# Ekgs on the bls level



## CobraIV (Nov 19, 2013)

So I work in an ER as a tech besides being an EMT. The other night a bls crew showed up with a pt who's chefs complaint was abdomen pain, on arrival to the ER the pt was in the trendelenburg position since the bls crew wasn't able to get a pulse. The pt was speaking in full sentences and didn't appear in distressed.  Anyways I got the page to preform an ekg. I did the ekg and printed it. The ekg read normal sinus rhythm. After an ekg the protocol is to show the doctor assigned to them. As I leave the room both of the bls crew ask to look at it. I showed them it, one crew member stared it for almost 20 minutes.  They asked me to print them out a copy. I thought to myself why you're bls? You don't do ekgs. If they were medics and asked alittle nicer id print them a copy. I didn't say that to them since I am typically a nice guy plus it was 6:15 in the morning. Obviously I didn't give them a copy but another tech did because they were up her a $$.



So my question lies with if a bls crew ask for a copy of the ekg do I give it to them? I understand if they need it as a study aid for medic school but it falls under hippa laws. The pts name, med rec, social are on the ekg as well as my name. This isnt a face sheet thats going with the report , they wanted it for :censored::censored::censored::censored:s and giggles. If its so important for their "studies" couldn't a clinical instructor provide their students with an ekg?


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## DesertMedic66 (Nov 19, 2013)

It is still their patient so the HIPAA laws do not apply here. Many companies have a follow up with patients so the crews can find out what was going on and what the outcome was. 

Just because an EMT isn't in medic school doesn't mean they aren't trying to learn about EKGs. Heck I'm an EMT and if there is an interesting cardiac patient I will ask nicely for a copy of the 12-lead for my own interest, never have I been denied. 

There is a very simple fix to take off patient info. After you make a copy, use a sharpie to cover the info you don't want them to have.

Since that was their patient in the first place, they already have the patients social number and medical info


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## Tigger (Nov 19, 2013)

HIPPA isn't real, HIPAA is.

Also, I see no reason for you to deny a perfectly legitimate request made by someone who in all likelihood who just wants to be a better EMT. 

I'm a basic and am required to learn basic interpretation. Should I not have access to my own patient's EKGs?


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## DesertMedic66 (Nov 19, 2013)




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## Mariemt (Nov 19, 2013)

Actually, they may have wanted it for their paper work as they had a pt they couldn't find a pulse on speaking in full sentences . They only asked for a copy, they never said they needed it for medic school. If that is what they wanted it for they could find 5,000,000 of them online.

If you if your partner hadn't given them one, the nurses or the er physician probably would have and then given you strange looks the rest of the day wondering why you hadn't.

The pt was theirs to begin with. Let's remember that. They know the laws. Apparently more than you do as you thought you couldn't share this with them.


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## Mariemt (Nov 19, 2013)

And as am EMT myself? I have been taught how to do ekgs, 12 leads and we do 3 leads and include the strips in our paperwork.


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## Brandon O (Nov 19, 2013)

They probably want to learn. This usually falls under professional courtesy.

Are you concerned about the HIPAA issue or the inconvenience?


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## Jawdavis (Nov 19, 2013)

If they needed it for their paperwork, absolutely. If they just wanted it to study sure, just make sure names and patient information are blacked out.


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## Christopher (Nov 19, 2013)

CobraIV said:


> I thought to myself why you're bls? You don't do ekgs.



Ho ho ho, how mistaken. Our EMT's do 12-Leads (they don't interpret, but they acquire them).

Hopefully we'll move out of the old world mindset and start embracing BLS 12-Leads.


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## Mariemt (Nov 19, 2013)

Christopher said:


> Ho ho ho, how mistaken. Our EMT's do 12-Leads (they don't interpret, but they acquire them).
> 
> Hopefully we'll move out of the old world mindset and start embracing BLS 12-Leads.



The er doc really likes it when we send one ahead. Or have a strip in our hand as we walk in. 

I learned during clinical to do all three. They had me do the 12 leads then I did ekgs in the er as it was what they did during down time.


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## unleashedfury (Nov 19, 2013)

They wanted to study it? Or learn more about 12 Leads 

I'll be honest 12 Lead ECG inteperitation is probably one of my weakest points. I get them from medics, ER techs and various people all the time in a way to improve my skills. 

If HIPAA is what your concerned about, simply black out the info with a sharpie. It was their patient, so the continuum of care applies. not a big deal.


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## CobraIV (Nov 20, 2013)

Tigger said:


> HIPPA isn't real, HIPAA is.
> 
> Also, I see no reason for you to deny a perfectly legitimate request made by someone who in all likelihood who just wants to be a better EMT.
> 
> I'm a basic and am required to learn basic interpretation. Should I not have access to my own patient's EKGs?



excuse my french


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## jaksasquatch (Nov 20, 2013)

EMT's are able to do 12 leads where I'm from. I don't see anything wrong with it.


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## medicdan (Nov 20, 2013)

jaksasquatch said:


> EMT's are able to do 12 leads where I'm from. I don't see anything wrong with it.



I don't think the issue is whether EMTs can obtain 12 leads, but the interpretation.


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## VFlutter (Nov 20, 2013)

medicdan said:


> I don't think the issue is whether EMTs can obtain 12 leads, but the interpretation.




Exactly. Our techs, non-certified with a few weeks orientation, obtain EKGs with no problem.


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## jaksasquatch (Nov 20, 2013)

medicdan said:


> I don't think the issue is whether EMTs can obtain 12 leads, but the interpretation]
> 
> True I've seen a few that really desire to be the best medic print out a strip and read it. HoweverI've never seen one ask for a copy. Still it doesn't violate HIPAA so it should be alright. I would wan't to be safe and have the personal info blotted out though.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> *It is still their patient so the HIPAA laws do not apply here. *Many companies have a follow up with patients so the crews can find out what was going on and what the outcome was.



Actually this is a direct violation of HIPAA, state and hospital policies.

The ECG was done on the hospital machine and contained patient information. Therefore it is part of the hospital chart. It was not generated by the EMTs.  

If a student wants a copy, all patient identifying information must be removed and there must be a contract identifying the student and the school's association with the hospital. 

For follow up info this should be done through an liaison agreement. There have been situations where the "off the side courtesy" has come back to haunt hospital employees.  Often this happens when some in EMS abuse the privilege by trying to learn details about a patient which actually was not theirs but the person was a friend of a friend, a celebrity or a news worthy trauma.  All it takes is someone saying they got the info from ER Tech Joe or Joe RN, a "reliable" source while discussing the patient at the station or in the restaurant for some deep trouble for the hospital employee to happen. The EMT or Paramedic will be clear since it is the hospital employee who should have known better.

This is all basic stuff which should have been stressed in the hospital orientation regarding privacy and restressed frequently in privacy notices.  Prehospital providers do not get as much training on HIPAA which would account for the attitudes encountered when you try to explain why you can not just hand out patient records.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> Actually this is a direct violation of HIPAA, state and hospital policies.
> 
> The ECG was done on the hospital machine and contained patient information. Therefore it is part of the hospital chart. It was not generated by the EMTs.
> 
> ...



I wouldn't say its basic stuff. Many providers in the field setting and in the hospital setting feel that it doesn't not violate HIPAA. Just to be sure I looked at the law again and found nothing that says it can or can't be done. 

Also in my first post you will see that I stated you can/should black out all patient identifiers.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> I wouldn't say its basic stuff. *Many providers in the field setting and in the hospital setting feel that it doesn't not violate HIPA*A. Just to be sure I looked at the law again and found nothing that says it can or can't be done.
> 
> Also in my first post you will see that I stated you can/should black out all patient identifiers.



For a hospital employee in California to be okay with this is disturbing especially since California privacy laws make HIPAA look tame.  There have been enough examples of violations sent out to all hospitals in California which should have been mandatory reading for all.

_The law specifically prohibits an individual or entity that receives medical information based on a patient authorization from further disclosing the medical information without a new authorization._

The above is straight from California and HIPAA makes a similar statement. If you want the records for your own purpose, you must have authorization.  Your  care of that patient is done. The ECG was done after arrival and is no longer pertinent to your treatment of this patient since you are no longer treating them. Therefore you do not need your own personal copy. But, you can discuss it while still in the hospital and the patient is still in the ER with other direct care givers.


I can also point out a few more things with your earlier post.



DesertEMT66 said:


> It is still their patient so the HIPAA laws do not apply here. Many companies have a follow up with patients so the crews can find out what was going on and what the outcome was.
> 
> Just because an EMT isn't in medic school doesn't mean they aren't trying to learn about EKGs. *Heck I'm an EMT and if there is an interesting cardiac patient I will ask nicely for a copy of the 12-lead for my own interest, never have I been denied. *
> 
> ...



First,  you have now violated the trust of the hospital employee who probably was "doing you a favor" by announcing what they did on a very public forum where you have put a lot of information to make identifying you fairly easy.  This is exactly what I meant in my earlier post about Joe RN told me or gave me the info. Your open comments about people giving you part of the patient's chart could put those at the hospitals you frequent under scrutiny. 

The next point is that it "WAS" their patient as in past tense. The ECG was done in the hospital and is now part of the patient's chart in the hospital. If you want to discuss something about the patient and what is in the chart, you can probably do so while still in the hospital but just having the patient earlier does not give you the authority to take copies of the patient's hospital chart with you. Even the patient has to sign a form to take copies of their chart.  Even hospital personnel who have been direct care providers in the ER will not be allowed access to the patient's chart once report is given to the next care giver. 

The last part about already having access to the patient's info and social security number is why certain privacy rules had to be put into place. You should never use this information to access the patient's chart for your own gain and all copies of this information should be handed over to the appropriate people or shredded. 

I suggest you read HIPAA and California law again. I also suggest that if someone does give you something as a favor which could be seen as a violation, don't tell everyone on a public forum.


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## jrm818 (Nov 20, 2013)

Dear Clipper,

Please define "protected health information," according to the federal government (OP is not in california).  Assume that the tech blacked out all demographic info from the EKG..

Thanks


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## Clipper1 (Nov 20, 2013)

jrm818 said:


> Dear Clipper,
> 
> Please define "protected health information," according to the federal government (OP is not in california).  Assume that the tech blacked out all demographic info from the EKG..
> 
> Thanks



DesertEMT66 
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DesertEMT66 is from California and that is who I was replying to.


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## jrm818 (Nov 20, 2013)

Oh heck, I can't hold back, I'll help you a bit.

Try looking here: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/


or just trust me that the government said this:

"De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15"

never mind exemptions for company operations...like quality improvement (which I admit may depend on an organized QA/QI follow up program...but that's another issue)



Edited to add: I don't doubt that you'll ignore this again, but here goes: OK, Desert is in CA, so define PHI either federally or in the fiefdom of California.  Thanks.


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## Clipper1 (Nov 20, 2013)

CobraIV said:


> Obviously I didn't give them a copy but another tech did *because they were up her a $$.*
> 
> 
> So my question lies with if a bls crew ask for a copy of the ekg do I give it to them? I understand if they need it as a study aid for medic school but it falls under hippa laws. The pts name, med rec, social are on *the ekg as well as my name*. This isnt a face sheet thats going with the report , they wanted it for :censored::censored::censored::censored:s and giggles. If its so important for their "studies" couldn't a clinical instructor provide their students with an ekg?



Okay let me address the OP. 

The OP obviously knows the HIPAA policy and hospital policies he is in.  The OP is directly responsible for this part of the patient record.  Yes, an ECG is part of the patient record.  This is medical information about the patient.   This is medical information about the patient regardless of what state it is in. HIPAA may concern itself with electronic transfer of data but the actual medical information data is and has been protected for decades long before HIPAA.   

The OP may have to answer for any extra copies printed by the machine.  This is also why hospitals are going to electronic ECGs and eliminating the need for paper copies.

And, at no time should anybody be up someone's *** to give out copies of the patient's chart. 

The OP is correct for protecting the patient's medical data and probably should rethink giving out copies to the others also.  It could bite him later.


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## Clipper1 (Nov 20, 2013)

jrm818 said:


> Oh heck, I can't hold back, I'll help you a bit.
> 
> Try looking here: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/
> 
> ...




Patient privacy laws mean their treatment and medical records will not be made public or given out just for the asking by any one. Would you want everyone to know about your family's medical problems to be discussed at the local diner? How many abortions your sister had? What sexually transmitted diseases you have been treated for? What about the back injuries or cardiac problems you have been trying to keep from your employer? This is your personal medical information. It should not be given out to anyone who thinks it is cool and could be left for others to know your business also.

 At some time you have to use some common sense and know your own state laws. Also, have you never read the privacy laws which are posted everywhere in hospitals and in brochures at the bedsides.  No it is not appropriate to take medical information about a patient from a chart without further authorization and an explanation of your intentions.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> Patient privacy laws mean their treatment and medical records will not be made public or given out just for the asking by any one. Would you want everyone to know about your family's medical problems to be discussed at the local diner? How many abortions your sister had? What sexually transmitted diseases you have been treated for? What about the back injuries or cardiac problems you have been trying to keep from your employer? This is your personal medical information. It should not be given out to anyone who thinks it is cool and could be left for others to know your business also.
> 
> At some time you have to use some common sense and know your own state laws. Also, have you never read the privacy laws which are posted everywhere in hospitals and in brochures at the bedsides.  No it is not appropriate to take medical information about a patient from a chart without further authorization and an explanation of your intentions.



If there is no patient info on the 12-lead then your first paragraph is pointless. That's one of the nice things about not having any patient identifiers.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> If there is no patient info on the 12-lead then your first paragraph is pointless. That's one of the nice things about not having any patient identifiers.



But the ECG machine will know another copy was made which is not accounted for. Electronic foot prints are a reality and hard to fight if your name is one them.
How you use this information when you talk about it in public such as "the guy in the MVC" at 5th and Elm, will be identifiers.  

Just refrain from feeling you are entitled or asking hospital employees for information they are reluctant to give which should be obtained through the proper channels.  They are taking a risk for you.

You can also email this discussion to the risk managers and HR at the local hospitals to see what they think. That probably would be the best way to learn the policies of the hospital and the state.  I will probably do that any way to see if there are any updates in California since they are the first to know.   I think hospitals should be aware of any breaches which might be happening since the consequences for the employee and the hospital are very real.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> But the ECG machine will know another copy was made which is not accounted for. Electronic foot prints are a reality and hard to fight if your name is one them.
> How you use this information when you talk about it in public such as "the guy in the MVC" at 5th and Elm, will be identifiers.
> 
> Just refrain from feeling you are entitled or asking hospital employees for information they are reluctant to give which should be obtained through the proper channels.  They are taking a risk for you.
> ...



We use a copy machine to make copies, I'm sure they can print several copies from the machine but never have I seen them do it. 

If talking about an accident on a street is a violation then probably every provider (or at least the ones who teach) is guilty. 

If I hear a dispatch for a male having a heart attack at 1234 Banana street, doing a little bit of research I can find out information. By your standards that is a violation.


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## jrm818 (Nov 20, 2013)

Clipper1 said:


> How you use this information when you talk about it in public such as "the guy in the MVC" at 5th and Elm, will be identifiers.



That would be a violation all on its own, and would happen regardless of the EKG copy - nothing to do with the act of giving a crew involved in the patients care a redacted EKG. 

Hospital policy may indeed prohibit sharing of EKG's.  None of us have any idea if this is the case in the OP's hospital, and honestly I doubt he does either, else he would not have asked here.  If it is hospital policy, I would say it's a stupid one probably based on over-reading the HIPAA privacy rule.

There are very good reasons for encouraging educational discussion of patients among providers and making it easy for EMS providers to follow up on patients or gather more information about them.

I have little doubt that a non-clinician bureaucrat like a risk manager could care less about improving clinical practice when compared with the (erroneously) perceived risk of a HIPAA violation, but that doesn't make for good policy.

I would of course object to overhearing any provider discuss my sister's abortions in a restaurant, but if I overheard an EMS crew talking about an interesting nuance of an ECG from an interesting but anonymous case, I'd probably be impressed that they cared enough to learn from their experience.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> If I hear a dispatch for a male having a heart attack at 1234 Banana street, doing a little bit of research I can find out information. By your standards that is a violation.



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.


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## Clipper1 (Nov 20, 2013)

jrm818 said:


> That would be a violation all on its own, and would happen regardless of the EKG copy - nothing to do with the act of giving a crew involved in the patients care a redacted EKG.
> 
> Hospital policy may indeed prohibit sharing of EKG's.  None of us have any idea if this is the case in the OP's hospital, and honestly I doubt he does either, else he would not have asked here.  If it is hospital policy, I would say it's a stupid one probably based on over-reading the HIPAA privacy rule.
> 
> ...



No it is not stupid to protect patients' medical information. Even teaching hospitals have to know the boundaries of using certain information for education. 

We don't know the intent of these EMTs.  Bragging rights? Cool call with the guy in Bed 2 and this is his ECG...  Is it a celebrity's ECG and you want to show it around?  Another co-worker's ECG?  Isn't it a double standard for you not wanting to hear about your sister's abortions but willing to hear about the guy next door who has a cardiac condition which could be career ending and he hasn't told anyone yet? Isn't that personal to him and his family also?

You also keep bringing up HIPAA. The state also has certain privacy rules.  The hospitals must protect everyone equally and the rules should apply to all.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> No it is not stupid to protect patients' medical information. Even teaching hospitals have to know the boundaries of using certain information for education.
> 
> We don't know the intent of these EMTs.  Bragging rights? Cool call with the guy in Bed 2 and this is his ECG...  Is it a celebrity's ECG and you want to show it around?  Another co-worker's ECG?  Isn't it a double standard for you not wanting to hear about your sister's abortions but willing to hear about the guy next door who has a cardiac condition which could be career ending and he hasn't told anyone yet? Isn't that personal to him and his family also?
> 
> You also keep bringing up HIPAA. The state also has certain privacy rules.  The hospitals must protect everyone equally and the rules should apply to all.



As it has been stated many times before black out all the patient info on the EKG. Now there is no way to tell if it is your dad, a famous celebrity, or John Q Citizen.


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## Clipper1 (Nov 20, 2013)

Bottomline as it pertains to the original post. Don't beg or harass for copies of a medical record you are not entitled to. It just shows a great disrespect fot that employee and could put their job in jeopardy. Their bosses will not know what info was blacked out.   If you still want a copy go through the proper channels. If not, you probably know you are skirting the lines and know the direct responsibility will fall to the one giving the ECG.

Desert, I still suggest you definitely go through the proper channels and talk to the hospital risk management.

BTW, you do know copy machines store the image?  This is why you don't make copies of personal data at Office Depot.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> Bottomline as it pertains to the original post. Don't beg or harass for copies of a medical record you are not entitled to. It just shows a great disrespect fot that employee and could put their job in jeopardy. Their bosses will not know what info was blacked out.   If you still want a copy go through the proper channels. If not, you probably know you are skirting the lines and know the direct responsibility will fall to the one giving the ECG.
> 
> Desert, I still suggest you definitely go through the proper channels and talk to the hospital risk management.
> 
> BTW, you do know copy machines store the image?  This is why you don't make copies of personal data at Office Depot.



Yes I am aware that copy machines store images. If that is a issue why are medical records put thru copy machines at every hospital that I have ever been to?


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> Yes I am aware that copy machines store images. If that is a issue why are medical records put thru copy machines at every hospital that I have ever been to?



That is why most of these machines now have coded access.

You are missing the point. Electronic footprints will catch up with someone eventually. You don't seem to appreciate the risks someone is taking for you.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> That is why most of these machines now have coded access.
> 
> You are missing the point. Electronic footprints will catch up with someone eventually. You don't seem to appreciate the risks someone is taking for you.



Coded access as in you have to have a code to use it? If that's what you are meaning, I have yet to see a hospital with it.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> Coded access as in you have to have a code to use it? If that's what you are meaning, I have yet to see a hospital with it.



I don't know which hospitals you are referring to specifically. But I do know some of the hospitals you have mentioned on this forum do have codes for their copy machines as well as the door to the room they are in. This was an issue for security when we were doing the EMR upgrades for the hospitals in your area.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> I don't know which hospitals you are referring to specifically. But I do know some of the hospitals you have mentioned on this forum do have codes for their copy machines as well as the door to the room they are in. This was an issue for security when we were doing the EMR upgrades for the hospitals in your area.



Uhhh no. Maybe on the floor they do but in the ERs negative.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> Uhhh no. Maybe on the floor they do but in the ERs negative.


I will be at a hospital just south of you for another 2 weeks. I will check with the facilities in your area we helped with their EMRs. It is not good if info is easily accessible to non hospital employees. The ED would be a weak spot with many distractions.


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## DesertMedic66 (Nov 20, 2013)

Clipper1 said:


> I will be at a hospital just south of you for another 2 weeks. I will check with the facilities in your area we helped with their EMRs. It is not good if info is easily accessible to non hospital employees. The ED would be a weak spot with many distractions.



Then you may want to visit other hospitals that are not in CA.


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## Clipper1 (Nov 20, 2013)

DesertEMT66 said:


> Then you may want to visit other hospitals that are not in CA.



I have been. Most recently some in Washington and Oregon. California is not my home state.
There is a nationwide push for hospitals and medical offices to upgrade their EMRs and data security.  This is nothing new but it takes time for a system to be built which includes many areas...even ECGs.


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## Brandon O (Nov 20, 2013)

Clipper1 said:


> 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...


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## Clipper1 (Nov 20, 2013)

Brandon O said:


> 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.


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## Brandon O (Nov 20, 2013)

Clipper1 said:


> 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.


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## MaroonMedic (Nov 21, 2013)

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.


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## Clipper1 (Nov 21, 2013)

Brandon O said:


> 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.


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## Brandon O (Nov 21, 2013)

Clipper1 said:


> 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.


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## Clipper1 (Nov 21, 2013)

Brandon O said:


> 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.


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## Brandon O (Nov 21, 2013)

Clipper1 said:


> 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.


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## muchlinskim (Nov 25, 2013)

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!


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## Clipper1 (Nov 25, 2013)

muchlinskim said:


> 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.


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## muchlinskim (Nov 25, 2013)

Clipper1 said:


> 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.


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## Mariemt (Nov 25, 2013)

Clipper1 said:


> 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.


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## Clipper1 (Nov 25, 2013)

Mariemt said:


> 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.


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## EMT856 (Dec 13, 2013)

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.


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## mycrofft (Dec 13, 2013)

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.


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## xrsm002 (Dec 19, 2013)

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.


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