violating HIPAA?

jadelpn, LPN, EMT-B · Apr 24, 2015

The medical record number is perhaps what is needed to set up the tele--and to be sure it is the right patient, right record, right whatever.

I also would think there's some sort of billing issue too--for instance, if PMH suggests that patient has a cardiac history, they can bill insurance accordingly as opposed to a patient being on tele for no other reason than to satisfy a policy. So they need to have as much information as they can for billing purposes.

Make sure if you are sending this information, there is a cover sheet with a confidentiality clause on it. Otherwise, it is all about the billing.

KelRN215, BSN, RN · Apr 24, 2015

No, it's not a HIPAA violation. The people who work in the telemetry department are bound by HIPAA as well, so they can't share this information with anyone and the information is relevant to why the patient may be placed on telemetry.

Home Health Columnist / Guide · Apr 24, 2015

Make sure if you are sending this information, there is a cover sheet with a confidentiality clause on it.

If telemetry techs are expected to be monitoring the patients, then they should know little more info about the patient. It is NOT HIPAA violation as considered part of the job.

Use caution when transporting patients too: Make sure the nursing hand off report (which includes PMH, medical record number, labs, vital signs) has a coversheet on top or at least blank piece of a paper so if other family members with patient they aren't privy to info. One of our hospitals had HIPAA privacy breach charge as face sheet face up and FAMILY member complained as patient didn't want some of info shared.

michlynn, BSN, RN · Apr 24, 2015

The medical record number is perhaps what is needed to set up the tele--and to be sure it is the right patient, right record, right whatever.
I also would think there's some sort of billing issue too--for instance, if PMH suggests that patient has a cardiac history, they can bill insurance accordingly as opposed to a patient being on tele for no other reason than to satisfy a policy. So they need to have as much information as they can for billing purposes.
Make sure if you are sending this information, there is a cover sheet with a confidentiality clause on it. Otherwise, it is all about the billing.

It has nothing to do with billing and they don't have to put the MRN in the system whenever they program the patient into the monitor. Really all they need over there is a name and a room number so I feel like we're giving them more info than they need to know.

MrChicagoRN, RN · Apr 25, 2015

It has nothing to do with billing and they don't have to put the MRN in the system whenever they program the patient into the monitor. Really all they need over there is a name and a room number so I feel like we're giving them more info than they need to know.

A room number is never a valid patient identifier.

It could be fatal if they misidentified and monitored the wrong patient

michlynn, BSN, RN · Apr 25, 2015

A room number is never a valid patient identifier.
It could be fatal if they misidentified and monitored the wrong patient

Yes I understand what you are saying but I'm not sure if everyone is getting what I'm saying... The patients are not identified through tele based off of their MRN they are only in the tele system by name. Th new policy is only changing the form that we fax from the floor to tele which is why I'm saying we are giving them more info about the pt than they really need to know. The info that we are giving them is not relevant to what is on the tele monitor other than a name and a room #.

Anonymous865 · Apr 25, 2015

Yes I understand what you are saying but I'm not sure if everyone is getting what I'm saying... The patients are not identified through tele based off of their MRN they are only in the tele system by name. Th new policy is only changing the form that we fax from the floor to tele which is why I'm saying we are giving them more info about the pt than they really need to know. The info that we are giving them is not relevant to what is on the tele monitor other than a name and a room #.

I think you have a valid concern. A central aspect of the HIPAA rule is the the principle of "minimum necessary." The information available to a health care worker must be limited to the minimum that is necessary for the HCW to do their job.

If telemetry was able to perform their job in the past w/o the PMH, labs, vitals, etc., then what has changed now? Why do they now need this information to do their job when they didn't need this information last month? If they do not need this information in order for them to do their job, then it is a HIPAA violation for them to have this information.

Refer to this summary from the Office of Civil Rights (the federal agency responsible for enforcing the HIPAA regulations.) Look at the section on Limiting Uses and Disclosures to the Minimum Necessary

Summary of the HIPAA Privacy Rule

Seaofclouds, BSN, RN · Apr 25, 2015

Yes I understand what you are saying but I'm not sure if everyone is getting what I'm saying... The patients are not identified through tele based off of their MRN they are only in the tele system by name. Th new policy is only changing the form that we fax from the floor to tele which is why I'm saying we are giving them more info about the pt than they really need to know. The info that we are giving them is not relevant to what is on the tele monitor other than a name and a room #.

I strongly disagree that those things aren't important for the people watching the monitor to know. Knowing a patient has a PMH of Afib is necessary information. Electrolyte imbalances can cause major dysrhythmias, so getting that information could signal that they need to pay closer attention to that patient.

I do understand your concern over the sudden change and you could ask why the change came about. At the same time, I can see why the additional information is helpful to the telemetry techs. At my work, we even tell our telemetry techs about medications we are giving the patients that can cause rhythm changes. It's all about having the person watching the monitor be fully informed and knowing what to watch out for. If that's not the reason for the change at your work, you could discuss the need for minimally sharing information with your management or corporate compliance/risk management team.

michlynn, BSN, RN · Apr 25, 2015

I strongly disagree that those things aren't important for the people watching the monitor to know. Knowing a patient has a PMH of Afib is necessary information. Electrolyte imbalances can cause major dysrhythmias, so getting that information could signal that they need to pay closer attention to that patient.
I do understand your concern over the sudden change and you could ask why the change came about. At the same time, I can see why the additional information is helpful to the telemetry techs. At my work, we even tell our telemetry techs about medications we are giving the patients that can cause rhythm changes. It's all about having the person watching the monitor be fully informed and knowing what to watch out for. If that's not the reason for the change at your work, you could discuss the need for minimally sharing information with your management or corporate compliance/risk management team.

I'm not disagreeing with you in that sense at all, we always tell our techs the reason the doc ordered tele and if they are on certain anti arrhythmic meds but, once again, the reason for the change in the form was not so the techs had more info about the patient but was only done so that every floor was submitting the same paperwork. I'm well aware of the why the change happened and it was not for the reasons you are suggesting. I, as well as multiple other employees, have emailed management with concerns, I just thought I would see what other nurses thoughts were on the topic.

Seaofclouds, BSN, RN · Apr 25, 2015

Is there any reason they didn't have the other floors switch to the form you were previously using? I'm just curious and trying to figure out what they were hoping to accomplish if this really wasn't done to provide the specific information to the tele staff.

michlynn, BSN, RN · Apr 25, 2015

Is there any reason they didn't have the other floors switch to the form you were previously using? I'm just curious and trying to figure out what they were hoping to accomplish if this really wasn't done to provide the specific information to the tele staff.

I think they were just aiming for consistency amongst the floors. On my floor all of the pt's have monitors and we've never had an issue with the forms that we fax over so I'm not sure why they just didn't make everyone else use ours. I know other floors have had some issues regarding pt's being transferred to other floors and tele not being aware of it which is what I think prompted this "change" which is why I think there's other forms that we could use that don't involve such a great deal of pt info.