Privacy Violation???- How to deal....

MedicPrincess

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Ok...not sure this is the right spot, but I don't think I ever posted in this area, so I choose it :)

We just had a HUGE Privacy Act violation at the ER I work in. There were to people being registered for similar conditions - "I think I am in Labor." I was the registrar on one lady, I will call Patient A and another girl had Patient B. Well Patient B was finished before Patient A and sent on her merry way. The girl registering Patient B some how decided it would be ok to lean over and begin a converstion with Patient A ABOUT Patient B - her name, her symptoms, her due date, and the number of babies she was carrying. In the most tactful way I could, I kept interrupting, until finally I had to stand up and take her out of the room so to speak. So, anyway, there is the big uproar about it at our facility....and that got me to thinking...

When 911 activates they dipatch the appropriate units to where they need to be (obviously). Now our dispatches will go something like this "Sta 17, Med 101, Delta Response to 123 Smith Street for Difficulty Breathing.” Once the first Fire Unit gets in service, or as soon as practical – depending on the call- they will proceed with patient information – something like “Sta 17, Med 101 your responding to a 50 y/o F, c/o Diff Breathing. Patient is turning color, clammy, dizzy, ect” whatever they find pertinent, including whether or not Sheriff’s Department in en route (for suicide attempts, assaults, OD’s, ect).

Now everyone knows most of the county has scanners. Is there a better way, perhaps a digital pager system that your departments use? It would seem that this could get to be a huge liability for our systems if we go to say 123 ABC street for a suicide attempt, or assault, or even a regular difficulty breathing call and the people at 121 ABC street have a scanner and now the whole neighborhood knows that the people at 123 ABC street have problems.

I am sure this has been discussed all over the place. How do we protect the privacy of those calling 911 when the call has to be dispatched some how? Do any of you have a preset list of Signal codes, or 10 codes, for the type of call? How much patient info over the air is to much in the initial dispatch? I would say the only the “FORBIDDEN” is stating over the air a patient is HIV/HEP or any other disease positive. They cannot say that, at all, even if the patient volunteers it. Instead they use a Signal 99.
 

Chimpie

Site Administrator
Community Leader
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Yes, some depts have 10 Codes/Signals. Some use digital/alpha pagers. Some are just told to look at their computer screens.

I believe alpha pagers work best because all the info is saved on the pager till you erase it.
 

ffemt8978

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My understanding of this is that anything that goes to the 911 call center is a matter of public record, so HIPAA does not apply. Most agencies have adopted the address and symptoms method of dispatch, "Unit 123, respond to 101 Main St. for Chest Pain" and do not broadcast the patient name. It only becomes a HIPAA violation if the information broadcast relates to a specific, identifiable patient.

On a similar note, I've filed complaints with a couple of local hospitals for the way their ER's want their run reports broadcast. Basically, at the end of your report (via radio, cell phone or however) they insist that you broadcast to them the patient's name and date of birth. Keep in mind, this is over an unencrypted radio frequencty that any scannerhead can listen to. The hospitals answers have always been, "We'll look into it."
 

rescuecpt

Community Leader Emeritus
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We use EMD (10-Charlie-6 type of thing), which most people with scanners (even those of us who do this alot) can't figure out too easily, unless you have the EMD cards next to your scanner. ;)

My ambulance corps is piloting a program where the information is received on a printer in the dispatch office, rather than over dispatch radio. For now, they are doing both (until they are sure the printer system works properly) but it seems like a good way to protect privacy. More than that though, it's nice to have everything on a printed sheet. We rigged the printer to make 2 copies, one for dispatch, one for us. It has the address, nature, name (if known), cross streets, and a little narrative (you are responding to a 77 yo female complaining of chest pain. Patient has cardiac history. Enter through side door on house. etc).
 

emtI

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There is a section in the HIPAA regulations that govern what is called "incidental disclosures". The information that is sent out over the dispatch radio is what we need to handle the call. There are some agencies that have encrypted freq's, but we don't. We are a small rural volly service, of which I am the HIPAA officer. Anything that we need to properly and safely respond to a scene and to treat the patient is allowed to be given over the radio. if dispatch has sensitive info that they feel doesn't need to go over the air, and they have time to call us, they do. If we are sent to a remote location in our 700 square mile rural coverage area, and we need the name of the residence, we ask for it. It is what we need to get to the patient, and is therefore allowable, and is NOT a HIPAA violation. We do have a cell phone in the unit that we sometimes use if need be, but there are areas of our county with dead spots that we get no reception in, so we have no choice but to use the radio.

The HIPAA regulations only apply to covered entities. As a generality, most dispatch centers are not covered entities unless they are a part of your organization, and even then I think you can determine the dispatch portion to be a hybrid entity, and therefore not applicable.

Where HIPAA comes in is once we receive the protected health information (PHI) it is our responsibility to protect the privacy and security of that information.

HIPAA is not meant to hinder patient care in any way. It is meant to protect the information we receive from being released inappropriately.

I have had hospitals ask for specific identifiable patient information, and if I have time and access, will phone it in. If not, I just politely tell them that I will relay that to them on arrival, or I will radio dispatch and ask them to please phone the hospital and let them know who we are bringing in.
 

Jon

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#1 thing of HIPPA.... IT IS NOT SUPPOSED TO "GET IN OUR WAY" WHEN IT COMES TO PATIENT CARE... I can't say how many RN's and ADON's I've had fights with working transport.. taking someone on even a "routine" transfer. I'm sorry... I NEED to know the story with this patient, in case something changes, and I have to divert.

Princess... what you describe is a B.F.D. - if you or ANYONE who SAW IT HAPPEN report it, the agency will be fined big time.,,

As for radio transmissions... we can't control "scanner land" and dispatch must give us certain info.

My county uses voice pagers (Minitor III, IV, V) and MDC's in the trucks, as well as an 800 MHZ trunking system for radios.

Sample Fire Dispatch (Structure fire) "Station 52, 53, 55 Ambulance. 123 Main Street, Cross streets Walnut and Oak, The Murphy Residence, Westtown Township, A House, Box 5205" then it repeats

Sample EMS Dispatch "Station 33 ambulance, Medic 92. Hickory House Nursing Home, 800 W. Walnut street, Cross streets Elk and Elm, Rm 320, West Caln Township, Respitory Difficutly" Then it repeats

Fire Dispatches sometimes get "residence" names.... EMS usually dosen't.

With EMS... usually gathered by calltaker - Agen, Sex, Onset, Med Hx, Meds...

MDC reads "90 y/o F, Fall this AM, now unresponsive. Hx High blood Pressure, Heart problems, stroke. On meds, has taken...."

OR... 16 y/o M, threating to slash his wrists with kitchen knife. Hx psych problems, on meds, unk. if taken"

Our calltakers often get info confused, and are horrible spellers :lol: :rolleyes: :eek: :rolleyes:

Dispatch will read ALL info over the radio if ALS or BLS unitrequests it b/c they don't have MDC or MDC is broke... (happens a lot :angry: :rolleyes: )

Jon
 

emtbuff

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When dispatch contacts us we know what we are possibly going to ex chest pain, MVA, and so forth. Along with the address. We seldom ask for names unless we are out in the country side trying to find the house. We usually have a police unit responding with us and lots of times if it is in town they are on scene or if it is out in the country we alot of times end up following them to the house. If we aren't familiar with where we are going from the get go we have asked dispatch for directions. But I agree with others that it is info that we need to know. Know for calling in a report to the hospital I alot of time say the age, gender, what is going on, vital, and ETA. As for scanner land we will never be able to control.
 

emtbuff

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I am currently right now going through about the same thing as you are EMTprincess as we had a call a while back for a transfer to a local hospital. Reson being is that it was an OB that was ready to go. and our small hospital doesn't do OB delivery. So anyhoo we get pt loaded pt is getting along pretty well and she told us before we even left after she found out who was going with she told us not to tell her parents as they didn't know. Well anyways found out the other EMT who was suppose to be watching the new driver drive (still on probation) ended up in the back cuz she thought she knew everything and she ended up kinda scolding the pt that we aren't delivering in the ambulance and she can't push you know just really inappropriate stuff where the other EMT and I were fine with it that if we had to deliver we would. So we drop her off head back home. Two days later I heard she had spilt the beans and the parents found out, now have been told the daughter did tell mom and dad but still dad was asked by the firechief how things were going and that came from the other EMT. So lots of stress and finding out the only thing she has happen is that she is to take a class over hippa again or something to the likes. I was not happy with this at all and as of right now am refusing to run with her.

So on a side note I am intrested in what your protocal says is disimplenary actions are to something like this.

Good luck EMTPrincess.
 

Jon

Administrator
Community Leader
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As for Socials and DOB.... inappropriate... WHY do they need that?? Age and Sex... unless DOB is part of a command call... like How old the newborn is...

For a hospital report.. I'll say... this is Jon with ____ Ambulance, I've got a 90 y/o F, fall from standing at Sunrise (Asst. Living) -LOC, -anti-coagulatns, -neck/back pain, Facility wants them evaluated for 1" lac aboe right eye. Vitals are stable, see you in 5... any questions??

No HIPPA violations, and it's over in 45 seconds.


As for "Mom-to-be" Steve Berry did an intresting editorial on this a few months back in Jems... his cartoon "Ma'am, we found the source of your daughter's abdominal pain" while holding an infant....

Remember, a child who is pregnant, is an adult in matters of her / her baby's health.... you aren't allowed to tell her parent anything!

Jon
 

emtbuff

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Remember, a child who is pregnant, is an adult in matters of her / her baby's health.... you aren't allowed to tell her parent anything!

Yep they are adults our was a legal adult cuz she was over the age of 18.
 
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