Reporting abnormal lab results

  • 1.  Reporting abnormal lab results

    Posted 10-10-2018 11:35 AM
    We had an interesting incident occur recently regarding how our hospital reported out abnormal labs to our patient. ​We are the PCP. Patient had labs drawn on site at our facility. (We lease our lab to the local hospital) Abnormal lab results were reported by the hospital's off-site testing facility to our local hospital location. It happens that our patient is an employee at the lab located at the hospital. Staff recognized the patient as their employee and supervisors decided to notify the patient and send patient home until treatment ordered by PCP.

    So not only was the patient notified by her supervisors instead of us, her PCP, but her supervisors were made aware of the abnormal test results and acted in 'the best interest of patients as employee is a lab tech and involved in direct patient care'. I am not certain that this was handled appropriately. Are there other hospital systems that can weigh in on this? Is there a procedure that requires notification to employees by supervisors when they are in direct pt care that would override the hipaa confidentiality aspect?

    Rasan Leathers CHPS
    Director of Compliance
    Third Street Family Health Services

  • 2.  RE: Reporting abnormal lab results

    Posted 10-11-2018 10:42 AM
    ​In my view, if the Lab staff and supervisors obtained the Lab results (PHI) in performing their work related duties, the disclosure to the patient does not implicate HIPAA.  It raises possible policy/practice issues, patient safety, etc., but HIPAA allows PHI to be disclosed to a patient.   HIPAA does not require the disclosure be made only by a physician or mid-level.

    If the disclosure among Lab staff and supervisors was something other than inadvertent (e.g. gossip, violation of the minimum necessary rule, etc.), a LoProCo analysis should be performed.

    Scot Houska CHC
    Chief Compliance Officer / Privacy Officer
    Community Hospital
    Grand Junction,CO

  • 3.  RE: Reporting abnormal lab results

    Posted 10-11-2018 10:54 AM
    Maybe I'm off base here, but I see boundary issues with this scenario.

    The supervisor of the employee acted in a health care role when they elected to send the employee home due to the lab results. The supervisor should not act as both supervisor and health care provider. The appropriate course of action would be for the supervisor to notify the PCP office ("stat" if they are that concerned about how the employees condition may affect job performance) and request the PCP notify the patient immediately.

    Proximity caused some blurred boundaries here.

    I would suggest a policy review be conducted and the lab supervisor be counseled on appropriate procedure.

    Just my two cents...

    Dr. Randy Lewis, LMFT, CHPC
    HIPAA Privacy Officer
    Orange County Government
    Orlando, FL

  • 4.  RE: Reporting abnormal lab results

    Posted 10-12-2018 06:21 AM
    I agree with Randy. This is a boundary issue and I do see this as a privacy issue and more. Our patients give us their PHI to treat, support and diagnose them. Those patients include our friends, family, community members, coworkers and even us. We simply must keep that information confidential. Labs have some of our most sacred PHI - things such as HIV results and other tests that we may not want our employers or anyone to know. I'm not aware of any exception that would allow this sequence of events. Presumably these results would have been sent electronically to the PCP and if it was that urgent of an issue the PCP would have called the patient immediately. I see these 3 issues that need to be investigated: 1) Lab staff acting outside their roles and stepping into a in a medical decision making capacity for a patient they do have have a treatment relationship with; 2) Lab staff disclosing PHI to coworkers who have no business need to know that information; 3) Lab staff not following proper workflow with respect to patient notification of lab results.

    Brenda Manning J.D., C.H.C., C.H.P.C.
    Compliance Director, Privacy
    Carilion Administrative Services Building, Ste. 1201
    213 S. Jefferson Street
    Roanoke, VA 24011
    (540) 224-5757
    Fax: (540) 510-224-5787
    Integrity Help Line Compliance: (844) 732-6232

    Our Mission: Improve the health of the communities we serve.

    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.

  • 5.  RE: Reporting abnormal lab results

    Posted 10-15-2018 04:18 PM
    ​Thank you everybody for the weigh-ins. I spoke with the lab supervisor who told me that due to the employee having a highly contagious infection that requires patient isolation, they sent the employee home instead of allowing them to continue to do phlebotomy on their patients and to await to hear from her PCP. The lab results were given to the hospital lab early in the morning before our office was open, and the employee reported to work early in the morning before our office would be open. Per the lab supervisor, the lab tech who received the result notified lab supervisor. I have requested the supervisor to look into their procedures on reporting of abnormal tests that involve employees as confidentiality and employer access/disclosure must be maintained. I feel that if a situation such as this one warrants notification over privacy in order to protect the patient, an assessment should be documented as to why.

    Rasan Leathers CHPS
    Director of Compliance
    Third Street Family Health Services