HIPPA as it relates to EMS Systems...

November 7, 2008

This is probably an easy question to answer, but I can't seem to find

a clear answer, sooooooooo I am again forwarding this to the only

persons I know of that have the collective knowledge of a paragod..

lol.. Seriously though I need help with this question:

What can and cannot be considered a HIPPA violation as it relates to

patient care reports that have been completed and " turned in. " To

clarify further who exactly is authorized to read a PCR that I wrote

on pt. so and so on say October 2, 2008? I understand that obviously

the QA/QI committee is privy to this information for obvious reasons,

and likely the Director, but who else is covered?

This question was posed to me by a coworker and I hope to give

him/her a definitive answer.

Also, I've recently posted about FDA/DPS/DEA narcotic documentation

and have yet to see an answer. Is this something that cannot be

answered, or is it something that is of no interest. I have made a

couple of postings, but have had very little if any discussion about

them. If I am incorrectly posting, please feel free to let me know.

Also let me say that i appreciate the discussions that are generated

on here, I've learned to look at things from a different perspective

based on some of your replies, and have recently discovered Dr.

Bledsoe's website which has a ton of useful information. As I am

relatively new to EMS (approximately 3 years total), I am slowly

learning that we are pretty much " the bastard children " fortunately

there are people like Dr. Bledsoe and others whose names I can't

recall off the top of my head, who truly care about EMS and

furthermore UNDERSTANDS what we do, the importance of what we do, and

the NECESSITY of what we do, we can all hold our heads high and be

proud of who we are, even if we are underappreciated.

Thank you for any assistance you can provide..

Sr. NREMT-P

November 9, 2008

Hi, . Welcome to the list and to EMS. Since no one else has attempted to

answer your posts, I will address part of it - Gene or Wes or any of the other

lawyers on here can correct me if I am wrong or incomplete - but I will leave

the DEA documentation to someone else. I know what I have always done in my

services or seen done, but I couldn't quote you the exact law to review on that

part.

As for the HIPAA, FIRST basically ANYONE who DOES have a right to know to

continue patient care until the patient is released from care has a right to

read your chart. So anyone working in the hospital, nursing home, rehab center,

whatever who is continuing to care for the patient and needs the information to

continue to care for the patient by knowing " start to now " type things has a

right to read the chart without asking anyone. In your service, the EMS

Director, the QA/QI committee, the billing agent, and the Medical Director have

the right to read your chart without permission. If the oncoming crew is not

doing QA or doesn't need to look at your chart to see what supplies or equipment

you used or anything else, they really don't have a right to read it. However,

they are covered by their HIPAA agreement that should be signed with the service

when they are hired so if it is in the drawer and they read it, they are bound

by the privacy rules. Anyone who walks into that EMS office other than those

listed here are NOT allowed to view the chart even on the computer screen where

you are typing it in, which means steps must be taken to ensure that no

unauthorized person can see the screen while you are typing in the chart, can't

access the part of the computer where charts are stored to view them, can't

easily access an unfirewalled computer from the net to read them,can't see the

chart lying up on the desk, etc etc. Board members for the service should not

generally have access to files or charts because it is not necessary for them to

review them for patient care. However, issues could arise on an individual

basis where a patient may have to be discussed in a Board meeting or

administrative meeting above the Director (such as a patient who is abusing the

system for instance) so Board members should be trained in HIPAA and sign an

agreement for those situations. But they would have to be handled in a private

special session that does NOT include general public in attendance.

A patient generally has a right to see their own records. (However, I read

recently that case law has supported for HOSPITALS that a patient's records do

not belong to THEM but to the hospital. I don't know where that leaves EMS -

Gene or Wes would have to answer that one.) Someone's verified legal guardian

or medical power of attorney person has a right when the patient is too young or

is incompacitated mentally - they serve as the patient would. (Make a copy of

the PROOF that they have that right, such as the parent's drivers license or the

medical power of attorney document.) A patient's lawyer does if they produce a

signed release by the patient. Law enforcement ONLY has access to whatever

information contained in the chart or about the patient when it relates to an

immediate threat to public health or an immediate life-threatening crisis that

could cause someone death or immediate harm if they information is delayed

waiting on a subpoena. Other than that, nothing can be discussed with law

enforcement or judges or other lawyers except under court order or subpoena or

signed patient release specifically stating that purpose.

Now here is where MOST people fall down on the job in my opinion. ANY release

of that chart (except at the receiving facility where you leave the patient or

for standard billing of the run) MUST be documented and kept on file for patient

or legal guardian review upon demand. In other words, if a patient's lawyer has

a release to get a copy of the chart, the release needs to be kept and the

attorney's name and such placed on the list with the date. If the receiving

hospitals' Trauma Coordinator swears she did not get a copy of the chart and

needs a copy, I would place that release on the list. Even if the PATIENT or

his/her legal guardian wants a copy of the chart, put it on the list.

That is all that is popping into my brain yet on a Sunday morning without having

had a full cup of cappucino yet. LOL

Jane Dinsmore

To: texasems-l@...: daniel.murphy@...: Sat, 8 Nov 2008

00:20:01 +0000Subject: HIPPA as it relates to EMS Systems...

This is probably an easy question to answer, but I can't seem to find a clear

answer, sooooooooo I am again forwarding this to the only persons I know of that

have the collective knowledge of a paragod.. lol.. Seriously though I need help

with this question:What can and cannot be considered a HIPPA violation as it

relates to patient care reports that have been completed and " turned in. " To

clarify further who exactly is authorized to read a PCR that I wrote on pt. so

and so on say October 2, 2008? I understand that obviously the QA/QI committee

is privy to this information for obvious reasons, and likely the Director, but

who else is covered?This question was posed to me by a coworker and I hope to

give him/her a definitive answer.Also, I've recently posted about FDA/DPS/DEA

narcotic documentation and have yet to see an answer. Is this something that

cannot be answered, or is it something that is of no interest. I have made a

couple of postings, but have had very little if any discussion about them. If I

am incorrectly posting, please feel free to let me know. Also let me say that i

appreciate the discussions that are generated on here, I've learned to look at

things from a different perspective based on some of your replies, and have

recently discovered Dr. Bledsoe's website which has a ton of useful information.

As I am relatively new to EMS (approximately 3 years total), I am slowly

learning that we are pretty much " the bastard children " fortunately there are

people like Dr. Bledsoe and others whose names I can't recall off the top of my

head, who truly care about EMS and furthermore UNDERSTANDS what we do, the

importance of what we do, and the NECESSITY of what we do, we can all hold our

heads high and be proud of who we are, even if we are underappreciated.Thank you

for any assistance you can provide.. Sr. NREMT-P

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November 9, 2008

thank you jane.. that was very educational and much appreciated...

Memento Mori...

Sr.