“It is imperative that we obtain the diagnosis and treatment outcomes of our patients, or else good treatment decisions will mean no more than the bad treatment decisions, and the ignorant medics will remain ignorant”
- Me
What do I mean by that?
- Many hospital systems have decided that it is a HIPAA violation to provide patient outcomes, and diagnosis’ to prehospital agencies.
- Without this information, there is no way to provide information about how a paramedic’s treatment may have benefited or harmed a patient.
Are the hospital systems right?
The simple answer is NO.
As part of a QA/QI process, all information may be disclosed from the receiving hospital to the transporting agency. Under the QA/QI umbrella, HIPAA has no baring. Furthermore, the treating physician for that patient is, initially the medical director for that transporting agency. If one physician transfers a patient to another physician, they are more than entitled to that patient information. There is no difference between a physician in a hospital whom transfers out a patient, and a medical director whom oversees a paramedic. THEY ARE BOTH THE TREATING PHYSICIANS. They both deserve the right to know what happened to that patient. The medical director can then use that information for the QA process however he wishes.
What is the benefit of having this outcome information?
- Imagine ignorantly treating the same symptoms the wrong way. Information about your patient’s outcome could inform you of this mis-treatment, and you could then make the appropriate changes.
- Now imagine an entire EMS agency treating the same types of patients the wrong way. Outcome data could show trends in beneficial or detrimental treatment outcomes, and the appropriate changes could then be made.
So why the reluctance?
- The first reason is ignorance – the hospitals just don’t know that this information is just as much ours, as it is theirs.
- The overwhelming reason is presumably the reluctance to display their own poor performance. Hospitals will keep their save rates, door-to-balloon times, botched surgeries, and other information that may alter the money they make or fork out, under lock and key if they can.
So what can we do?
I am leaving this answer up to my readers. Any attorneys out there who have taken this on? Any supervisors or managers who have sat at the table and come up with a plan of action? LET US KNOW.
Please comment on this, and get the discussion going…
I have had pretty good relations with most receiving facilities. In general, I have asked for information from people higher up where I work, but I have also asked at hospitals, when I have been there. I have had mostly positive responses from the people I talked with at the facilities, when not, the bosses ask.
This inappropriate restriction of information really should be penalized as much as the inappropriate release of information. Hospitals have lawyers telling them that, You will never get in trouble saying No. This is the same approach taken by many medical directors toward the appropriate use of pain medicine, sedatives, nitrates, and standing orders in general. This is inappropriate, irresponsible, and ignorant and should not be tolerated.
I have explained to staff at some facilities that I will encourage patients to avoid their facility because the patient seems to come last in their approach to patient care.
I also seem to have decent luck finding out my patient outcomes, but only through trial and error or finding out who to ask. Sometimes it seems like you have to find a few people to ask, so one person isn’t “overburdened” by asking. One would think that learning this way should be the rule, not the exception. I have heard with some of the electronic PCR software out there that gives prehospital providers access to that information because it makes “one continuous record”. That seems like it would help, but obviously technology could pose as many problems as solutions. Does anybody know anymore about this?
Excellent topic…hopefully we can make finding out this important information more common place. Rogue Medic, I admire your style, but I normally answer the “Why do you want to know?” question with “Why would I not want to know?” or “How can we afford not to know?”
Tim & Geoff,
it usually is not an issue for an individual paramedic to get outcome information on one of their patients. This can simply be done by going back to the hospital and speaking with the treatment physician. I too do this often, and it is very useful. Unfortunately, not every paramedic does this. Furthermore, it shouldn’t be the only way to get the outcome data. You should have the information automatically provided to you for, at least all of your high priority patients. I personally think that there should be a secure server in which the EMS agency and hospital systems can share data. I think that you should be able to look up the information with a click of the mouse at any given time. Password protected of course. What do you think?
Sounds like a great idea, I was thinking more about what I said regarding ePCR and access to patient information. It was one of the EMS podcasts, I cannot remember which one however. Before access to everything, like you said, information on our high priority patients definitely. I also think any of our patients that our interventions or more importantly “diagnostic skills” played a part in, for example, STEMI, CVA that was “reversed” w/ either fibrinolytics or clot retrieval, “gut feeling” trauma patients who were discovered to have a serious injury that was not obvious on-scene. Just a feeling I have that often it is not what we do to our patients, but how we assess them to get them to the best facility to suit their needs.
If done correctly, I wonder about patients who could have been transported to some sort of alternative destination besides the ED. If our profession is ever to evolve, that could be important information as well. However, I am aware that there are many factors that would play into this besides patient complaint such as insurance, time of day, etc…
I work in a system, where the one receiving hospital we have flat out refused to give us patient follow information, citing, of course, HIPAA. After EIGHT months of persistence, as well as gaining backing from our system head and medical director, and legal advice stating that there would be in fact, no HIPAA violations, the hospital reluctantly agreed to release this information only to me, who was at the time our CQI officer.
now, i can attest, that this information was invaluable to improving patient care, and trying to match patient presentations to diagnoses and treatments… For example, the number of atypical presentations that ended up being cardiac was only overshadowed by the number of patients who ended up being septic.
so, while wholeheartedly endorsing a program like this, i will disclose the disappointing ultimate irony. and that is, the number of providers who actually have no interest in this information. i fully understand the implications of what kind of providers they may be, but it is the fact nevertheless.
David