Privacy Officer's Roundtable

I would love to get your opinion on the practice of flagging charts when a patient/visitor acts in an aggressive manner.  Here are some hypothetical scenarios:

Scenario #1
Mr. Doe brings his wife to her doctor's appointment.  While in the waiting area, he gets into an argument with someone on his cell phone.  He is asked to lower his voice and becomes aggressive to the point where the police have to be called.

1. Is staff allowed to search their electronic health record database to see if Mr. Doe is a patient of anyone in its health system, and to flag his chart stating that he is aggressive?

Scenario #2
Now suppose Mr. Doe is the patient and after he acts in an aggressive manner toward the doctor, the doctor dismisses him for his practice.  The staff know that the patient has two upcoming appointments with different specialists. 

2. Are staff allowed to flag the chart stating that he is aggressive?
3. Are staff allowed to contact the specialists and let them know the patient is aggressive?
4. Are staff allowed to recommend that nobody in the entire health system see this patient? (except of course if the patient presents to the ED with a emergent medical condition)

Scenario #3

After his appointment with a neurologist, our poor Mr. Doe goes to the parking lot and begins stopping cars, banging on their hoods, and yelling at people that he is going to give them a citation.  Security is called and they try to de-escalate the situation, but it doesn't work.  Security then calls the police, but the patient leaves before the police arrive.  Security reports this behavior to the proper internal committee.

5. Is the internal committee allowed to search their electronic health record database to see if Mr. Doe is a patient of anyone in its health system to flag his chart that he is aggressive?
6. Is the internal committee allowed to report his behavior directly to the doctor?

Your input is greatly appreciated!

Thank you,
Cinda



​​​

------------------------------
Cinda
Compliance/Ethics & Privacy Director
Ohio
------------------------------

Scenario #1: The husband is not there as a patient so it's not appropriate in my opinion to search to see if he is a patient. The wife is the patient, so wouldn't a better alternative be flagging her chart noting that the person accompanying her may present a danger?

Scenarios #2: Yes I think that's fine if staff think safety is an issue, but it seems extreme. I've seen cases like that where the patient only had a beef with one physician and was charming to everyone else. 

Scenario #3: Yes I think that's fine and falls under TPO. Yes you can tell the doctor about it. Activities like this that occur in the parking lot are not PHI and even if they were the doctor is his treating care provider. ​​​

------------------------------
Brenda Manning J.D., C.H.C., C.H.P.C.
Privacy Director
Privacy Officer
Carilion Clinic

The views expressed herein are my own and do not represent those of my employer. They are not meant to constitute legal advice or create an attorney-client relationship.
------------------------------

Original Message:
Sent: 12-16-2021 03:15 PM
From: Cinda Kropka
Subject: Flagging Charts

I would love to get your opinion on the practice of flagging charts when a patient/visitor acts in an aggressive manner.  Here are some hypothetical scenarios:

Scenario #1
Mr. Doe brings his wife to her doctor's appointment.  While in the waiting area, he gets into an argument with someone on his cell phone.  He is asked to lower his voice and becomes aggressive to the point where the police have to be called.

1. Is staff allowed to search their electronic health record database to see if Mr. Doe is a patient of anyone in its health system, and to flag his chart stating that he is aggressive?

Scenario #2
Now suppose Mr. Doe is the patient and after he acts in an aggressive manner toward the doctor, the doctor dismisses him for his practice.  The staff know that the patient has two upcoming appointments with different specialists.

2. Are staff allowed to flag the chart stating that he is aggressive?
3. Are staff allowed to contact the specialists and let them know the patient is aggressive?
4. Are staff allowed to recommend that nobody in the entire health system see this patient? (except of course if the patient presents to the ED with a emergent medical condition)

Scenario #3

After his appointment with a neurologist, our poor Mr. Doe goes to the parking lot and begins stopping cars, banging on their hoods, and yelling at people that he is going to give them a citation.  Security is called and they try to de-escalate the situation, but it doesn't work.  Security then calls the police, but the patient leaves before the police arrive.  Security reports this behavior to the proper internal committee.

5. Is the internal committee allowed to search their electronic health record database to see if Mr. Doe is a patient of anyone in its health system to flag his chart that he is aggressive?
6. Is the internal committee allowed to report his behavior directly to the doctor?

Your input is greatly appreciated!

Thank you,
Cinda



​​​

------------------------------
Cinda
Compliance/Ethics & Privacy Director
Ohio
------------------------------

I am in agreement with Brenda's answers.  We use Allscripts and there is a place to put info like that and then it will appear when the chart is brought up.

------------------------------
Ann Dunham
MBA, SPHR, CHC, CHRC
Compliance Officer
Hannibal Regional Healthcare System
Hannibal, MO
------------------------------

Original Message:
Sent: 12-17-2021 06:25 AM
From: Brenda Manning
Subject: Flagging Charts

Scenario #1: The husband is not there as a patient so it's not appropriate in my opinion to search to see if he is a patient. The wife is the patient, so wouldn't a better alternative be flagging her chart noting that the person accompanying her may present a danger?

Scenarios #2: Yes I think that's fine if staff think safety is an issue, but it seems extreme. I've seen cases like that where the patient only had a beef with one physician and was charming to everyone else.

Scenario #3: Yes I think that's fine and falls under TPO. Yes you can tell the doctor about it. Activities like this that occur in the parking lot are not PHI and even if they were the doctor is his treating care provider. ​​​

------------------------------
Brenda Manning J.D., C.H.C., C.H.P.C.
Privacy Director
Privacy Officer
Carilion Clinic

The views expressed herein are my own and do not represent those of my employer. They are not meant to constitute legal advice or create an attorney-client relationship.

Original Message:
Sent: 12-16-2021 03:15 PM
From: Cinda Kropka
Subject: Flagging Charts

I would love to get your opinion on the practice of flagging charts when a patient/visitor acts in an aggressive manner.  Here are some hypothetical scenarios:

Scenario #1
Mr. Doe brings his wife to her doctor's appointment.  While in the waiting area, he gets into an argument with someone on his cell phone.  He is asked to lower his voice and becomes aggressive to the point where the police have to be called.

1. Is staff allowed to search their electronic health record database to see if Mr. Doe is a patient of anyone in its health system, and to flag his chart stating that he is aggressive?

Scenario #2
Now suppose Mr. Doe is the patient and after he acts in an aggressive manner toward the doctor, the doctor dismisses him for his practice.  The staff know that the patient has two upcoming appointments with different specialists.

2. Are staff allowed to flag the chart stating that he is aggressive?
3. Are staff allowed to contact the specialists and let them know the patient is aggressive?
4. Are staff allowed to recommend that nobody in the entire health system see this patient? (except of course if the patient presents to the ED with a emergent medical condition)

Scenario #3

After his appointment with a neurologist, our poor Mr. Doe goes to the parking lot and begins stopping cars, banging on their hoods, and yelling at people that he is going to give them a citation.  Security is called and they try to de-escalate the situation, but it doesn't work.  Security then calls the police, but the patient leaves before the police arrive.  Security reports this behavior to the proper internal committee.

5. Is the internal committee allowed to search their electronic health record database to see if Mr. Doe is a patient of anyone in its health system to flag his chart that he is aggressive?
6. Is the internal committee allowed to report his behavior directly to the doctor?

Your input is greatly appreciated!

Thank you,
Cinda



​​​

------------------------------
Cinda
Compliance/Ethics & Privacy Director
Ohio
------------------------------

Original Message:
Sent: 12/17/2021 6:25:00 AM
From: Brenda Manning
Subject: RE: Flagging Charts

Scenario #1: The husband is not there as a patient so it's not appropriate in my opinion to search to see if he is a patient. The wife is the patient, so wouldn't a better alternative be flagging her chart noting that the person accompanying her may present a danger?

Scenarios #2: Yes I think that's fine if staff think safety is an issue, but it seems extreme. I've seen cases like that where the patient only had a beef with one physician and was charming to everyone else. 

Scenario #3: Yes I think that's fine and falls under TPO. Yes you can tell the doctor about it. Activities like this that occur in the parking lot are not PHI and even if they were the doctor is his treating care provider. ​​​

------------------------------
Brenda Manning J.D., C.H.C., C.H.P.C.
Privacy Director
Privacy Officer
Carilion Clinic

The views expressed herein are my own and do not represent those of my employer. They are not meant to constitute legal advice or create an attorney-client relationship.
------------------------------

After his appointment with a neurologist, our poor Mr. Doe goes to the parking lot and begins stopping cars, banging on their hoods, and yelling at people that he is going to give them a citation.
Security is called and they try to de-escalate the situation, but it doesn't work.

Security then calls the police, but the patient leaves before the police arrive. 

Security reports this behavior to the proper internal committee.

----------------------------
Ornament Central
---------------------------