Has anyone else experienced this?

[rcollins]

I'm sorry to disagree but I think this does have to do with HIPAA. They don't want to give you Joe Smith's info because you may never treat him in your hospital. I'm sure they don't want to be held responsible for giving out information about patients if they don't have to. If they can give you the patients you request wouldn't that work? As a blood banker this really stinks but as a hospital worker it makes sense.

I wonder if you could involve the attorneys, like the previous poster said, and draw something up that both facilities could sign. The reason they're providing all their blood bank histories and the reason you need them could be stated. Do they need to send out a form letter to the patients stating they're releasing their information? I'm sure there are a lot of legal aspects that (while annoying and sometimes pointless) need to be considered.

[eric1980]

For the greater good, I think it's best that this information be shared. It's kinda selfish for the outgoing hospital management to refuse releasing important medical data to the patients' new caregiver. They do not lose anything if they transfer the information, but the patients stand to gain.

[John C. Staley]

I can see requesting info on a patient you are working on that appears to have a problem, I can even see the reasoning behind requesting the facilitie's positive antibody files. I can not see getting in a lather for them not wanting to share the files for every patient they ever did any blood bank testing on. In my world that is just a little over the top and frankly I would refuse to provide it if you were asking me.

[Malcolm Needs ☆]

But John, if the information was shared (and what is so secret about it) you wouldn't be bothered more than once.

By not sharing it, you may well be bothered several times, and then you would have to go through your files every time, taking up a lot more of your time. Share it all once, and there will be no problems for you in the future.

[eric1980]

Remember, we should be patient-oriented. This is not an opinion. If there are any policy that obstruct others from improving safety of the patients, then the policy is wrong!

And certainly patient confidentiality doesn't apply here, isn't it?

[clmergen]

Has anyone considered the sheer logistics of being able to share this data? I have a computer system that is 18 years old and has 6 hospitals using it. How would I even begin to share that. This hospital is willing to share their information on an as needed basis, I think they are being very helpful.

[John C. Staley]

clmergen,

The logistics of the process is a lot of where my stance on this subject comes from as well as the importance / usefullness of the information.

A lot of it boils down to cost / benefit and I see this being a lot of work for mostly imagined benefit. Now if you are willing to pay for my time, at a price of my choosing, I might be willing to work with you but if you are just asking for it out of the goodness of my heart I'm afraid you would have a very long wait.

As far as the information being secret. Medical records are confidential and if you cannot provide any better reason than "the patient MIGHT, SOMEDAY, POSSIBLY come to my hospital and it would be good to know that they are A Pos with no problems", it is unlikely any one would provide that info in this day and age.

[Malcolm Needs ☆]

Has anyone considered the sheer logistics of being able to share this data? I have a computer system that is 18 years old and has 6 hospitals using it. How would I even begin to share that. This hospital is willing to share their information on an as needed basis, I think they are being very helpful.

So, when your computer system finally falls over, do you think the licensing authorities will accept that, "Sorry, but we can't transfer our old data to our new computer system, so we're going to have to start again from scratch?"; I don't think so!.

And yes, I agree with you John that it will be expensive and time consuming, but, having experienced (on the side lines) the problems with HCV testing in the UK (or, rather, not testing in the early days) our judiciary would not accept the argument that it may only affect a few people, so we should not bother.

In this case, there is a very good chance that the patients will be common to both hospital owners, and so even more reason that the information should be shared. Medical records are, I agree, confidential, but not to the extent that keeping something confidential that will have a material effect on the patient should be kept secret.

We have a number of pregnant ladies we test for anti-D levels at our Laboratory who are shared care with the referring hospital, and the hospital where they are given an IUT. It is vital that the referring hospital is informed that a) an IUT has been administered, so that they know to give irradiated blood components to the baby, if it requires further transfusion after it is born, and also, as many of these ladies actually give birth at the referring hospital, if they have produced any additional atypical alloantibodies, should they require transfusion.

There are times when confidentiality can be taken to an extreme; and this is one of them.

:mad:

[RR1]

I agree that transfusion data should ideally be transferred to new host systems. With newer systems this is happening to an extent. How do you cope with the following scenaro:

1.Four hospitals merge

2.New computer system with shared database implemented.

3.Each hospital also owns as a minimum one legacy system, with traceability data.

4.Remember each hospital has own patient numbering system.

How easy would it be to populate the new system with potentially 8 different databases? Sometimes we need to be realistic about this. As systems standardise over the coming years this will not be such a problem, but for now it's very difficult to achieve.

[Malcolm Needs ☆]

Nobody is pretending it is easy Rashmi, but the NHSBT has just migrated ALL of its antibody data from the APEX computer system (for red cell antibodies) and the HITS computer system (for HLA, etc, antibodies) over to the new Hematos computer system and, as far as we know, after extensive testing, no data has been lost, so it can be done (if there is a will).

[Malcolm Needs ☆]

I agree that transfusion data should ideally be transferred to new host systems. With newer systems this is happening to an extent. How do you cope with the following scenaro:

1.Four hospitals merge

2.New computer system with shared database implemented.

3.Each hospital also owns as a minimum one legacy system, with traceability data.

4.Remember each hospital has own patient numbering system.

How easy would it be to populate the new system with potentially 8 different databases? Sometimes we need to be realistic about this. As systems standardise over the coming years this will not be such a problem, but for now it's very difficult to achieve.

Actually, having reread the UK Guidelines on this Rashmi, it is difficult to achieve, but it is required. It is covered in sections 16 to 20 of the BCSH Guideline, The specification and use of information technology systems in blood transfusion practice, Transfusion Medicine 2007; 17: 1-21.

It is a very comprehensive document and an excellent cure for insomnia!

[clmergen]

When my computer system is replaced I will migrate all of my data over to the new system. As a system we have worked ways to migrate data from multiple hospitals to ours. It is possible and required. And whoever supplied my new computer system would be doing that transfer (most likely)

In this case, there are 2 different hospitals owned by different healthcare systems . You can't upload one hospital's computer system into a second hospital's system. HIPAA would definately apply to that.

As for sharing data, we do it all the time. Our area has multiple systems and we all call each other for the problem patients only. And the old hospital is already doing that for the new hospital. Maybe not in the timeliest of manners but it is being done.

[geekay]

++++++

Edited July 1, 2009 by engeekay2003
entry at the wrong place !

[geekay]

Hello there,

I dont think this is something , to be too much bothered with !

I feel that, this is something which can be resolved by having a frank discussion across the table .

Definitely, the earlier management will pass on the "blood banking part of the records" (at least) if they are made to realise the importance.

You should be happy with the fact that, they agreed to give the details when it is required..

Think about the situation if they had said a "NO" ? That shows that they are considerate... and will pass on the details of all the patients if they are made the realise the importance of that !

Think about more simple solutions rather than going for more complicated ways like "legal" !

best wishes ...

sincerely,

engeekay2003

[Malcolm Needs ☆]

Hello there,

I dont think this is something , to be too much bothered with !

I feel that, this is something which can be resolved by having a frank discussion across the table .

Definitely, the earlier management will pass on the "blood banking part of the records" (at least) if they are made to realise the importance.

You should be happy with the fact that, they agreed to give the details when it is required..

Think about the situation if they had said a "NO" ? That shows that they are considerate... and will pass on the details of all the patients if they are made the realise the importance of that !

Think about more simple solutions rather than going for more complicated ways like "legal" !

best wishes ...

sincerely,

engeekay2003

The whole point is engeekay2003, that the "new" laboratory should not have to ask. The information should be available as of right.

How will the "new" laboratory know when to ask? Antibodies (and by that I mean clinically significant antibodies, such as anti-Jka) disappear in vitro and in vivo. So an individual comes in through ER, requiring a transfusion (not necessarily urgent) and the "new" laboratory gets a clear antibody screen. They give blood that is not Jk(a) antigen negative, and the patient has an anamnestic response and ends up with renal failure. Would the "new" laboratory know that they should have asked in such a situation? No.

Now, in most situations, this could happen because the patient has been treated in a hospital remote from the "new" laboratory (and I would have no problem with that - accidents happen), but in this case it would be a preventable accident, because the patients with antibodies of the "new" laboratory are much more likely to have been tested by the "old" laboratory (unless there is a mass exodus of patients from around the area, or a mass ingress of new patients).

In such a case, i honestly think that, if a patient suffers from such a reaction, the "old" laboratory is culpable, and should be sued.

:mad:

Just as a matter of interest Brenda, has there been any favourable movement from the "old" laboratory?????

Edited July 1, 2009 by Malcolm Needs

[clmergen]

Malcolm,

I work in an area that has 12 hospitals (more if you count the military hospitals). I work in the largest of all the hospitals with the most acute care. We recieve patient transfers from those hospitals plus from smaller hospitals outside this immediate area. I ONLY call for blood bank history on those patients that require a workup and this is ONLY if I can determine where the patient came from If the antibody screen is negative I call no one. Every hospital in this area treats patients that may likely come to my hospital. How is this different than the original question? Two different hospital systems should not be sharing patient information without cause. Potentially being a patient is not cause. What if some of the patients didn't like the new hospital and found out that the old hospital shared their information. HIPAA would definitely be pertinent at that point.

Daily we all risk the non-detectable anti-Jka or some other antibody that has dropped below detectable limits. And that is why more sensitive methods such as Gel and Solid phase are being put into use.

(wasn't going to respond but love a good debate)

[adiescast]

OK, I guess I'll add my two cents. This could be considered part of the "Portability" of the "Health Information Portability Act" (I think I missed an A in there, but you get the idea). The original point of HIPAA, before the privacy issue got hooked onto it, was that a patient's medical records should be available to anyone treating said patient. This was considered to be good for the patient and could prevent several different healthcare providers from prescribing things that will blow up when combined in one body or a procedure from being done without knowledge of the fact that it could be harmful to this particular patient. Also, the current American government stance on Information Technology in healthcare is that it will allow information to flow between providers as needed.

We do not currently share antibody/problem information with other healthcare providers outside of our hospital system. I wish we could, because we have patients that go to one or the other of us depending on their insurance provider or the doctor they select, etc. We had a patient who went to another institution for transfusions who ended up in our ER with transfusion reactions on three different weekends before we figured out who was transfusing him and the fact that they had not detected the anti-FYa the patient developed in addition to his other three antibodies. Once we were able to share this information with them, voila!, the patient stopped coming in with transfusion reactions.

The problem, of course, (in addition to everyone's fears of HIPAA) is that we all use different identifiers, so it could be difficult to tell if we are talking about the same person. Also, we don't use the same computer systems and they may or may not be willing to talk with each other. These are issues that could be resolved, as someone pointed out earlier in the discussion thread.

Maybe that was more than 2 cents...

[LAS]

Obviously a lot of opinions here, all with their own validity. Yes, as blood bankers we feel compelled to know everything we can so that we can keep our patients safe, but I admire John's pragmatism - ultimatley there is just so much we can do. We all transfuse patients all the time without knowing of any previous BB history from other institutions, especially if the Ab screen is negative. In a perfect world we would have everyone's history available to us when necessary but...

Even if it was determined that this is not a HIPPA issue, it sure walks and talks enough like one to raise questions. My institution would not share our patients' medical records in batch. It would be done on a case by case basis.

[eric1980]

===Wall of textes below===

As some of us have said above, there are two ways we look at it:

Practically - We all process specimens from patients who might have sought treatment at other facilities and if the screening is negative, we will not question the patient where else s/he had received transfusions before, and will issue blood as what we see in our own records. To share all patient information may not be worthwhile, just as why we do not do AGH crossmatch for all compatibility testing.

Morally - If we have shared transfusion information of all patients, then there will be (almost) no chance that we will cause secondary immune response when their antibody titre levels go down beyong gel detectable range. I myself have spotted a case in my 3 years of BBing experience of a new patient to my hospital having positive antibody screen from my sister hospital, but showed negative when my colleague did the AbSc. If I do not have this information, we might cause serious transfusion reactions that are preventable. But to share transfusion records of all patients to all blood banks is a logistic nightmare.

In my humble opinion, the way we should do to tackle this issue is to base our decisions based on morals. If we talk about practicability in every aspect of Blood Banking, then we are basically following SOPs and maintaining status quo as "it's not worthwhile to do this". The BB industry will then not progress forward as fast as if we follow the below...

We should base on what to do based on morals. If we know what is good for the patients, and if we agree on it, we could work together to find out a practical solution! Then whatever practical issues which people preach will be rendered invalid. It's inpractical, because they are unwilling to do it for (perhaps) $ or selfish reasons or just because they are lazy. It's practical, because we are willing to do it, and we know it's for the patients. As what Clmergen said above, the patients "may not like the new hospital", but in my opinion, "the medicine is bitter". You may not like the taste of the medicine, but it's good for you. Parents, is this familiar to you? ; )

When problems arise, think of why you chose (if you chose) to be a blood banker, and base your decision on that.

[MACWHC]

As I read this thread several points come to mind as a blood banker for 15+ years now in IT.

Ideally as a blood banker would I want this info? Yes but, only for those patients who had a positive result.

Importing all those negatives means I have to search through more data to ensure that I'm really looking at the patient I think I am. How many of these converted patients have passed on, or passed through your area and will just be clutter?

Pragmatically from the IT standpoint several thoughts come to mind.

Who's going to pay for this conversion? Who from the now defunct organization will work with the 3rd party to do the conversion? Does your current hospital want to pay for this conversion? I know the almightily dollar shouldn't rule the world but I bet your hospital isn't willing to pay the 50K+ it's going to cost to get the info.

What are you going to use as identifiers for this conversion. Generally it's Name, DOB, Sex, SSN needed for computer matching of the admission record to a blood bank record. (MRN omitted as we are obviously not comparing apples to apples) I can understand the reluctance of the defunct institution of not wanting the SSN of all of their old patients with blood bank records being put out there.

Finally who becomes responsible for all the records that are not an exact match? John Doe vs John R Doe same DOB, Sex and SSN, do you throw those out?

What on the surface seems like a simple and reasonable request is actually as all on this thread have pointed out, quite complex.

[eric1980]

^This is exactly what I talked about in my previous post in this topic.

If we harp on the issue of pragmatism, then we wouldn't get anything done, and it will certainly not help anyone.

But if we have a group of people who have the power to do it, and want to do it, then they can do it, and ultimately, it's our patients who will benefit. If we prevent a lethal transfusion, all costs will be justified.

I am still curious what is the outcome of the situation faced by the topic creator.

[Malcolm Needs ☆]

I am in total agreement with you eric1980, and do not agree with all the points made by AMCWHC.

It is not just a question of those patients with an antibody. ALL patients (except most of those who are group AB) have antibodies, and very dangerous ones, called anti-A, anti-B and anti-A,B. If you read my post in the thread on witnessing blood withdrawals AMCWHC, you will see a horror story that (nearly) took place at an (unnamed, but world famous) London Teaching Hospital.

Now, I am not saying that transferring all of the patient records would have prevented this, but it would have minimized the chances. Yes, it is expensive (and a pain in the ****) but, as eric1980 says, it is probably less than the price of being sued.

:eek:

Edited July 8, 2009 by Malcolm Needs
As usual, appalling spelling!

[John C. Staley]

So.......... now we're going to be sued for information we don't have because a patient sought treatment else where.

Nonsense!!!

Sorry Malcolm but this is an issue you and eric will find no support from me.

[RR1]

Actually I think what MACWHC has stated is totally realistic. The more cluttered a data-base becomes, the greater the risk of error. I want data extracted of patients with known antibodies.....not the rest.

We have enough problems with trying to reduce duplication on our own patient records, importing data that is difficult to link will cause even more confusion. How would you create a merged patient file of same name, dob with six different patient record numbers?

Ideally there would be one single system throughout the country (but that's not going to be achieved before I retire), that would sort this out to some extent.

[Mabel Adams]

And can we justify spending this 50K if it means some children don't get vaccinated for some preventable illness or someone gets less prenatal care? Or it drives up the cost of health care so anothr 100 Americians are forced to join the uninsured? Health care dollars all come from somewhere and there has to be a reasonable cost/benefit ratio.