Ekgs on the bls level

[Brandon O]

That is not a medical record. And the person has not been stated to be a resident or owner at that address.

However, the first decade of HIV changed a lot when dispatch or the EMTs/Paramedics were saying "Be advised the resident at that address has HIV or AIDS". EMS also used to identify the patient by SS# on the air to dispatch for billing ID.

My understanding is that patient identifiers over the open air are considered an unavoidable disclosure for operational purposes, and are fine as long as there's a reasonable effort to limit the amount of information to whatever's necessary. That's always how it's been described to me, anyway. I wouldn't be surprised if it's somewhat unclear, since ambulance-type operations aren't really the main focus of the law...

 

[Clipper1]

My understanding is that patient identifiers over the open air are considered an unavoidable disclosure for operational purposes, and are fine as long as there's a reasonable effort to limit the amount of information to whatever's necessary. That's always how it's been described to me, anyway. I wouldn't be surprised if it's somewhat unclear, since ambulance-type operations aren't really the main focus of the law...

That does not mean you can announce Mr. Smith has AIDS and give out his SS# on the open air.

You can warn of certain hazards for other arriving crews.

This year more focus is on EMS and its PHI security.

 

[Brandon O]

That does not mean you can announce Mr. Smith has AIDS and give out his SS# on the open air.

You can warn of certain hazards for other arriving crews.

This year more focus is on EMS and its PHI security.

Right. That's what I meant by a reasonable effort to limit the information to what's needed.

In general, I would say there's a constant tension between the letter of HIPAA and the day-to-day navigation of it. If you talk to the folks who have to administrate and manage the former, they will essentially tell you to never speak to another human being ever; if you talk to the folks in the trenches, they usually take a rather dim (or let's say pragmatic) view of it all. Dancing between those extremes is the name of the game. I will certainly agree, however, that the last thing either side ever wants is for an issue to be elevated into the official eyeball, because then the first group is forced to push levers and file papers and do their thing, and that is a giant pain for everyone.

 

[MaroonMedic]

OP,
I've asked for ECG's from techs and nurses before (as a basic) so that my paramedic partner would voluntarily help me understand some interpretations. Although I was curious about the physical rhythms themselves, we also would go over why they were having the symptoms they presented with along with why their 12-lead showed what it did. I felt it actually helped me to understand a little better about WHY the patients were presenting as they did when I could visibly see an arrhythmia/IRR. I've never been denied a strip, but I've always asked kindly and wouldn't push any nurse or tech beyond what they feel comfortable giving to me.

 

[Clipper1]

Right. That's what I meant by a reasonable effort to limit the information to what's needed.

In general, I would say there's a constant tension between the letter of HIPAA and the day-to-day navigation of it. If you talk to the folks who have to administrate and manage the former, they will essentially tell you to never speak to another human being ever; if you talk to the folks in the trenches, they usually take a rather dim (or let's say pragmatic) view of it all. Dancing between those extremes is the name of the game. I will certainly agree, however, that the last thing either side ever wants is for an issue to be elevated into the official eyeball, because then the first group is forced to push levers and file papers and do their thing, and that is a giant pain for everyone.

But I can also see the stance HIPAA is trying to take. This is the electronic age and it is very, very easy for data to get diverted to serve somebody else's purpose and not the patient. We've already seen numerous examples of FaceBook and other breaches of information. Now imagine what some are doing with the personal data such as SS#. Health care workers, including EMTs could find out info about anybody if they desired if there were not some type of privacy rules in place. This we have already seen which initiated some of the states to get tougher long before HIPAA. I bet you have certain safe guards on your computer to prevent privacy breaks. What about credit care protection? Do you freely give out your SS# to anyone or leave your credit card lying around? Imagine what it is like to protect all the patients in this country who are in some type of health care system and still have enough access for the necessary people. The US is also not the only country with a HIPAA type system of regulations. Every country which engages in the electronic transfer of data has a similar type of regulations just with a different name.

 

[Brandon O]

But I can also see the stance HIPAA is trying to take. This is the electronic age and it is very, very easy for data to get diverted to serve somebody else's purpose and not the patient.

Of course. And I do think that most providers recognize the principle it's trying to legislate. But on the everyday level, it really has to be applied with a common sense filter, or you end up like the guy who can't turn left ("sorry doc, not an ambiturner"). Technically, literally, am I allowed to stand in the corner watching the initial interventions for my patient and seeing where things go? You could probably argue it's no longer germane to my care and therefore I don't need to know. When I drop by a couple hours later, can I ask the nurse what happened with that patient? Do we really want a system where that kind of thing is verboten? More to the point, would that kind of system really add any substantial amount of privacy, and how many legitimate educational opportunities is it sacrificing to get it? Most of us have already seen how difficult it is to get long-term patient followup from hospitals, and the reason cited is always, always HIPAA.

 

[Clipper1]

Of course. And I do think that most providers recognize the principle it's trying to legislate. But on the everyday level, it really has to be applied with a common sense filter, or you end up like the guy who can't turn left ("sorry doc, not an ambiturner"). Technically, literally, am I allowed to stand in the corner watching the initial interventions for my patient and seeing where things go? You could probably argue it's no longer germane to my care and therefore I don't need to know. When I drop by a couple hours later, can I ask the nurse what happened with that patient? Do we really want a system where that kind of thing is verboten? More to the point, would that kind of system really add any substantial amount of privacy, and how many legitimate educational opportunities is it sacrificing to get it? Most of us have already seen how difficult it is to get long-term patient followup from hospitals, and the reason cited is always, always HIPAA.

True. But in large systems, it is difficult to track which Paramedic did what. Not everyone is on an EMR with legible writing and some only use numbers as their identifiers. Some also believe a uniform gets them a free pass. I could use a well known Paramedic who had many, many visitors wearing an EMS uniform who had never met the man before his tragic event but wanted a pass to have "a little look" more for the sake of curiosity or wanting to be part of the big media spectacle. Some also demanded they be given medical information yet they had not even met the man before come to the ICU. We deal with this for many high profile cases and those which aren't when distant cousins start crawling in who claim to be the DPOA but can't show proof. Sometimes the regulations are a blessing until Case Managers can weed through the mess.

Also, what makes EMS more special than the ED RNs who might like to see what is going on with one of their former patients but know if they can not just run up to the ICU nor can they log on to access the medical record. Most have come to accept that and many understand the need to limit interruptions in patient care.

This is why EMS agencies should have a liason to gather updates. It is often easier for one person to be granted the access rather than 100.

HIPAA is what is cited by many but those who have been in health care also know privacy regulations have been around for decades. Patients have been informed of their privacy rights and should expect their privacy to be respected for not just the paper aspect.

These regulations get played up tighter when you have people who just have no commonsense to resist recording a patient at a scene especially in an inappropriate manner.

 

[Brandon O]

I could use a well known Paramedic who had many, many visitors wearing an EMS uniform who had never met the man before his tragic event but wanted a pass to have "a little look" more for the sake of curiosity or wanting to be part of the big media spectacle. Some also demanded they be given medical information yet they had not even met the man before come to the ICU. We deal with this for many high profile cases and those which aren't when distant cousins start crawling in who claim to be the DPOA but can't show proof.

This is admittedly tricky. Some of the most challenging "HIPAA moments" have been when I was involved with care or transport of a colleague. The urge to tell everyone back at the base is hard to resist. On the other hand, what if they're truly sick and may want support? (I figure: ask if they want you to let people know, or specific people, or what...)

Also, what makes EMS more special than the ED RNs who might like to see what is going on with one of their former patients but know if they can not just run up to the ICU nor can they log on to access the medical record. Most have come to accept that and many understand the need to limit interruptions in patient care.

I would say there is no difference, and ethically I can't imagine many people would object to this either. It serves a legitimate training function and has little potential for harm.

This is why EMS agencies should have a liason to gather updates. It is often easier for one person to be granted the access rather than 100.

Realistically, it is often nearly impossible for that one person to get anything, because that person is talking to someone wearing the "official" hat, and hospitals have no incentive to help out with CQI, so it's easier to just zip their lip. That's why the informal avenues are often the only ones.

 

[muchlinskim]

Our State Medical Director is pushing hard to get BLS Units/EMT Basics to do 12 lead in the field, mainly to identify STEMI. Our BLS units do 12 lead frequently. Whenever I acquire a 12 lead in the field, I ask to see the ER 12 lead once they complete it so I can compare them. I have never been denied. HIPAA is not an issue.....I already have all the patient information. Times are changing, BLS is expected to do more and more. BLS, ALS and ER is a team, we have to work together!

 

[Clipper1]

Our State Medical Director is pushing hard to get BLS Units/EMT Basics to do 12 lead in the field, mainly to identify STEMI. Our BLS units do 12 lead frequently. Whenever I acquire a 12 lead in the field, I ask to see the ER 12 lead once they complete it so I can compare them. I have never been denied. HIPAA is not an issue.....I already have all the patient information. Times are changing, BLS is expected to do more and more. BLS, ALS and ER is a team, we have to work together!

Looking at an ECG in the ER on your patient will not get any argument. Taking the ECG with you for personal reasons might be questioned.

 

[muchlinskim]

Looking at an ECG in the ER on your patient will not get any argument. Taking the ECG with you for personal reasons might be questioned.

Agreed. I would never take the ER EKG with me nor make a copy.

 

[Mariemt]

Looking at an ECG in the ER on your patient will not get any argument. Taking the ECG with you for personal reasons might be questioned.

The op was never sure why they wanted a copy. He assumed. He never stated knowing the actual reason.

 

[Clipper1]

The op was never sure why they wanted a copy. He assumed. He never stated knowing the actual reason.

If there had been a legit reason there would not be a reason to assume. If there had been a legit reason, they could have gone to a supervisor instead of the two people doing the ECGs.

 

[EMT856]

EMTs should learn basic arrhythmia recognition anyways, but so what if you give them an EKG printout. Maybe they already know what they are looking at and are trying to figure out what is going on with their patient. I always look at EKGs, and and labs that I can to learn how to figure out what is happening to my pt.s.

Just my two cents.

 

[mycrofft]

Two barrels:
1. THe EKG done by then hospital is part of the hospital's medical record and it's distribution/disposition is governed by their rules. HIPAA aside, the Alferd Packer Memorial Hospital is not likely to smile on pieces of their medical records leaving…but then again they might not care if the pt identifiers etc are off. Ask!

2. Anyone using an EKG needs to be certified to read to a pretty good degree. My MD depended upon his machine's software which read "Sinus Tach with occasional PVC". Over a couple years the symptoms worsened but the machine kept to its story. Saw new doc and newer machine, AFIB was diagnosed, too late for conservative measures. Can't rely on software always, not even your electronic thermometers and pulse oximeters which use a predictive algorithm for fast results, if not the real results.

 

[xrsm002]

There a difference between doing an EKG/3 lead and I reading one and by reading I don't mean what the machine says it is. I mean using the rules of interpretation to read the waves.