HIPAA VIOLATION

[Never2Old]

I work in the Compliance Organization of a large Electronic Health Care company, and no, this is not even remotely a HIPAA violation. Moat people don't spell it right, let alone even understand HIPAA regulations and how they apply. However, many states have Privacy Laws, as well as companies have specific SOP's regarding social media, etc. That is the issue.

 

[akflightmedic]

Not necessarily... I have taken picture of car accidents, because when the trauma attending says "this guy is fine, why did you take him here instead of to the trauma center"? I can say "because he was unrestrained with a foot of intrusion into the driver's side door where he collided with the tree.... don't believe me? check out the picture I took of the car."

Oh Dr.P, did you seriously bring up this archaic mindset from 20 years ago??? I expect way better from you Sir. Yes a decade + ago we all had Polaroids on our unit to snap pictures so the trauma surgeon could get a glimpse of MOI, but in this day and age, a car could be completely demolished and due to awesome engineering, the passengers walk away. Or the opposite can happen and they get a love tap from behind and have a neck fx. How the car looks is damn near irrelevant...your assessment and your ability to convey the findings of your assessment is what is relevant. A picture is not a 1000 words, it is a distractor with no proven relationship between damage and injury. A competent medic or surgeon can get all they need without seeing your iPhone glamour shot.

 

[VFlutter]

The thing with HIPAA is that nobody that i know if actually fully understands it, even some of the docs. maybe @ERDoc could weigh in on that side. with while DrParasite said, is true and legal. While i'm not entirely sure that i would want to do it. Like previously stated since it is not universally understood, that means IF and a big IF the case goes to court it will be a toss up. While this may seem out in left field i also think that it is kind of relevant due to the fact everybody is willing to sue at the first opportunity.

This. Most people do not really understand and err on the side assuming everything is a violation. As long as is there is no clearly identifiable features, identifiers , or information then it is not a violation. Sometimes people can caught up with social media because if they post a picture that then has a time and date attached to it, it can fall into the reasonable assumption of a patient.

Many healthcare providers take pictures for educational purposes and it is totally fine if done correctly.

 

[ERDoc]

Moat people don't spell it right

Sorry, I couldn't let this little piece of irony go unmentioned. No harm intended PA, just found it funny.

Oh Dr.P, did you seriously bring up this archaic mindset from 20 years ago??? I expect way better from you Sir. Yes a decade + ago we all had Polaroids on our unit to snap pictures so the trauma surgeon could get a glimpse of MOI, but in this day and age, a car could be completely demolished and due to awesome engineering, the passengers walk away. Or the opposite can happen and they get a love tap from behind and have a neck fx. How the car looks is damn near irrelevant...your assessment and your ability to convey the findings of your assessment is what is relevant. A picture is not a 1000 words, it is a distractor with no proven relationship between damage and injury. A competent medic or surgeon can get all they need without seeing your iPhone glamour shot.

I agree with this but keep taking the pics. I enjoy seeing them once the pt is stabilized.

To address the OP, it doesn't sound like a HIPAA violation to me but like PA said, most of HIPAA is not understood, even by hospitals and lawyers. There was a local case a few years ago that I cannot get into the details of but several people lost their jobs over something that wasn't a HIPAA violation but the hospital wasn't taking any chances. When the HIPAA police come, if the hospital shows that they were proactive they will be punished much less.

 

[akflightmedic]

So keep putting our careers at risk, maybe look like an uncaring idiot to the surrounding public and possibly upsetting the patient for your post stabilization enjoyment?? Roger!

There are several departments in FL now since the Okaloosa incident where it is policy of NO cameras on duty. No cell phones in back of unit, no pictures on scene, etc. It is a new age

 

[Chef]

I would think that she has violated a company policy and not a formal HIPPA violation. Still cause for termination.

Pics to share MOI information to the ED staff = yes, then delete.
Pics to share on social media of any sort = NO, policy violation. Time to find a new job.

 

[akflightmedic]

Do you take pictures when someone falls from a ladder?
Do you take pictures when they tumble from a mobility scooter?
Do you take pictures when they slip and fall in the shower?
Do you take pictures when they trip over a tree root on a nature trail and twist their ankle or fracture a leg?

Does the medical staff "believe" your description for all those things above? Do they doubt why you brought them to one place over another? Are they able to confirm your findings? Are they able to determine extent of injuries from their own assessment in conjunction with what you shared with them?

If yes, then WHY do we need pics of car crashes? Why can the staff not "believe" you based on your report? Why can they not determine and confirm your findings and additional findings with their assessments and/or diagnostic equipment? It all seems to rest on this Holy Grail of a scene photo showing the MOI apparently...

 

[NysEms2117]

Does the medical staff "believe" your description for all those things above? Do they doubt why you brought them to one place over another? Are they able to confirm your findings? Are they able to determine extent of injuries from their own assessment in conjunction with what you shared with them?

If yes, then WHY do we need pics of car crashes? Why can the staff not "believe" you based on your report? Why can they not determine and confirm your findings and additional findings with their assessments and/or diagnostic equipment? It all seems to rest on this Holy Grail of a scene photo showing the MOI apparently...

This all makes sense... and is very logical... However, I feel as if it would be safe to say that the majority of higher level providers on this forum REALLY know what they are talking about. Yes, i know there are always smarter and more experienced people, BUT I think if you looked on the big scale that sometimes (above 30-40% of the time) the ER's get a "bs" report. Not everybody in EMS truley cares about everything that happens to the patient. I know there will be bad apples with every Bushel. I feel as if pictures can help confirm a diagnosis, but not make one.
**This is my opinion, I am not a high level provider, I have Limited experience in EMS**

 

[akflightmedic]

So WHO do you show the picture to before you leave? The one nurse taking report? The entire trauma team if it is significant? Chase down the doc if less severe? What if it is shift change? See my point?

I do NOT have limited experience, I am somewhat informed and practiced. My whole point to taking it this far is A) to show that with any good clinician, the picture is irrelevant (even with a bad one, it is still relatively irrelevant) because the injuries present themselves and B) since there is little value to a picture, why put yourself in a position to get blame or termination?

 

[NysEms2117]

Again, like i said my experience in the EMS field is very limited. If it was me, I would not take any picture with any relative info on it (license plate, face, even badge of a car.) I would try to focus on any intrusions to the car. I would show it to the nurse, or whoever would see it to give the patient the best "effort" i had. Now, this is going to be a bit out there, but hear me out. The old saying of "better to have it and not need it, then need it and not have it" is what i think of here. Granted I AM NOT taking 30 pictures of the car, simply 1-2 where i feel there could be some effect on patient care. Worst case scenario, nobody knows you took a picture aside from yourself and maybe your partner(poof deleted). Yes, i know the argument to that is to trust your workers, but honestly thats what any company has to do every single day. If there are news cameras and all that I'm going nowhere near taking pictures of anything, because at that point if the Doc wants a picture say "turn on channel xyz".

FOR ME, it is most likely in-experience talking, and i would rather have a picture to show the doctor or nurse or whomever is there (just to back up what I did). Granted i will never be the high level of practitioner where i currently work. Not trying to step on toes, just throwing out how i see it.

 

[akflightmedic]

I absolutely understand what you are saying and hope you entertain further dialogue. If so, explain to me what care you would render that would be questionable to others without that picture proof?

As stated earlier, I have had low speed impacts which required a trauma alert and I have had high speed roll overs where everyone walked away with shaky knees and nothing more. Does a picture impact the care I would render in either of those scenarios? Would it impact the care a team in the hospital would give? Let's say you took a picture of that low impact crash and the hospital staff was unimpressed. The patient complains of some benign symptoms but the treating team goes in a different direction (unlikely) or forgets your picture 30 seconds after you show it? What have you accomplished with the picture?

At what point do you stop patient care and take pictures? Is the risk you place yourself at greater or less than the care of the patient? Is your job/career worth stopping what you are doing, taking pictures on the off chance that it "might help"? In this day and age with the awesome engineering of most vehicles, your picture is worthless. Now take it further...general public sees you and complains or takes a picture of you taking a picture and gets it on the news or the patient complains, or your partner rats you out.

And finally, how do I as an employer know that you deleted the picture on your personal phone? What risk and liability have you put ME (the company or service) at all over a picture?

To me these are great questions and very real possible scenarios...risk versus gain. Risk is VERY heavy in a scene picture taking equation....

 

[NysEms2117]

Well as an EMT-B on an ALS rig, in the eyes of the law, i provide no care, i assist my paramedic partner in providing care. Personally i would not take a picture unless i felt it could do justice. If you have a low speed accident and the patient is really bad, would i take a picture- no, why? because of exactly what you said, it would not be beneficial to patient care. BUT my other point to that is that verbal communications with the ER wont get you much farther, you can explain all of what the patient has, but the MOI as a low speed MVA from what i have gathered experience wise, would remain near the same level of care. Repeating what i said earlier in this post, i think we are in different shoes, I am an EMT-B, and not the primary provider, MOST CERTAINLY not on an ALS rig. Where i work it is a 3 person team, more specifically the crew i usually work is an EMR-driver, EMT-me, CC Medic- main provider. I also completely agree with you they are on their way out, due to the fact a car can crumble down to a box, and the passengers walk away with nothing more then a scratch.

And finally, how do I as an employer know that you deleted the picture on your personal phone? What risk and liability have you put ME (the company or service) at all over a picture?

You don't, but then again what does an employer really know. When im in the field does the state know if i kicked in a door properly? Do they know if i "apprehended according to protocols"? Do they know what really goes on in the field? How would they even know you took a picture?
This may also be me working in LE, and having the paranoid feeling all the time. I said this yesterday in this thread (i think, was a long day yesterday) I dont take videos running after my parolees, or fugitives. As long as there is NO identifiable information about the accident or whatever you feel the need to photograph, i feel as if it meets the following criteria of:
1. In your judgement you feel it will benefit the patient by taking the picture
2. You feel it can help CONFIRM, not MAKE the diagnosis in the ER
3. You are not putting yourself in danger taking the picture(Crossing the highway to do it or something absurd), i understand any first responders job is inherently dangerous, but i feel as if you can make the link of what i'm talking about.
4. Your not deliberately putting yourself in a ****ty situation by doing it (walking past a news camera or something along those lines) to take the picture

*my post does not reflect my employer, I follow all proper protocols to the best of my ability while representing said employer*

 

[Reynolds One]

ENOUGH with taking pictures and posting on social media!

To me, whether or not this is a true HIPAA violation that warrants someone getting fired is irrelevant. Put the damn camera away. It's not professional. Period.

 

[Tigger]

I take pictures on scenes all the time and I post them on social media! Of course I am also the social media coordinator, so that sort of falls into my purview. How else do we expect the public to know what we do?

It's never a priority, but if there are enough resources on scene or we aren't going to transport, you bet I'll be getting pictures of a TA, tech rescue, flight transport, or other such things. I assigned someone to take photos on our last backcountry rescue (mostly because that person was not being useful, but still). I don't take pictures of patients, license plates, or identifiers and use some professionalism (no fatals etc), but EMS has an image problem and if we want community support, we need to show them what we do. Unequivocal nevers help no one.

 

[ERDoc]

So keep putting our careers at risk, maybe look like an uncaring idiot to the surrounding public and possibly upsetting the patient for your post stabilization enjoyment?? Roger!

Yes, this is what you should be doing because it is all about me.

Pictures will never change the management of a pt in the ER. I am going to base my treatment on the pt exam and not the pictures. Obviously there are times when MOI is hugely important (GSW, stabbing, falls) but as others have said, with the safety built into cars now, cars can be demolished and people walk away unharmed.

 

[NysEms2117]

Yes, this is what you should be doing because it is all about me.

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