I admit I find that uncomfortable . In the UK your employer would not be informed if you had Child Protection plan in place

In schools we try to persuade parents to share the information on medical matters , purely as a matter of safety so that we can go in and train teachers on the condition and how to deal with an emergency . We have care plans for all children with long term serious illnesses and allergies These are signed off by parent , health and school and each keeps a copy They are updated every 6 months or sooner if a change in condition occurs

We do have a drop in in the high school Again where necessary we would obtain the clients permissiion to share ( unless it is a CP issue )

At the end of the day , if your child has a serious illness and you refuse to share with teachers ( albeit designated ones ) , if something goes horribly wrong you cannot sue the school for lack of care - that is the fact I tell all parents if they refuse to co-operrate

I have to say it rarely happens in serious cases and the fact that Johnny still wets the bed at 14 is of no concern at school unless thy go on a residential so I would then have a chat with Johnny - suggest he sees our paediatrician for medication and give him some tips re drinking etc and let him choose Does he want the lead teacher to know ( just in case) Can he have a separate room ? There are ways round most things if you get cooperation .

bergren · Dec 21, 2008

New FERPA Privacy update from US Department of Education:

http://www.ed.gov/policy/gen/guid/fpco/hottopics/ht12-17-08.html

hickjoe · Sep 2, 2009

While it is OK to share general information with teachers to enable them to do their job more effectively, I would always speak with the parents before sharing specific information in order to have the parents on board - even if your district has a general consent form that parents sign at the beginning of the school year. This will enable you to have an opportunity to speak with the parents and explain the importance of the teachers having possibly life-saving information about their child. You can avoid having to share a lot of specific information if you have pre-prepared information sheets about certain conditions and/or emergency situations that you can give to the teachers at the beginning of the school year. Another good way to educate the teaching staff is to provide informational sessions 3-4 times a year or more, depending on your availability, about certain conditions that may or not affect kids in their classroom. With HIPPA in place you cannot simply open up your personal professional files to anyone who asks - even administration. So go carefully with what you share. Working in a school is no different that working in a hospital or any other medical/nursing facility when it comes to information and nursing files.

MelissaJaneRN · Oct 11, 2009

Agreed with everything stated- my two cents- Teachers collect the emergency cards at the beginning of the year which have a space provided for parents to write in medical issues. I know this only applies to the classroom teacher and for parents who fill in that space. But anyway, just saying that teachers get this info often before the nurse does!

Maine17 · Oct 19, 2009

This is kind of a followup question -something that has been bothering me. My school district (and many others) use a medical record system where the nurses log in each student visit. My concern is this system allows the principal, his secretary and the guidance counselors all access to this log when they pull up the student. I feel this is a breech of confidentiality-what do you think? Thanks.

bergren · Oct 20, 2009

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

Maine17 · Oct 21, 2009

We have no audit ability or any way to know who is looking at our logs. The rationale the district uses to allow our logs to be read by the principal/secretary is that the principal needs to be aware of what is going on in their school, esp. if there is not a nurse in the building. Four of our schools have full time nurses and two have half-time nurses. We keep our principals up to date on all serious situations. Rarely does a school not have a nurse in the building or availble if needed.