Pediatric Informatics: Computer Applications in Child Health (Health ...

306 D.M.N. Paperny
Aunt Lisa transports her 6 month old niece to the doctor at the mother’s request for a fever.
She hand carries a note signed by mother giving Aunt Lisa permission to consent for
treatment. The pediatrician assesses that a lumbar puncture is necessary. The mother is
unavailable by phone.
The pediatrician may: 1) accept the note in good faith if it appears to be valid, 2) ask a
MD colleague to co-sign consent with him as an emergency, or 3) look in the scanned
document portion of the EMR for aunt’s name or others who can consent.
22.4.2 Releasing Information
Only the person who can CONSENT for treatment can release EMR information
related to that treatment: 3
A teenager consents for family planning, including a pelvic examination. Only she is
allowed direct access to release the portion of the medical record regarding that procedure/
treatment.
When custody issues are present, documentation that establishes legal guardianship
including but not limited to court orders and Durable Power of Attorney for Health
Care are required.
22.4.3 Restricting Access to PHI According to Role
“The information belongs to the patient, but the actual record belongs to the
physician.” 4 To control PHI to the level of detail needed to assure confidentiality,
restricted access to specific data according to role is required (adolescent
patient: all records; parent: all records up to age 13; physician and case manager:
all; nurse: vital signs and immunizations; pharmacist: medications/allergies;
receptionist: demographics/billing):
A medical assistant mother looks into an EMR to see if her teenager’s antihistamine is
refillable, and notices her daughter is also on birth control pills.
Organizational and employee agreements in health systems must include and
specify precise restrictions on access and use of PHI as well as disciplinary actions
in the case of violations.
22.4.4 Restricting Access to Psychiatric PHI
Psychiatry notes are frequently separated physically from other parts of the medical
record. In EMRs, mental health diagnoses and progress notes may be restricted
electronically to Psychiatry staff, but psychotropic medications prescribed for the