Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

HIPAA Education for EMS Week

Writing about the EMS Office Hours podcast, A Lighter Note On EMS Week, I mentioned that we might be better off spending our time on HIPAA Education. Let me explain.

HIPAA Education –

HIPAA (Health Insurance Portability and Accountability Act of 1996) is generally misunderstood. We should have a week just to educate hospital, nursing home, and doctors’ office staff about their obligation to share information with us.

If I am transferring care to someone else and I do not provide a report, including available information about medications, allergies, medical history, and current medical condition, I am abandoning that patient and my license may be restricted/suspended/revoked for that.

This is also true of a nurse or doctor telling me to just transport a patient because they have transferred care to the hospital.

If the patient has already been transferred to the hospital, then the patient must be already at the hospital and not on their property, so I am cancelled – Right?

Maybe that is not the best way to explain things. I could point out that not providing a report as part of pretending to be transferring care to me is something that the state nursing/medical board might take very seriously. The patient is in room X, is not transfer of care. A sealed envelope is not transfer of care.

If anything bad happens – this is EMS, so nothing bad ever happens – and I am not aware of allergies, medications, history, recent changes in treatment, or something else that might affect the patient’s response to my treatment, that is not going to look good.

I asked for report, but the nurse/doctor refused to provide information. At this point, something bad has happened, so I can point out that it would not have been good to delay on scene attempting to find out what is going on with the patient.

Fortunately, it has been a long time since I have dealt with a real refusal to provide information, but I do get some people telling me, The patient is in room X. I respond with, What’s going on. If they say, The patient needs to go to the hospital, I just start asking the questions that should get me the answers that would be a part of a real transfer of care.

I am polite, but I don’t start moving to the patient’s room, unless accompanied by someone giving me report. If they want the patient transported, and I am not even going into the patient’s room, they need to figure out a way to get me to transport their patient – and as long as the patient is in their facility, the patient is their patient. Most of the time, this is not an issue. Frequently, people seem to be surprised that I am asking questions – as if EMS does not usually do that. Maybe some of us do not, but is that any different from not giving report?

Then there is the other side of HIPAA Education –

We can educate people at the hospital about who is permitted access to information about patients we transported. Yes, we are included in that.

I know. There is no we in team, but who pays any attention to a cliché?

It may be necessary for your organization to make arrangements with a contact person to have a formal process to provide information, so that they know they are not providing the information to the wrong people. We are not the wrong people. We are entitled to that information.

One of the big problems with EMS is that too many of us work at getting the vital signs to look good at the time of transfer, even though we had to do things that will decrease the likelihood that the patient will have a good outcome.

Delayed on scene intubating to arrive with a tube that looks good.

Caused hypoxia while intubating to arrive with a tube that looks good.

Flushed out blood and clotting factor with a lot of fluids to arrive with a blood pressure that looks good.

Et cetera.

If we follow the outcomes of our patients (they are our patients, too) and read the research on the treatments we provide, we may not be so aggressive with harmful treatments. We may be more aware of what is best for our patients.

It is a mistake to claim that, We got the patient to the hospital alive, but they killed him.

If we follow up on what happens with the patient in the hospital, and why the patient receives the treatments provided, maybe we will understand more about patient care.

EMS is not about coming up with vital signs that look good for the QA/QI/CYA bureaucrats.

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Comments

  1. I agree with you, Sir. I’d be willing to bet patients would like for pertinent information to be provided to EMS for their safety and well being. It would be tempting to tell those unwilling to provide the report needed for the transfer that there may be no I in team, but there is a U in suck!