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

[Anonymous]

Anonymous wrote:I think there is some confusion here about HIPAA. I'm pretty sure this type of use/disclosure (I'm not sure what the legal difference is) is allowed for "treatment". It's coordination of care.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html

A covered entity may, without the individual’s authorization:

Use or disclose protected health information for its own treatment, payment, and health care operations activities.
For example: A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual’s treatment.

seriously doubt the school nurse is a health care provider under HIPAA. I have never consented to care for my child by the school nurse.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think there is some confusion here about HIPAA. I'm pretty sure this type of use/disclosure (I'm not sure what the legal difference is) is allowed for "treatment". It's coordination of care.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html

A covered entity may, without the individual’s authorization:

Use or disclose protected health information for its own treatment, payment, and health care operations activities.
For example: A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual’s treatment.

seriously doubt the school nurse is a health care provider under HIPAA. I have never consented to care for my child by the school nurse.

You can read the full text of the legislation. Definitions are included, and there is a FAQ that specifically addresses the "school nurse" role. I don't know how it can be more clear.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think there is some confusion here about HIPAA. I'm pretty sure this type of use/disclosure (I'm not sure what the legal difference is) is allowed for "treatment". It's coordination of care.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html

A covered entity may, without the individual’s authorization:

Use or disclose protected health information for its own treatment, payment, and health care operations activities.
For example: A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual’s treatment.

seriously doubt the school nurse is a health care provider under HIPAA. I have never consented to care for my child by the school nurse.

LOL!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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[/b], physicians, or other health care providers [b]for treatment purposes, without the authorization of the student or student’s parent.

You are assuming, by citing this provision, that the school nurse is treating the kid for the same condition. You don't have any facts to support that. it may be the case that the school nurse is going to "treat" the kid on the school property -- or might be called upon to do so. Or not.

If the kid went to the ER to have a raisin removed from his nose, then you cannot make a credible claim that school nurse will continue the plan of care when school resumes on Monday and continue to "treat" the now-removed nose raisin. There's nothing to treat.

OP would have to be willing to divulge what the medical issue was that was treated in the ER to make a call on this.

Are you not familiar with what "return precautions" and a "discharge plan" are? Literally every ED discharge has them. It's standardized paperwork, usually. Sometimes modified but always present.

This is exactly why the DHHS made FAQ sheets.

I can assure you, the discharge plan never includes the school nurse in its to-do list.

Take medication as directed. Report to the lab in one week. Change dressing when it is saturated or soiled.

Follow up with your provider who is not the school nurse in 3 days.

Report any continued bleeding / dizziness / vomiting etc etc to your provider who is not the school nurse.

I write discharge plans. The contract DCPS school nurse is not implicated, implicitly or explicitly, in discharge planning.

I'm not sure who you think is looking at the dressing to see whether it is saturated or soiled, or to check if there is bleeding, or vomiting, or what have you, when the kid is at school. (?)

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think there is some confusion here about HIPAA. I'm pretty sure this type of use/disclosure (I'm not sure what the legal difference is) is allowed for "treatment". It's coordination of care.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/disclosures-treatment-payment-health-care-operations/index.html

A covered entity may, without the individual’s authorization:

Use or disclose protected health information for its own treatment, payment, and health care operations activities.
For example: A hospital may use protected health information about an individual to provide health care to the individual and may consult with other health care providers about the individual’s treatment.

seriously doubt the school nurse is a health care provider under HIPAA. I have never consented to care for my child by the school nurse.

You can read the full text of the legislation. Definitions are included, and there is a FAQ that specifically addresses the "school nurse" role. I don't know how it can be more clear.

that FAQ only cites to a provision on immunization records.

School nurse is *not* providing ongoing care to my child - is not part of their medical team. Children’s ER apparently wants to outsource follow-up calls to the school nurses instead of doing it themselves. That is not a caregiving activity. This would suggest my OB could call my office nurse to discuss my HPV treatment and call me in for a follow up PAP.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

No, you can homeschool.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

also “for treatment purposes” is an important phrase. providers cannot disclose information to anyone they want and claim it was “for treatment purposes.” it has to be someone who is actually treating me/my child for the condition, with my consent. Otherwise they could send my information to any random health care professional who knows me. “Hey just thought you might like to encourage your neighbor to get a mammogram! Our records show she is overdue. We see you are a doctor so we thought you could help.”

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

also “for treatment purposes” is an important phrase. providers cannot disclose information to anyone they want and claim it was “for treatment purposes.” it has to be someone who is actually treating me/my child for the condition, with my consent. Otherwise they could send my information to any random health care professional who knows me. “Hey just thought you might like to encourage your neighbor to get a mammogram! Our records show she is overdue. We see you are a doctor so we thought you could help.”

Please read OP’s follow up post. You’re arguing a moot point. The consent for the school nurse was in the ER paperwork.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

also “for treatment purposes” is an important phrase. providers cannot disclose information to anyone they want and claim it was “for treatment purposes.” it has to be someone who is actually treating me/my child for the condition, with my consent. Otherwise they could send my information to any random health care professional who knows me. “Hey just thought you might like to encourage your neighbor to get a mammogram! Our records show she is overdue. We see you are a doctor so we thought you could help.”

Please read OP’s follow up post. You’re arguing a moot point. The consent for the school nurse was in the ER paperwork.

Apparently there was no ability to opt out.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

also “for treatment purposes” is an important phrase. providers cannot disclose information to anyone they want and claim it was “for treatment purposes.” it has to be someone who is actually treating me/my child for the condition, with my consent. Otherwise they could send my information to any random health care professional who knows me. “Hey just thought you might like to encourage your neighbor to get a mammogram! Our records show she is overdue. We see you are a doctor so we thought you could help.”

Please read OP’s follow up post. You’re arguing a moot point. The consent for the school nurse was in the ER paperwork.

Apparently there was no ability to opt out.

You can always cross out, initial and date, items you don’t agree with on medical or legal forms. Do you think every sentence on a consent form will offer an opt out option?

Always ask for a paper copy when presented with electronic consent forms.

The bigger issue imo is that this is an unexpected item in an ER form. When you are in the ER with a sick or injured kid, your brain is not going to be able to digest several pages of legal jargon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:This seems to be a violation of HIPPA unless you signed a form that unknowingly allowed Children’s to share info with the school. Even if your school nurse is contracted to Children’s your child was not their patient at Children’s. Therefore they shouldn’t have had access to the info.

On the contrary, HIPAA specifically excludes exchange of information between health care providers in the course of ongoing care for the same patient. This never requires a waiver. I can find the citation, if you would like.

But I don’t consent to “ongoing care” by the school nurse.

You consent to care by the school nurse by having your child attend the school where the school nurse works. Maybe you can opt out, or maybe homeschool. And HIPAA explicitly does not require your consent when there is communication between healthcare agents "for treatment purposes" -- not just the reatment purposes you want, or think are important.

Hey, argue with your congressional representatives. If HIPAA doesn't cover what you want, then argue for it to be supplanted or modified.

I don’t consent - school attendance is mandatory and required by law.

also “for treatment purposes” is an important phrase. providers cannot disclose information to anyone they want and claim it was “for treatment purposes.” it has to be someone who is actually treating me/my child for the condition, with my consent. Otherwise they could send my information to any random health care professional who knows me. “Hey just thought you might like to encourage your neighbor to get a mammogram! Our records show she is overdue. We see you are a doctor so we thought you could help.”

I've enjoyed reading this discussion; please don't ruin it by being purposefully obtuse. The child was seen by a health care provider and attends school which places her under the jurisdiction of another health care provider. HIPAA isn't just about protecting privacy; it's specifically set up to strike a balance between privacy and allowing an unobstructed flow of relevant medical information. You argue that the medical information is not needed. The nurse apparently thinks that it is. Having the process be more clear and potentially including a right to opt of this kind of sharing out might make sense. But that's very different from your health care provider randomly contacting a doctor in your neighborhood to suggest you get a mammogram. Surely you can see that.

[Anonymous]

I’m with you, OP. I don’t like this one bit and agree this is a violation of your child’s privacy. I would ask the hospital patient relations person to show you where exactly you signed the consent form allowing the ER to disclose your child’s medical information to the school nurse. What if the child was in the ER for a mental health issue?

[Anonymous]

OP again...so I did mention to the director person that 1) consent for sharing information with the school nurse should be more pronounced (instead of being co-mingled with all the other general consent info and 2) there should be an "opt out" option for any parent that doesn't want to use that service (as it stands now, there is not...unless you just cross out whatever section you object to).

I also mentioned to her that while there is a blurb about sharing info with the school nurse on the consent forms, there is absolutely NOTHING in the discharge paperwork that mentions that. As a matter of fact, our discharge paperwork explicitly says that parents are to follow up...if child doesn't have a PCP then parents should find one as soon as possible, etc. Nowhere does it mention that the school nurse will follow up or will act as a resource for the child/family after discharge...the school nurse isn't mentioned at all in our d/c paperwork.

I was also very concerned that they didn't see an issue with this being a blanket policy, and that they didn't have anyone in place to review the ER visits before calling school nurses and sharing what could be sensitive information about a child's health status. I asked if they had ever considered having the care managers call parents first (before calling the school nurse) just to confirm that they were ok with the school nurse being given the ER visit info, and she said they had not....but it's something she'd be willing to discuss with her team.