Who am I, the HIPPA police?

[ICRN2008]

"Protecting private health information is not just good practice, it is the law!"

I heard this slogan during one of my many HIPPA trainings, and I really took it to heart. Apparently, some of my co-workers did not. As some of you know, I am a medical technologist. In my position, I have access to laboratory results for patients throughout our entire health system. I was working alone in the lab today, and one of my co-workers put me in a very compromising position. Here is my story; please hang in there because it is long...

A nurse called me while I was busy (getting platelets ready for HER patient) and asked me to look up some labs. I told her I was busy at the moment and would call her back; I assumed the results were for one of her patients and related to that patient's care.

When I called her back and asked for the medical record number, she said she didn't have it and proceeded to give me HER OWN NAME. She said "the nurse practitioner and I have been trying to look up the results and we can't find them in the computer". I told her that I could not give the results to her, nor could I release them to the nurse practitioner because the NP was not the ordering provider and was not directly involved in that nurse's (patient's) care. She snapped back "Well then, who do I have to ask, God?" and proceeded to give me attitude in general. I calmly told her that if she was interested in her lab results, she would have to fill out a request and submit it to the medical records department or call her physician's office on Monday.

About an hour later, I received a call from the ED physician. He requested the lab results on a patient, and proceeded to give me the SAME NURSE'S NAME. I didn't realize it until we hung up because I was involved in other tasks, but when I did figure out what was going on I immediately called him back and told him that since he was not the ordering physician he could not have access to those results (this is the policy of our laboratory). He stated that this nurse was now under his care as his patient. I had a strong feeling that he was lying to me because the nurse had not been admitted as a patient to our hospital, but I could not prove that he wasn't telling me the truth. At this point, with this being a gray area and the physician obviously being a lot higher than me on the power ladder, I gave in. I printed a copy of the results and sent it to him. I also made a note in the computer that I had done so in case I am questioned in the future.

How dare this nurse put me in such a compromising position! It makes me absolutely furious when people expect me to break the rules for them just because they are employees of the hospital!!!!! The thing that upsets me the most is that they are asking me to RISK MY JOB and sometimes VIOLATE THE LAW because they can't be inconvenienced to follow proper channels.:angryfire

There was another circumstance a few months ago when the charge nurse from the ED brought in a throat swab from her SON and requested that we run a rapid strep "off the books". This is absolutely a violation of laboratory policy, not to mention ethical standards. Why should she receive a free test just because she works here? And for her family member, no less! I told my co-worker that he should not make promises like this in the future, and if he did to make sure not to involve me. My co-workers have run numerous free pregnancy tests for their "friends" (fellow employees) on the floors.

Just to make sure I am absolutely clear, I am not bashing nurses (obviously, since I am in nursing school myself). The physician deserves equal responsibility in this incident. So please do not flame me as singling out nurses. I am in fact criticizing all health care workers who violate policys and laws.

We as members of the health care team should be above reproach. This means following proper procedures when accessing private medical records, obtaining a valid order for all tests run in the laboratory, and paying for all of the care we receive. How can we expect our patients to respect us if we do not hold ourselves to high ethical standards?

I am not looking for a debate, just a bit of support. Thanks for listening :)

[JVanRN]

Bottom line is that there is an accepted procedure for her getting her own results, and calling and harassing the lab tech ain't it. She's taking advantage of the fact that she works there to circumvent that procedure that anyone else would have to go through. And she's putting the lab tech in the middle of it.

I'll willing to bet that no one would release the results to anyone else that happened to call that wasn't a nurse or staff member. We really don't have privileges above and beyond the man on the street. That nurse could get fired under the policies and procedures that I am certain her facility has in place.

I agree here. I don't think the OP was violating HIPAA, but she could have been in danger of violating hospital policy by directly releasing results to the nurse herself. If a non-hospital employee patient wanted lab results released to them, we as nurses/lab techs/whatever can not just directly release them to the patient. Usually there are channels they must go through for that. This nurse was obviously taking advantage of the fact that she works there.

Dumb as it may seem. Yes, they were the nurses own results, and she does have a right to them. But to put another person on the spot like that isn't right either. I can see where the nurse is coming from and I can see where the OP is coming from. I don't think the OP should worry so much about a HIPPA violation but maybe more of a violation of hospital policy.

All that said. Have I looked up my own lab results on the hospital computer? Yep, all the time. Have I ever asked someone to run results for me "off the record"? No, I'm not ballsy enough to do that, but I have seen it done. I don't agree with that, but who am I to say. I don't think the nurse was wrong for wanting her own test results and even asking directly for them, but if the OP was uncomfortable with it, she should not have pressured her.

[ICRN2008, BSN, RN]

I agree that I should read the legislation myself to have a better understanding of what it truly says. Unfortunately, if I interpret the law in a manner inconsistent with my employer's policies and procedures, they still have the right to terminate me.

There are certainly instances where people are denied information that legitimately belongs to them. However, the organization has a right to protect itself from litigation, and if this means they must adopt a very narrow interpretation of the law then so be it. They require that people make requests for test results in writing to the ordering physician or the medical records department for a reason; they want a paper trail in place in case they are ever challenged with a lawsuit in the future. For instance, let's say that I worked as a nurse in a large hospital and called down to the lab from the unit to request results. Only they weren't my results; they were for a co-worker. The tech answering the phone does not know every nurse's voice, and takes this nurse (#2) at her word that she is who she says she is (nurse #1). The results are released, and pretty soon the whole department knows about nurse #1's lab results.

Although the lab has access to results from across the health system, it is not our job to give them out on any patient except those currently admitted to our facility, and then only to licensed caregivers. I think that this is a reasonable policy considering how much money the facility could lose if faced with a lawsuit for inadvertent breaches of privacy.

[Gompers, BSN, RN]

I agree that I should read the legislation myself to have a better understanding of what it truly says. Unfortunately, if I interpret the law in a manner inconsistent with my employer's policies and procedures, they still have the right to terminate me.

There are certainly instances where people are denied information that legitimately belongs to them. However, the organization has a right to protect itself from litigation, and if this means they must adopt a very narrow interpretation of the law then so be it. They require that people make requests for test results in writing to the ordering physician or the medical records department for a reason; they want a paper trail in place in case they are ever challenged with a lawsuit in the future. For instance, let's say that I worked as a nurse in a large hospital and called down to the lab from the unit to request results. Only they weren't my results; they were for a co-worker. The tech answering the phone does not know every nurse's voice, and takes this nurse (#2) at her word that she is who she says she is (nurse #1). The results are released, and pretty soon the whole department knows about nurse #1's lab results.

Although the lab has access to results from across the health system, it is not our job to give them out on any patient except those currently admitted to our facility, and then only to licensed caregivers. I think that this is a reasonable policy considering how much money the facility could lose if faced with a lawsuit for inadvertent breaches of privacy.

Most of us have agreed that it was wrong for the nurse to put you in that situation. If she is unable to access the computer to get her own results, then she needs to have her doc give her the information.

However, if she looks up her own results (not involving anyone but herself, using her own computer codes, etc.) then I don't think that's a HIPAA violation. It might be against hospital policy, but it's not HIPAA because it's not violating her privacy.

I know that when I've had labwork done, I've told my doc, "I'll just look up the results next time I work" and I've never been told that I shouldn't. I've just been told, "Okay, but let's set up an appointment or at least a phone call to DISCUSS the results after you see them."

[Balder_LPN, LPN]

I have been working with HIPAA since 1997, far longer than most people in healthcare. HIPAA does not prevent a covered entity (you in this case) from disclosing information to an authorized individual (the pt is authorized thier own info)

One of the biggest problems with HIPAA is that it is so complicated it is hard for anyone to complety understand. Add to that the fact of most covered entities (providers) receiving no more than 3hrs training on HIPAA, leaves things ripe for this type of misunderstanding and headaches and problems for us and PT's too.

Of course I am not addressing your facilities policies, only in respect to HIPAA

[DaFreak71]

Breaking a hospital policy does not automatically mean that you are violating HIPPA. But violating HIPPA most likely breaks hospital policy. There's a difference.

I cannot imagine how it would violate HIPPA to give out test results to the patient. The whole intent of HIPPA is to protect privacy, surely a patient does not have to be protected against knowing their own results. That is absurd.

As far as suspecting the DR of lying just so that the test results could be released, who cares? Who is going to complain? The nurse who got her own results? No. The DR who said what he said so that the results could be released? No. In this case I think that instead of truly analyzing the situation, you stuck to the beaurocratic rules like a drowning man clings to a life raft. Rules are there for a reason, but it is people who apply them and common sense should rule. I reject the notion that nurses should have to go through a doctor to get their own results. Do we not have enough medical knowledge to effectively take care of dying patients? If so, don't we also have enough medical knowledge to comprehend what a lab result means?

HIPPA's intent is good. The way it is carried out is often times in opposition of that intent. Now we are protecting the patient from even knowing about his own condition? Egads!

Adri

[JVanRN]

This is probably another topic all together, but what do you do in the instance that a patient is admitted in house and they want a print out of labs or other diagnostic tests? I know they tell us as nurses, we are not really supposed to tell the patient unless it's normal. (I'm just going on what I was told...no, I haven't read policy) Since we may not be able to interpret what exactly the abnormality is and it's not really in our scope of practice to interpret test results to patients (I will answer questions about certain tests I'm comfortable with...some BMP results ect..., but I don't want to be bombarded with a bunch of questions I'm not prepared to answer)

They definately have a right to them and I know sometimes doctors can be tied up and not able to give results right then and there. But if your a person anxiously awaiting results to a test, that wait can be hell. This is kind of common in NICU too. A baby will have a head ultrasound and the parents will want to know the results. Many times it may show some sort of abnormality, but it's not really a abnormality that's a huge deal (if that makes sence). I just tell the parents that I either don't have the results or that the test is resulted but that is something the doctor needs to speak with them about. They usually understand, but our doctors are super about keeping parents informed, I know this is not always the case.

[Gompers, BSN, RN]

They definately have a right to them and I know sometimes doctors can be tied up and not able to give results right then and there. But if your a person anxiously awaiting results to a test, that wait can be hell. This is kind of common in NICU too. A baby will have a head ultrasound and the parents will want to know the results. Many times it may show some sort of abnormality, but it's not really a abnormality that's a huge deal (if that makes sence). I just tell the parents that I either don't have the results or that the test is resulted but that is something the doctor needs to speak with them about. They usually understand, but our doctors are super about keeping parents informed, I know this is not always the case.

For "big" stuff like head ultrasounds, ECHOs, chromosome tests, etc. - I'll tell the parents that the test hasn't been read yet and the docs will call them when they have the results. I'll say this even if I was right next to the ultrasound tech and doc and know what the result is - but that kind of thing is the doctor's responsibility, not mine.

Now, if the family wants to know, say, the lastest blood gas or blood count, and they've been there for months and months already and know a little bit about normal ranges - then I'll tell them and explain what it means and what we're doing about it.

Now, if any patient/family wants printed lab results - for that they have to go through medical records. That's part of the chart and needs to be treated as such.

[JVanRN]

Rules are there for a reason, but it is people who apply them and common sense should rule. I reject the notion that nurses should have to go through a doctor to get their own results.

HIPPA's intent is good. The way it is carried out is often times in opposition of that intent. Now we are protecting the patient from even knowing about his own condition? Egads!

Adri

Again I sort of agree here. Common sense should prevail, but I can see where the OP might have been uncomfortable though. I have been asked to look up results for fellow employees (nurses I work with, may have been off or whatever). I've done it, but in the back of my mind it concerned me a little. Not because I was worried about HIPAA ,worried the nurse would report me, or had some sort of guilt weighing on my conscience, but our computer use is tracked. I don't really want my supervisor coming up to me some day wanting to know why I was looking up all these people's lab results. The possibility of that happening aren't great...but it still can. That's really my main problem with looking up co workers results for them. I just try to look up my own and don't really ask people to look up mine.

[rpv_rn]

Playing devil's advocate here:

What one has to be careful of is the reliability of the person calling on the other end. How can the receiver validate that it is truly the nurse calling for her own lab results? The caller could be another nurse, friend or family member who has no legal right to medical information.

[BamaBound2bRN]

I have read many posts by nurses who were bad mouthing docs, technicians, administrators, etc. for not respecting the nurses position and work load. Now we have a support person/Tech. catching grief from a nurse at work trying to intimidate the tech. into breaking policy, and nurses immediately side with the nurse- sorry, but wrong is wrong regardless of who does it. The OP should have stood her ground, and policies are meant to protect all of us, even if they are inconvenient.

[Jolie, BSN]

I agree wholeheartedly with the OP that it was highly inappropriate of the nurse to put her (the lab tech) in the position of violating hospital policy for the sake of the nurse's convenience in obtaining the lab results without having to wait over the weekend.

Why didn't the nurse call her doctor's answering service and berate them into contacting the doctor for the results? Because it wouldn't have worked, that's why! So, because whe knew that she couldn't bully the doctor into providing the results sooner, she chose to bully her colleague, the lab tech. How inapropriate! Not to mention that she pulled the tech away from important duties for her own convenience. That could have jeopardized patient safety.

In the future, should a situation like this come up again, I would simply state, "I don't believe that hospital policy allows me to provide that information. I'll contact my supervisor to clarify, and ask him/her to call you back."

[ICRN2008, BSN, RN]

I agree wholeheartedly with the OP that it was highly inappropriate of the nurse to put her (the lab tech) in the position of violating hospital policy for the sake of the nurse's convenience in obtaining the lab results without having to wait over the weekend.

Why didn't the nurse call her doctor's answering service and berate them into contacting the doctor for the results? Because it wouldn't have worked, that's why! So, because whe knew that she couldn't bully the doctor into providing the results sooner, she chose to bully her colleague, the lab tech. How inapropriate! Not to mention that she pulled the tech away from important duties for her own convenience. That could have jeopardized patient safety.

In the future, should a situation like this come up again, I would simply state, "I don't believe that hospital policy allows me to provide that information. I'll contact my supervisor to clarify, and ask him/her to call you back."

Thanks for your support. Actually, I was unable to reach my supervisor yesterday because he was out of town. I spoke with him late this morning, and he agreed that I had absolutely done the right thing and would have faced disciplinary action if I had released the result to the nurse. He also stated that he thought it was a HIPAA violation. He said that I pretty much had no choice but to release the results to the ED physician, even if I suspected that what was happening was not on the up and up. My supervisor asked me to write up the incident and he will be forwarding it to HR and risk management on Monday. The medical director will also be notified and he will determine whether the ED physician violated any hospital policies (because the nurse was not an admitted patient at our facility and was not charged for the physician's services).