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

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

[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.

why is the school nurse a random busybody but not ER nurses?????? They have the same/equivalent credentials in providing care to your child, so why the disrespect?

Good thing that privacy laws exist so nobody needs to justify protecting their privacy to you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

How is ER follow-up assessment not care relevant to the ER records about the visit in questions? That's what follow-up by a trained professional is.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, do you tell your pediatrician whenever you have an ER visit? Have you gotten their thoughts on whatever issues that are bringing you to the ER? Your Ped will be more helpful than us about your child's health care (and as goes without saying, should be the first point of contact on their care and should know about all ER visits).

What? OP has not asked for help about their child’s health care. She had a specific question about school notifications. That’s it. There’s no need for you to dive into the health conditions of her children or think you need to provide advice about the medical conditions.

Well, it seems like for some reason, Children's National/the nurse has flagged this family as somehow needing more care beyond ER visits. That's why the nurse is calling.

OP says she was told this is a blanket policy to inform DCPS. The proper professional to flag for follow-up/continuity was the child’s ped at CP&A, and I’m sure OP was fine with that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

How is ER follow-up assessment not care relevant to the ER records about the visit in questions? That's what follow-up by a trained professional is.

Because, once again, HIPAA does NOT allow disclosure to any medical professional they want. Just the care team. The school nurse is NOT by default a member of my child’s care team for all purposes. Otherwise the ER could send your records to any random healthcare professional.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

Legal definition of Treatment means the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another.

So yes the hospital can inform the school nurse and the nurse can follow up to ensure that you've done follow up visits in regard to your child does in fact meets the legal definition of treatment.

school nurse isn't a random healthcare professional btw They do vision and hearing screenings for every child in the school, manage those annual health forms that are apart of re-enrollment.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

How is ER follow-up assessment not care relevant to the ER records about the visit in questions? That's what follow-up by a trained professional is.

Because, once again, HIPAA does NOT allow disclosure to any medical professional they want. Just the care team. The school nurse is NOT by default a member of my child’s care team for all purposes. Otherwise the ER could send your records to any random healthcare professional.

Do you think it actually says "care team" in the HIPAA regulation? Go back and read what it actually says, not what you think it says.

I'm all for people changing HIPAA if they feel it is incorrect or insufficient, but you can't change it just by metaphorically stamping your foot.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, do you tell your pediatrician whenever you have an ER visit? Have you gotten their thoughts on whatever issues that are bringing you to the ER? Your Ped will be more helpful than us about your child's health care (and as goes without saying, should be the first point of contact on their care and should know about all ER visits).

What? OP has not asked for help about their child’s health care. She had a specific question about school notifications. That’s it. There’s no need for you to dive into the health conditions of her children or think you need to provide advice about the medical conditions.

Well, it seems like for some reason, Children's National/the nurse has flagged this family as somehow needing more care beyond ER visits. That's why the nurse is calling.

OP says she was told this is a blanket policy to inform DCPS. The proper professional to flag for follow-up/continuity was the child’s ped at CP&A, and I’m sure OP was fine with that.

That's why I was asking. The OP hasn't actually said anything about what she is telling her pediatrician.

[Anonymous]

PS: It allows communication without need for consent to other qualified personnel "for treatment purposes." Specifically, HIPAA "allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school."

The school nurse provides care to the student while the student is at school. If the student is nauseated again, or develops a rash, or gets dizzy, or has wound drainage leaking through the bandage, or whatever else is covered in the ED discharge plan as return precautions or things to look for, they will be taken to the school nurse.

That is how school nurses work.

That is what HIPAA allows in communication. if you don't like it, please, feel free to advocate to change the law. But you can't change it if you don't understand it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, do you tell your pediatrician whenever you have an ER visit? Have you gotten their thoughts on whatever issues that are bringing you to the ER? Your Ped will be more helpful than us about your child's health care (and as goes without saying, should be the first point of contact on their care and should know about all ER visits).

What? OP has not asked for help about their child’s health care. She had a specific question about school notifications. That’s it. There’s no need for you to dive into the health conditions of her children or think you need to provide advice about the medical conditions.

Well, it seems like for some reason, Children's National/the nurse has flagged this family as somehow needing more care beyond ER visits. That's why the nurse is calling.

So? Again the OP hasn’t asked for help about their child’s health care so there’s no need to be commenting about the child’s needs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

Does the HIPAA Privacy Rule allow a health care provider to disclose protected health information (PHI) about a student to a school nurse or physician?
Yes. The HIPAA Privacy Rule allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school. In addition, a covered health care provider may disclose proof of a student's immunizations directly to a school nurse or other person designated by the school to receive immunization records if the school is required by State or other law to have such proof prior to admitting the student, and a parent, guardian, or other person acting in loco parentis has agreed to the disclosure. See 45 CFR 164.512(b)(1)(vi).- source HHS.gov

https://www.hhs.gov/hipaa/for-professionals/faq/517/does-hipaa-allow-a-health-care-provider-to-disclose-information-to-a-school-nurse/index.html

that does NOT give blanket permission to disclose to the school nurse for any reason. the nurse has to be actually providing care to the student relevant to the records. Childrens deputizing the school for ER follow ups ain’t it.

The nurse stationed in DCPS schools is not a school employee, has direct access to the CNMC health records when needed, has a CNMC email addresses, and no access to school records. While I don't know the specifics in this situation, if OP situation required a follow up by a nurse, it could make sense that this be the nurse in the school. As others have mentioned, the nurse following up is not going to be the same exact person who you saw in the ER. Why couldn't it be someone employed by the same hospital, with the same credential? It's not like it was deputized to a classroom teacher.

[Anonymous]

Anonymous wrote:PS: It allows communication without need for consent to other qualified personnel "for treatment purposes." Specifically, HIPAA "allows covered health care providers to disclose PHI about students to school nurses, physicians, or other health care providers for treatment purposes, without the authorization of the student or student’s parent. For example, a student’s primary care physician may discuss the student’s medication and other health care needs with a school nurse who will administer the student’s medication and provide care to the student while the student is at school."

The school nurse provides care to the student while the student is at school. If the student is nauseated again, or develops a rash, or gets dizzy, or has wound drainage leaking through the bandage, or whatever else is covered in the ED discharge plan as return precautions or things to look for, they will be taken to the school nurse.

That is how school nurses work.

That is what HIPAA allows in communication. if you don't like it, please, feel free to advocate to change the law. But you can't change it if you don't understand it.

So this seems like the answer to OP's question. There wasn't a violation of HIPAA.

[Anonymous]

Actually, when I go back and read it, OP wasn't asking about HIPAA. They were asking about whether anyone else had been contacted by the school nurse after they brought their kid to the ER.

It doesn't sound common, from the replies, but perhaps other people don't take their kid to the ER with the frequency of OP.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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.

Disagree. The Childrens ER can do their own follow up. If there are actual concerns about abuse then call CFSA not school. The school is not part of my child’s medical team, period.

I don't know what part you're disagreeing with. No Children's ED staff, which are already completely overwhelmed with wait times currently exceeding TWENTY HOURS, cannot follow up with you personally if their first efforts fail because you don't want your kid's school nurse to know whatever is going on. Everything else I typed above is factual and not something you can disagree with. Also, I did not accuse you of abuse... I said that CNMC staff may have been concerned that you would not follow up. Obviously it's appropriate for there to be a middle ground between doing nothing if they can't reach your pediatrician and reporting you to CPS.

[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.

It's not being shared with the school which includes admin and teachers it's being shared with the nurse who is covered under HIPAA law. Nurse still has to maintain medical records and privacy laws even when working in a school based location. They did their job making sure your child is okay and you're mad about it, so get over it.

wrong. when it goes to the school it becomes a FERPA record and can be disclosed to anyone with a “legitimate educational interest.”

That would be true if it was shared with a school employee. The school nurses in DC are not school employees. They are employees of CNMC. As a former DC teacher, I can tell you there there are lot of restrictions on what they can share with school staff because of this.