HIPAA Information available to out of town ER or not?

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RudyS
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HIPAA Information available to out of town ER or not?

Post by RudyS » Thu Nov 08, 2018 11:06 am

My physician's office recently asked me to sign a HIPAA release authorizing them to release my medical information to other providers. The explanation for the request was that if I were out of town, and found myself in a facility such as an ER, that the staff could call my physician for any information they might want/need. DW and I think it strange that such information could not, in an emergency, be provided in the absence of a signed document. Do any of you know if this is a realistic concern by my physician, or just sort of a CYA thing?
Last edited by RudyS on Thu Nov 08, 2018 12:55 pm, edited 1 time in total.

ResearchMed
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Re: HIPPA Information available to out of town ER or not?

Post by ResearchMed » Thu Nov 08, 2018 11:13 am

RudyS wrote:
Thu Nov 08, 2018 11:06 am
My physician's office recently asked me to sign a HIPPA release authorizing them to release my medical information to other providers. The explanation for the request was that if I were out of town, and found myself in a facility such as an ER, that the staff could call my physician for any information they might want/need. DW and I think it strange that such information could not, in an emergency, be provided in the absence of a signed document. Do any of you know if this is a realistic concern by my physician, or just sort of a CYA thing?
It's HIPAA (not HIPPA).

This will matter a lot for anyone searching for other threads here about HIPAA.
(Google offers an auto-correct choice, but not here to find other BH comments about it.)

RM
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Cunobelinus
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Re: HIPPA Information available to out of town ER or not?

Post by Cunobelinus » Thu Nov 08, 2018 11:16 am

Edit: my uninformed opinion is indeed uninformed. Should've stopped after writing the disclaimer.
Disclaimer: I am not a medical professional.

My understanding of HIPAA leads me to think this is a CYA thing. I'd be interested in hearing from the myriad medical professionals here though.

https://www.hhs.gov/hipaa/for-professio ... index.html
"The Security Rule defines “confidentiality” to mean that e-PHI is not available or disclosed to unauthorized persons. The Security Rule's confidentiality requirements support the Privacy Rule's prohibitions against improper uses and disclosures of PHI."

I would think a hospital with you as a patient would not be an "unauthorized person."
Last edited by Cunobelinus on Thu Nov 08, 2018 11:59 am, edited 1 time in total.

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cheese_breath
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Re: HIPPA Information available to out of town ER or not?

Post by cheese_breath » Thu Nov 08, 2018 11:18 am

HIPAA is Federal legislation. It's understandable why your physician would be reluctant to give your information out to anyone without your signed permission.

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Rupert
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Re: HIPPA Information available to out of town ER or not?

Post by Rupert » Thu Nov 08, 2018 11:35 am

Some providers read more into HIPAA than is actually there. It is partly a CYA thing and partly a genuine effort to comply with the law thing. I often have to request medical records of my clients. Some facilities/providers will accept a one-sentence waiver signed by the client (e.g., "I waive my rights under HIPAA"). Others require use of their own waiver, and sometimes those waivers can be 5 or 6 pages long. That said, aside from the emergency situation you describe, this particular authorization would also permit them to release information to other local providers who may need the information, e.g., a specialist you need to see, etc. It's more convenient for most patients to have them sign one global waiver than to have to call the patient in to sign individual waivers each and every time records need to be sent to another provider.

lernd
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Re: HIPPA Information available to out of town ER or not?

Post by lernd » Thu Nov 08, 2018 11:45 am

As an emergency physician, I highly recommend signing this document. What I think the office is asking you for is prior authorization to release information if a future request is made (by an outside ER or somewhere else). This prior authorization is potentially beneficial to you because if you are incapacitated, you cannot sign the release-of-information-request form that hospitals use to fax to other facilities to obtain information. Technically, according to HIPAA, one does not need authorization to send health information to other care providers (if felt to be in the patient's best interest), but try explaining that to an office administrator...over the phone...in an emergency. So, while you and your spouse are correct - the information should be shared if it is medically necessary - in reality arbitrary rules made in the (false) name of HIPAA can hold things up.

In true emergencies, the ER is often has limited information and a patient who cannot help provide that information. Relevant information such as past medical history, medications, allergies, contact information for family can be critically important (such that people should carry some of this basic information with them in a wallet sized card). Any option to facilitate the secure dissemination of health information should be taken.

RudyS
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Re: HIPAA Information available to out of town ER or not?

Post by RudyS » Thu Nov 08, 2018 12:58 pm

Thanks all. I fixed the title as instructed. We did sign the forms, but were just wondering about how necessary this was. Looks like it is.

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southerndoc
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Re: HIPAA Information available to out of town ER or not?

Post by southerndoc » Thu Nov 08, 2018 4:19 pm

If it is directly related to patient care, then information can be shared among providers. However, without this consent, your physician likely will be reticent to do so. They have the opinion that it's required in order to share information.

I would sign it. You aren't signing something to allow them to publish your health record in your local paper.

rg422
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Re: HIPAA Information available to out of town ER or not?

Post by rg422 » Fri Nov 09, 2018 12:30 pm

By giving consent, it may make things easier, however under the HIPAA exclusion rule, a provider will disclose your protected health information if it's being utilized for treatment, payment and/or healthcare operations.

toofache32
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Re: HIPPA Information available to out of town ER or not?

Post by toofache32 » Fri Nov 09, 2018 9:55 pm

Cunobelinus wrote:
Thu Nov 08, 2018 11:16 am
Edit: my uninformed opinion is indeed uninformed. Should've stopped after writing the disclaimer.
Disclaimer: I am not a medical professional.

My understanding of HIPAA leads me to think this is a CYA thing. I'd be interested in hearing from the myriad medical professionals here though.

https://www.hhs.gov/hipaa/for-professio ... index.html
"The Security Rule defines “confidentiality” to mean that e-PHI is not available or disclosed to unauthorized persons. The Security Rule's confidentiality requirements support the Privacy Rule's prohibitions against improper uses and disclosures of PHI."

I would think a hospital with you as a patient would not be an "unauthorized person."
Of course it's CYA. With up to $1.5 million fines for a breach??? Wouldn't you CYA??

Now, with that being said, there is an incredible amount of misinformation about HIPAA among even healthcare providers. This is due to the typical government lack of clarity hidden a 2000-page document. Provider to Provider communication does NOT need patient consent under HIPAA.


https://www.hhs.gov/hipaa/for-professio ... index.html

toofache32
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Re: HIPAA Information available to out of town ER or not?

Post by toofache32 » Fri Nov 09, 2018 9:58 pm

You guys have no idea how many pissed off wives I have dealt with when I call their husband to review biopsy results, and the wife answers the phone and wants to know the results. But he did not list her on the HIPAA form. Sorry ma'am, for $50,000 a pop, you can take it up with your husband. Oh, and tell him to call me back for the results.

blueman457
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Re: HIPAA Information available to out of town ER or not?

Post by blueman457 » Sat Nov 10, 2018 11:17 am

Delete.
Last edited by blueman457 on Sat Nov 10, 2018 11:21 am, edited 1 time in total.

blueman457
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Re: HIPPA Information available to out of town ER or not?

Post by blueman457 » Sat Nov 10, 2018 11:20 am

toofache32 wrote:
Fri Nov 09, 2018 9:55 pm
Cunobelinus wrote:
Thu Nov 08, 2018 11:16 am
Edit: my uninformed opinion is indeed uninformed. Should've stopped after writing the disclaimer.
Disclaimer: I am not a medical professional.

My understanding of HIPAA leads me to think this is a CYA thing. I'd be interested in hearing from the myriad medical professionals here though.

https://www.hhs.gov/hipaa/for-professio ... index.html
"The Security Rule defines “confidentiality” to mean that e-PHI is not available or disclosed to unauthorized persons. The Security Rule's confidentiality requirements support the Privacy Rule's prohibitions against improper uses and disclosures of PHI."

I would think a hospital with you as a patient would not be an "unauthorized person."
Of course it's CYA. With up to $1.5 million fines for a breach??? Wouldn't you CYA??

Now, with that being said, there is an incredible amount of misinformation about HIPAA among even healthcare providers. This is due to the typical government lack of clarity hidden a 2000-page document. Provider to Provider communication does NOT need patient consent under HIPAA.


https://www.hhs.gov/hipaa/for-professio ... index.html
+1

When I've requested information emergently, they fax it over ASAP. But this is only during daytime hours.

In emergent situations this release form isn't useful because it's after hours and the patient is going down fast. The most useful thing is to have a piece of paper in your wallet/purse with your medical problems, meds, allergies, surgeries, and other major medical information. Update it quarterly.

Blue Man

toofache32
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Re: HIPPA Information available to out of town ER or not?

Post by toofache32 » Sat Nov 10, 2018 11:35 am

blueman457 wrote:
Sat Nov 10, 2018 11:20 am
toofache32 wrote:
Fri Nov 09, 2018 9:55 pm
Cunobelinus wrote:
Thu Nov 08, 2018 11:16 am
Edit: my uninformed opinion is indeed uninformed. Should've stopped after writing the disclaimer.
Disclaimer: I am not a medical professional.

My understanding of HIPAA leads me to think this is a CYA thing. I'd be interested in hearing from the myriad medical professionals here though.

https://www.hhs.gov/hipaa/for-professio ... index.html
"The Security Rule defines “confidentiality” to mean that e-PHI is not available or disclosed to unauthorized persons. The Security Rule's confidentiality requirements support the Privacy Rule's prohibitions against improper uses and disclosures of PHI."

I would think a hospital with you as a patient would not be an "unauthorized person."
Of course it's CYA. With up to $1.5 million fines for a breach??? Wouldn't you CYA??

Now, with that being said, there is an incredible amount of misinformation about HIPAA among even healthcare providers. This is due to the typical government lack of clarity hidden a 2000-page document. Provider to Provider communication does NOT need patient consent under HIPAA.


https://www.hhs.gov/hipaa/for-professio ... index.html
+1

When I've requested information emergently, they fax it over ASAP. But this is only during daytime hours.

In emergent situations this release form isn't useful because it's after hours and the patient is going down fast. The most useful thing is to have a piece of paper in your wallet/purse with your medical problems, meds, allergies, surgeries, and other major medical information. Update it quarterly.

Blue Man
This is good information. I agree it's simplest to just carry your own. Especially if you're the type who lists your medications as "2 blue ones in the morning, then 1 yellow one at night, and a red one if I have a 'spell'."
Ask your doctor for your most recent "H & P" which will contain everything needed.

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neurosphere
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Re: HIPAA Information available to out of town ER or not?

Post by neurosphere » Sat Nov 10, 2018 12:04 pm

[Edit, toofache provided a similar link/answer above]

Physician here. I had a long answer typed (below) but figured I'd go to the source. This answer is easy:

https://www.hhs.gov/hipaa/for-professio ... index.html
Does the HIPAA Privacy Rule permit doctors, nurses, and other health care providers to share patient health information for treatment purposes without the patient’s authorization?

Answer:
Yes. The Privacy Rule allows those doctors, nurses, hospitals, laboratory technicians, and other health care providers that are covered entities to use or disclose protected health information, such as X-rays, laboratory and pathology reports, diagnoses, and other medical information for treatment purposes without the patient’s authorization. This includes sharing the information to consult with other providers, including providers who are not covered entities, to treat a different patient, or to refer the patient. See 45 CFR 164.506.
I don't consider myself a HIPAA expert, but I find I know more about HIPAA than anyone else I come into casual contact with. I often have to remind people who try to explain the "rules" to me that they are describing hospital policy, not the law. E.g. it is not against the law to send patient info via gmail, but it against hospital policy to send patient info way.

Anyway, here was my original, wordy response...

The law allows sharing of information with anyone on the "treatment team" so to speak, regardless of what forms are filled out. Forms may help facilitate or formalize the process, or prevent misunderstandings. I can pick up the phone and request (or provide) protected information to any healthcare provider involved in treating my patient. My patient in an ED? They call me and I can give them whatever they or I feel is helpful information. I have a new patient in my clinic, who doesn't recall the medication their previous doc prescribed? I have the patient give me the office number and I have my staff as for the med list over the phone. All of these are allowed.

I get calls ALL THE TIME from ERs who don't have a pediatric neurologist, including ERs who don't have anyone in their system. There is a severe shortage of peds neurology in most parts of the country, and I frequently find myself on the receiving end of un-paid consultations. "Hey Dr. Neurosphere, sorry to bother you and hope you are not on vacation, but I need to get your opinion on this child you don't know, but..."

I am allowed to "consult" any person about my patient who I think may be helpful. The patient has authorized me to do this when selecting me to provide them care. So, I call other docs all the time. If I get an MRI that I can't quite figure out what's going on, I routinely call my buddies who are pediatric neuroradiologists at other institutions for education/insight. If I get routine bloodwork and the kidney function seems "off" but I'm not sure, I'll run the case by the kidney docs. Screenshots of EEG segments are shared by epileptologists all the time in order to discuss difficult interpretations. Now, the law says the LEAST amount of necessary information should be communicated. So there is often no need to disclose names, etc. But in the case of a lab report or MRI, identifying information is often built-in to the data. It's not always possible to "sanitize" the data.

Hope that helps!

Neurosphere
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toofache32
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Re: HIPAA Information available to out of town ER or not?

Post by toofache32 » Sat Nov 10, 2018 1:23 pm

neurosphere wrote:
Sat Nov 10, 2018 12:04 pm

I get calls ALL THE TIME from ERs who don't have a pediatric neurologist, including ERs who don't have anyone in their system. There is a severe shortage of peds neurology in most parts of the country, and I frequently find myself on the receiving end of un-paid consultations. "Hey Dr. Neurosphere, sorry to bother you and hope you are not on vacation, but I need to get your opinion on this child you don't know, but..."

I am allowed to "consult" any person about my patient who I think may be helpful. The patient has authorized me to do this when selecting me to provide them care. So, I call other docs all the time. If I get an MRI that I can't quite figure out what's going on, I routinely call my buddies who are pediatric neuroradiologists at other institutions for education/insight. If I get routine bloodwork and the kidney function seems "off" but I'm not sure, I'll run the case by the kidney docs. Screenshots of EEG segments are shared by epileptologists all the time in order to discuss difficult interpretations. Now, the law says the LEAST amount of necessary information should be communicated. So there is often no need to disclose names, etc. But in the case of a lab report or MRI, identifying information is often built-in to the data. It's not always possible to "sanitize" the data.
I am a surgical subspecialist who also gets many "consults" for patients I have never met. I get a text or email of an xray at least once a week asking for my opinion. I stopped offering opinions on these cases after attending a malpractice lecture which addressed this phenomenon known as a "curbside consult". They showed a few cases where the doc offering his opinions was dragged into lawsuits even though he had never met or examined the patient. This includes the ER calling for "advice" when you're not even on call. It turns out there are ER docs who will write in the medical record "I spoke with Dr. Neurosphere who recommended this treatment." Like you, I like being helpful and offering my uncommon expertise, but it's not even close to being worth the liability.

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Re: HIPAA Information available to out of town ER or not?

Post by GrowthSeeker » Sat Nov 10, 2018 1:37 pm

What most healthcare professionals believe about HIPAA is that they cannot release ANYTHING without the patient's permission.
In fact, if the information to be released is specifically to be helpful to taking care of that same patient's medical problem, then it is perfectly OK for other hospitals or doctor's offices to release that information, say to an out of town ER. But most office staff, nurses, hospital medical records personnel don't understand this.

So in practice, almost no one will release anything without a signed release.
Just because you're paranoid doesn't mean they're NOT out to get you.

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neurosphere
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Re: HIPAA Information available to out of town ER or not?

Post by neurosphere » Sat Nov 10, 2018 2:00 pm

toofache32 wrote:
Sat Nov 10, 2018 1:23 pm
I am a surgical subspecialist who also gets many "consults" for patients I have never met. I get a text or email of an xray at least once a week asking for my opinion. I stopped offering opinions on these cases after attending a malpractice lecture which addressed this phenomenon known as a "curbside consult". They showed a few cases where the doc offering his opinions was dragged into lawsuits even though he had never met or examined the patient. This includes the ER calling for "advice" when you're not even on call. It turns out there are ER docs who will write in the medical record "I spoke with Dr. Neurosphere who recommended this treatment." Like you, I like being helpful and offering my uncommon expertise, but it's not even close to being worth the liability.
Yes, this is a risk. I could be involved in a lawsuit. I think the chances of losing a lawsuit are miniscule. But the costs of merely being named are of course substantial. Especially since it's possible my employer malpractice insurance may not cover such a case. That said, I have simply had to find peace with this. I just don't feel right refusing to provide advice within my highly specialized area of expertise when a child's health is at stake, when there are no other alternatives apart from airlift to a large hospital. But I completely understand why others might feel just the opposite.
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toofache32
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Re: HIPAA Information available to out of town ER or not?

Post by toofache32 » Sat Nov 10, 2018 2:20 pm

GrowthSeeker wrote:
Sat Nov 10, 2018 1:37 pm
What most healthcare professionals believe about HIPAA is that they cannot release ANYTHING without the patient's permission.
In fact, if the information to be released is specifically to be helpful to taking care of that same patient's medical problem, then it is perfectly OK for other hospitals or doctor's offices to release that information, say to an out of town ER. But most office staff, nurses, hospital medical records personnel don't understand this.

So in practice, almost no one will release anything without a signed release.
There is also justified fear of government overpower. The DOJ is authorized to enter your medical practice with guns on their hips and seize all computers/records and chain your doors shut. Guilty until proven innocent.

I have a few doctor friends who do not electronically transmit health information and are therefore not required to follow HIPAA rules. Many people do not realize that not all doctors are required to follow HIPAA rules.

blueman457
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Re: HIPAA Information available to out of town ER or not?

Post by blueman457 » Sat Nov 10, 2018 2:48 pm

toofache32 wrote:
Sat Nov 10, 2018 1:23 pm
neurosphere wrote:
Sat Nov 10, 2018 12:04 pm

I get calls ALL THE TIME from ERs who don't have a pediatric neurologist, including ERs who don't have anyone in their system. There is a severe shortage of peds neurology in most parts of the country, and I frequently find myself on the receiving end of un-paid consultations. "Hey Dr. Neurosphere, sorry to bother you and hope you are not on vacation, but I need to get your opinion on this child you don't know, but..."

I am allowed to "consult" any person about my patient who I think may be helpful. The patient has authorized me to do this when selecting me to provide them care. So, I call other docs all the time. If I get an MRI that I can't quite figure out what's going on, I routinely call my buddies who are pediatric neuroradiologists at other institutions for education/insight. If I get routine bloodwork and the kidney function seems "off" but I'm not sure, I'll run the case by the kidney docs. Screenshots of EEG segments are shared by epileptologists all the time in order to discuss difficult interpretations. Now, the law says the LEAST amount of necessary information should be communicated. So there is often no need to disclose names, etc. But in the case of a lab report or MRI, identifying information is often built-in to the data. It's not always possible to "sanitize" the data.
I am a surgical subspecialist who also gets many "consults" for patients I have never met. I get a text or email of an xray at least once a week asking for my opinion. I stopped offering opinions on these cases after attending a malpractice lecture which addressed this phenomenon known as a "curbside consult". They showed a few cases where the doc offering his opinions was dragged into lawsuits even though he had never met or examined the patient. This includes the ER calling for "advice" when you're not even on call. It turns out there are ER docs who will write in the medical record "I spoke with Dr. Neurosphere who recommended this treatment." Like you, I like being helpful and offering my uncommon expertise, but it's not even close to being worth the liability.
That's unfortunate. I emphasize to my trainees that you should not include curbside consults in any note, it's a curbside question.

Blue Man

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