Care manager at children’s shared details of child’s ER visit with school

[Anonymous]

Anonymous wrote:

Anonymous wrote:Please leave the school out of it and work with the nurse and hospital directly if you feel the need to discuss further. The school has nothing to do with it because nurses don’t work for DCPS. School staff have enough on their plate and won’t be able to provide you with any information or next steps about this.

False. The records may have become school records covered by FERPA when they were transmitted to the school. OP has every reason to contact the school, particularly if the nurse has been pushy and inappropriate about it.

Nevertheless, certain activities, when performed by a school, could be subject to other provisions of HIPAA that concern electronic transactions. According to the preamble to the December 2000 final rules, "the educational institution or agency that employs a school nurse is subject to our (HIPAA) regulation if the school nurse or the school engages in a HIPAA transaction." HIPAA transactions are defined in the Code of Federal Regulations (CFR) as "the transmission of information between two parties to carry out financial or administrative activities related to health care," including submitting claims. However, consent must still be secured under FERPA before the records are disclosed.

For some items, both HIPAA and FERPA apply, including electronic transactions of PHI.

https://nces.ed.gov/pubs2006/stu_privacy/healthrecords.asp

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

Why do you think one excludes the other? HIPAA excludes "education records," but it does not become purely an education record just because it is physically located in a school.

The point is that is is also a FERPA record which means it can be further disclosed within the school at the discretion of random busybody nurse. It compounds the invasion of privacy.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

Why do you think one excludes the other? HIPAA excludes "education records," but it does not become purely an education record just because it is physically located in a school.

The point is that is is also a FERPA record which means it can be further disclosed within the school at the discretion of random busybody nurse. It compounds the invasion of privacy.

If there is a record that falls under both FERPA and HIPAA rules, then both must be satisfied

The regulations follow the porting of the information, not the physical document. There is no photocopy created as a "FERPA record" that goes into the FERPA drawer or something, that can be accessed legally by more people just because it sits in a different drawer. It's still HIPAA protected.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think OP has exposed themselves as an attention seeker, is leaving out essential information, and the child has an open CFSA/Medical flag. From the details provided and reading between the lines, my gut is telling me that OP is leveraging a very stretched perception of what HIPAA is to mask the fact that the child has been flagged for possible need of extended support/care.

Using term "care manager" in the title of the post masks the fact that it was a Social Worker from the hospital that contacted the school nursing program to ensure follow up with the family, for whatever reasons/flag that may have been conveniently left out by the OP.

Multiple visits to the ER for certain reasons can definitely trigger a CFSA investigation without your knowledge, depending upon how a medical provider writes the evaluation or if the child has been flagged for possible medical neglect by Children's National. They can contact whomever they want to ensure the child's safety.

OP, your entitlement oozes through every inch of every response in this post. The energy you've exerted and time spent pestering the ED at your school about your child's health being followed up on, I hope you spend this much time actually addressing the underlying issues that would cause you to undermine a system put in place to protect children.

That’s a nice bit of fan fic there. Next time attempt to stay rooted in reality.

But yes, self-righteous fabulators like you are *precisely* why I keep
my kid’s records locked down.

At least there are no red flags anywhere at all in this thread.

There really are not. Just the normal DCUM thing of piling on a mom asserting rights. We are supposed to just accept what the system decrees.

I’ve probably taken my one kid to the ER maybe 9 times? Three croup (all severe enough for meds), one facial wound for stitches, one severe allergic reaction, two seizures, one suspected seizure, one episode of fainting/chest pain at school.

Of those nine I’d say 3 could have been handled at home (fainting, more mild croup, suspected seizure). But when you have one true ER worthy incident (croup with respiratory distress so bad they take them straight back, no waiting, for example) you tend to have a short trigger later. Also my ped did not have a nurse line at the time and there were no accessible urgent cares at 1am on Monday.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

Why do you think one excludes the other? HIPAA excludes "education records," but it does not become purely an education record just because it is physically located in a school.

The point is that is is also a FERPA record which means it can be further disclosed within the school at the discretion of random busybody nurse. It compounds the invasion of privacy.

If there is a record that falls under both FERPA and HIPAA rules, then both must be satisfied

The regulations follow the porting of the information, not the physical document. There is no photocopy created as a "FERPA record" that goes into the FERPA drawer or something, that can be accessed legally by more people just because it sits in a different drawer. It's still HIPAA protected.

My point is that the record becomes FERPA which allows disclosure to any school staff with a “legitimate educational interest,” which is an extremely subjective standard that gets violated all the time anyway in schools. That is not ok.

The miscarriage scenario was a good one. ER tells the nurse, nurse tells teachers, gossip spreads.

MANY work and edu organizations employ medical staff. I’m astonished that people truly believe that all their medical records are fair game for the company nurse. So you want your office to know about your abortion, STI screening, IVF attempts, psychological conditions? Obviously not. There is no intelligible principle here for disclosing everything to the school nurse other than the vague “part of the treatment team” that could be applied to any health care worker who knows you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

Why do you think one excludes the other? HIPAA excludes "education records," but it does not become purely an education record just because it is physically located in a school.

The point is that is is also a FERPA record which means it can be further disclosed within the school at the discretion of random busybody nurse. It compounds the invasion of privacy.

If there is a record that falls under both FERPA and HIPAA rules, then both must be satisfied

The regulations follow the porting of the information, not the physical document. There is no photocopy created as a "FERPA record" that goes into the FERPA drawer or something, that can be accessed legally by more people just because it sits in a different drawer. It's still HIPAA protected.

My point is that the record becomes FERPA which allows disclosure to any school staff with a “legitimate educational interest,” which is an extremely subjective standard that gets violated all the time anyway in schools. That is not ok.

The miscarriage scenario was a good one. ER tells the nurse, nurse tells teachers, gossip spreads.

MANY work and edu organizations employ medical staff. I’m astonished that people truly believe that all their medical records are fair game for the company nurse. So you want your office to know about your abortion, STI screening, IVF attempts, psychological conditions? Obviously not. There is no intelligible principle here for disclosing everything to the school nurse other than the vague “part of the treatment team” that could be applied to any health care worker who knows you.

I don't think you understand how it works when multiple regulations apply to a given document. I don't think I can help you with that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think OP has exposed themselves as an attention seeker, is leaving out essential information, and the child has an open CFSA/Medical flag. From the details provided and reading between the lines, my gut is telling me that OP is leveraging a very stretched perception of what HIPAA is to mask the fact that the child has been flagged for possible need of extended support/care.

Using term "care manager" in the title of the post masks the fact that it was a Social Worker from the hospital that contacted the school nursing program to ensure follow up with the family, for whatever reasons/flag that may have been conveniently left out by the OP.

Multiple visits to the ER for certain reasons can definitely trigger a CFSA investigation without your knowledge, depending upon how a medical provider writes the evaluation or if the child has been flagged for possible medical neglect by Children's National. They can contact whomever they want to ensure the child's safety.

OP, your entitlement oozes through every inch of every response in this post. The energy you've exerted and time spent pestering the ED at your school about your child's health being followed up on, I hope you spend this much time actually addressing the underlying issues that would cause you to undermine a system put in place to protect children.

That’s a nice bit of fan fic there. Next time attempt to stay rooted in reality.

But yes, self-righteous fabulators like you are *precisely* why I keep
my kid’s records locked down.

At least there are no red flags anywhere at all in this thread.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The health care providers, the ER case managers and the school nurses, see themselves as part of the same team, both are part of managing the care - they just work in different physical locations. One who works in a location where there is easier access to follow up with the child. It isn't really any different from a follow up from the ER to see how the child is doing. There is sharing of information within a healthcare team but you can't share that outside the health care team. The school nurse can't share anything with anyone else at the school and likely all health information is in an electronic documentation system that is the same system being accessed in the ER or remotely from whereever the health care teams work.

There would be a major privacy issue if the school nurse shared any information with the school or anyone outside of the health care team. The fact she is physically located inside the school is typically about ease of access to the children - it makes no difference in terms of what information she has access to or who she can share it with. It would be the same if she was physically located in a community health center or at a hospital or anywhere else.

Healthcare legislation and policy also has implied consent built in - that anyone who needs the information within the team to provide care can access it. For example, at the ER, you don't have to give express consent to each health care provider and they can share information and read the EHR if they are providing care.

The only real potential issue here is the blanket policy. The nurse located at the school has been given the role and responsibility to assess all the files and determine who needs follow up. However if not that nurse, then another nurse would be taking on that same role of assessing files of children who came to the ER to determine if follow up is needed. Neither would have been people actively providing care in the ER. Blanket policies however can be an issue at times and they should revisit the roles and responsibilities of each on the team.

Disagree. The school nurse is not in every instance a “member of the care team.” There absolutely is no implied consent that every medical/psychiatric visit my child makes results in implied consent to share the health record with the school. And once it goes to the school is is covered by FERPA not HIPAA, which means that some random school nurse could decide that my child’s medical records could be shared with teachers without my consent.

The Children’s ER is outsourcing its followup to the school nurses who are working for the school. Not OK.

Why do you think one excludes the other? HIPAA excludes "education records," but it does not become purely an education record just because it is physically located in a school.

The point is that is is also a FERPA record which means it can be further disclosed within the school at the discretion of random busybody nurse. It compounds the invasion of privacy.

If there is a record that falls under both FERPA and HIPAA rules, then both must be satisfied

The regulations follow the porting of the information, not the physical document. There is no photocopy created as a "FERPA record" that goes into the FERPA drawer or something, that can be accessed legally by more people just because it sits in a different drawer. It's still HIPAA protected.

My point is that the record becomes FERPA which allows disclosure to any school staff with a “legitimate educational interest,” which is an extremely subjective standard that gets violated all the time anyway in schools. That is not ok.

The miscarriage scenario was a good one. ER tells the nurse, nurse tells teachers, gossip spreads.

MANY work and edu organizations employ medical staff. I’m astonished that people truly believe that all their medical records are fair game for the company nurse. So you want your office to know about your abortion, STI screening, IVF attempts, psychological conditions? Obviously not. There is no intelligible principle here for disclosing everything to the school nurse other than the vague “part of the treatment team” that could be applied to any health care worker who knows you.

I don't think you understand how it works when multiple regulations apply to a given document. I don't think I can help you with that.

Did you even read the link? It pretty clearly said the health records become FERPA in school. HIPAA applies in limited scenarios. If you have something to substantiate that the FERPA disclosure rule does not apply (legitimate educational purpose) please post that link.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I guess I was so caught off guard because we've been to the ER dozens of times with each of our kids and were never contacted by the school nurse after a visit until now.

This jumps out at me. If you've been at the ER dozens of times for multiple kids without diagnoses, then something is really wrong. I can totally see them calling in extra support.

This is the OP again....please don't be a jackass. Yes...we've been to the ER DOZENS of times...ear infections, asthma attacks, allergy flare ups, sprained ankles, strep throat, ingrown toenail, suspicious rashes, food poisoning, spider bites, covid testing, stomach viruses, respiratory viruses, concussions, chicken pox...and more. Anybody that judges a parent for getting the appropriate medical care for their child is a moron....

You went to the ER for an ingrown toenail?

OP, do your kids have pediatricians? Do they have a nurse on call service? Do you use it?

Seriously this post makes me think that you are in need of exactly the kind of wrap around service DCPS is providing.

Rule of thumb, especially these days. is to avoid the ER at all costs unless it is an actual emergency. You’re the reason our friends’ recent visit to Childrens ER for their 3 year old took 12 hours.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think OP has exposed themselves as an attention seeker, is leaving out essential information, and the child has an open CFSA/Medical flag. From the details provided and reading between the lines, my gut is telling me that OP is leveraging a very stretched perception of what HIPAA is to mask the fact that the child has been flagged for possible need of extended support/care.

Using term "care manager" in the title of the post masks the fact that it was a Social Worker from the hospital that contacted the school nursing program to ensure follow up with the family, for whatever reasons/flag that may have been conveniently left out by the OP.

Multiple visits to the ER for certain reasons can definitely trigger a CFSA investigation without your knowledge, depending upon how a medical provider writes the evaluation or if the child has been flagged for possible medical neglect by Children's National. They can contact whomever they want to ensure the child's safety.

OP, your entitlement oozes through every inch of every response in this post. The energy you've exerted and time spent pestering the ED at your school about your child's health being followed up on, I hope you spend this much time actually addressing the underlying issues that would cause you to undermine a system put in place to protect children.

That’s a nice bit of fan fic there. Next time attempt to stay rooted in reality.

But yes, self-righteous fabulators like you are *precisely* why I keep
my kid’s records locked down.

At least there are no red flags anywhere at all in this thread.

The OP will never see it, sadly.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:
I guess I was so caught off guard because we've been to the ER dozens of times with each of our kids and were never contacted by the school nurse after a visit until now.

This jumps out at me. If you've been at the ER dozens of times for multiple kids without diagnoses, then something is really wrong. I can totally see them calling in extra support.

This is the OP again....please don't be a jackass. Yes...we've been to the ER DOZENS of times...ear infections, asthma attacks, allergy flare ups, sprained ankles, strep throat, ingrown toenail, suspicious rashes, food poisoning, spider bites, covid testing, stomach viruses, respiratory viruses, concussions, chicken pox...and more. Anybody that judges a parent for getting the appropriate medical care for their child is a moron....

You went to the ER for an ingrown toenail?

OP, do your kids have pediatricians? Do they have a nurse on call service? Do you use it?

Seriously this post makes me think that you are in need of exactly the kind of wrap around service DCPS is providing.

Rule of thumb, especially these days. is to avoid the ER at all costs unless it is an actual emergency. You’re the reason our friends’ recent visit to Childrens ER for their 3 year old took 12 hours.

PP again. I saw that the ingrown toenail required surgery and that you went to the ER when it was a true emergency. But the fact that it got to that point is surprising to me. It seems likely that you ignored less emergent signs that care or attention was needed.

Both of my kids have woken up with random high fevers (102 isn’t high BTW). When my toddler had a fever of 104+ in the middle of the night, I called the pediatrician, who advised several things to try to bring it down, and recommended only going to the ER if those things failed.

[Anonymous]

OP, I have two children, ages 9 and 5. We have been to the ER literally never. Beyond annual checkups, we have called their pediatricians advice nurse countless times, had televisits if they need a prescription, gone to urgent care once in a case when my son would not stop vomiting and once when my other son had a bad cut. Urgent care is the place for MANY of the items on your list, others probably required a call to the doc.

The ER is for ACUTE emergencies: that means that they would lose their life or the use of some part of their body unless their was an intervention.

I agree that your family is on a CFSA list and you may suspect that and that's why you are freaking out.

[Anonymous]

Children's ED has a way to flag patients that they believe may not provide appropriate follow up care in cases where they deem it necessary. In your case, you probably didn't leave a primary pediatrician's name, or they called that doctor and they said you were no longer a patient, or they couldn't reach that doctor; as a result, they used this alternate means of follow up. In this context, the school nurse is considered part of your care team. FWIW whether it's because you're a frequent flyer or because of your lack of a primary care doctor or something else, CNMC is concerned about your children and acted on that concern to avoid a child falling through the cracks. You may not like that this happened to you, but this kind of process saves kids lives. I will also say with your no diagnosis from one incident, etc comment that the hospital may have been concerned that you're in denial about your kid's medical condition, which would absolutely trigger this kind of follow up.

[Anonymous]

Anonymous wrote:OP, I have two children, ages 9 and 5. We have been to the ER literally never. Beyond annual checkups, we have called their pediatricians advice nurse countless times, had televisits if they need a prescription, gone to urgent care once in a case when my son would not stop vomiting and once when my other son had a bad cut. Urgent care is the place for MANY of the items on your list, others probably required a call to the doc.

The ER is for ACUTE emergencies: that means that they would lose their life or the use of some part of their body unless their was an intervention.

I agree that your family is on a CFSA list and you may suspect that and that's why you are freaking out.

Totally agree. None of my kids has ever been to the ED. Most of the conditions you list require, at most, a visit to an urgent care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm a nurse case manager for an insurance company. If OP has been at the ER "dozens of times" for each kid, including for that laundry list of non-urgent concerns the she is a REAL OUTLIER. You don't do that kind of thing in a vacuum. I wouldn't be surprised if she trigged some sort of "frequent flyer" outreach from Childrens.

She's also the type of patient/parent who lands on my list for insurance-company based case management. You don't spend that type of money without the insurance company also saying "what is going on here?, this is not typical use. This person is inappropriately using the ER ---the diagnoses don't merit the level of care. We need to intervene in this to see if some education is needed'

none of which justifies a HIPAA breach, of course.

It’s a good thing there wasn’t one in this situation.