So what is a Hipaa violation, anyway?

loriangel14, RN · Nov 23, 2012

Your first example would be ok but the second one has enough information that someone could know who you meant.It also depends on where you are when you are doing the talking.You never know who will overhear your conversation.

lulain · Nov 23, 2012

Thanks for the response!

I still don't really know why the 2nd example would be okay, and the first one wouldn't. If it's a small enough town, couldn't you say, "I had a patient who came in with an earache..." and someone might know who you 'mean'? I thought there had to be some solidly identifying information?

Also, can you mention a specific drug(s) a patient is taking, or is that identifying? Just want to make sure I have it right.

mariebailey, MSN, RN · Nov 24, 2012

I think disclosing the minimum amount of info necessary (i.e., leave out patient identifiers) to get your point across is ideal:

“Hallway conversations. Talking about patient information in public places is problematic. Although HIPAA does not address this problem specifically, its privacy principles reinforce the professional commitment to use care in such situations to avoid unintentional disclosure of information. Talking in elevators, discussing a case over lunch, discussing a difficult situation with friends over dinner — all of these situations raise the possibility that a client’s protected health information will be revealed inappropriately. Certainly, professionals may discuss, and should discuss, difficult situations in a healthy atmosphere of learning and problem solving. Again, the “minimum necessary” rule will help to guide these discussions. Remembering to delete identifying information when possible, exchanging only enough information to further the discussion, and holding such conversations away from busy public places will improve the ability to protect patient confidentiality.” HIPAA and Confidentiality | CE513 > Page 2

akulahawkRN, ADN, RN, EMT-P · Nov 24, 2012

It is a HIPAA violation to discuss or disclose enough information about patient that another person not related to their care would be able to figure out who it was. The 2nd example, the patient with an amputated thumb, who works at the sawmill, would probably be identifiable if there was only one sawmill in the town. The 1st example patient would probably not be specifically identifiable by the minimal amount of information released.

Incidental disclosure of that kind of information would probably be allowable if you are using that particular case as a teaching tool, and scrubbed as much information as possible out without compromising the usefulness of the case for teaching purposes. However, step should be taken to minimize the possibility that protected health information does not get out somehow.

On the other hand, if a lot of patients had their thumbs amputated and they all work at the sawmill, I would suspect that the 2nd example patient would be perfectly fine as it would be no longer very easy to determine which person that was that had their thumb amputated who worked at a sawmill.

In short, basically what you want to do is simply make sure that whatever you're talking about a patient that you do it in his private location as possible and that any information released would not allow the patient to be identified specifically, which includes telling the story about how they got sick or injured. Sometimes patient information is already in the public domain, that does not however, authorize indiscriminate release of protected health information. Even in very public cases, HIPAA violations can still occur.

loriangel14, RN · Nov 25, 2012

Thanks for the response!
I still don't really know why the 2nd example would be okay, and the first one wouldn't. If it's a small enough town, couldn't you say, "I had a patient who came in with an earache..." and someone might know who you 'mean'? I thought there had to be some solidly identifying information?
Also, can you mention a specific drug(s) a patient is taking, or is that identifying? Just want to make sure I have it right.

You got it backwards. I said the first one would be fine but the second one has too much indentifying info. Even the first one could be questionable if you were in a smalll town ( like me).

I just don't talk about my patients outside of work except at my sisters house ( we work at the same hospital).

rn_abbey · Jan 7, 2013

As someone who has similar feelings to the OP, this thread has been very helpful, thank you!

1MiMi1 · Feb 21, 2014

how about discussing the days work with a friend in a restaurant including some description about the patient but using no names.(tho bad idea I know) this is a fairly large town. the nurse works in a many different facilities as she's an agency nurse. violation and how bad?

elkpark · Feb 21, 2014

how about discussing the days work with a friend in a restaurant including some description about the patient but using no names.(tho bad idea I know) this is a fairly large town. the nurse works in a many different facilities as she's an agency nurse. violation and how bad?

Even in a fairly large town, you just never know who is at the next table in a restaurant, standing behind you at coffee hour at church, etc. If you share enough information that someone else who knew the person would be able to figure out who you were talking about, that's a violation.

The best rule of thumb is just to not talk about work outside of work.

IrishErin · Feb 21, 2014

Even in a fairly large town, you just never know who is at the next table in a restaurant, standing behind you at coffee hour at church, etc. If you share enough information that someone else who knew the person would be able to figure out who you were talking about, that's a violation.
The best rule of thumb is just to not talk about work outside of work.

This is true! Two girls that were in my class happened to be having a coffee/study date on their day off from clinical and school. They went to a local coffee shop to meet up and while in line to order a drink they began to discuss their clinical experience from the previous day. They were both doing a mental health rotation at a local hospital and were talking about the patients they had, and what their diagnosis were.

Little did they realise, the charge nurse from that particular unit was standing a couple of people behind them in line and really didn't like what they had to say. The nurse complained to the program coordinator about the two students and they were removed from the program!

You never know who might be listening, and even when you give little information it might just be enough for someone to recognize.

nurseprnRN, BSN, RN · Feb 21, 2014

Stickies used to be listed at the bottom of the forums,but now you have to go looking for them. This is the answer you seek:

https://allnurses.com/hipaa-nursing-challenges/answer-hipaa-violation-693686.html

kakamegamama · Feb 24, 2014

I remember the time on an elevator at work in which a couple of nurses were discussing a patient from my floor who died during a procedure (I was not one of them---they were from the procedure room). There were the 3 of us and a male, non-nurse on the elevator. By the time I returned to my floor the male was at the nurses' station making a very loud verbal complaint....the deceased patient was his in-law, and while he knew about the death, he was rightfully upset to overhear the death being discussed on the elevator. I never forgot that and avoided discussing patients anywhere outside of the floor.