Privacy of Health Forms

[malraux]

Just now, mds3d said:

I'm sorry, "the slow-line"?

Can you tell me what you mean by that?

Should they treat paying customers or someone else first?

[mds3d]

2 minutes ago, malraux said:

Should they treat paying customers or someone else first?

In the United States it is illegal for an emergency department to triage patients by ability to pay. Many Electronic Medical Records don't expose insurance information to ER personnel to prevent even subconscious decisions based on insurance status.  

The only time we (I work in an ER) make decisions for patients based on insurance is when we are concerned that we might better serve a patient by taking a specific action.  For example, I might check to see what medications your insurance will pay for (or what you can afford out of pocket) after we have decided to discharge you.  Or admissions will check to see that we are in-network after the decision to admit has been made (if not we transfer you to someone who is in network if possible). 

 

[malraux]

3 minutes ago, mds3d said:

In the United States it is illegal for an emergency department to triage patients by ability to pay. Many Electronic Medical Records don't expose insurance information to ER personnel to prevent even subconscious decisions based on insurance status.  

I almost added something about EMTALA, but felt brevity was better.

[willray]

18 minutes ago, mds3d said:

I'm sorry, "the slow-line"?

Can you tell me what you mean by that?

While ERs cannot deny service, or provide different service for the uninsured, it's not unheard of for the admitting process to spend time trying to determine insurance carrier/etc status when this is not immediately clear.

Edited April 12, 2019 by willray

[mds3d]

1 minute ago, willray said:

While ERs cannot deny service, or provide different service for the uninsured, it's not unheard of for the admitting process to spend time trying to determine insurance status when this is not immediately clear.

We do spend time determining insurance status if you don't have any available.  Of course this presumes that you are either actually uninsured or unable to provide your SS# and Insurance carrier (this is enough if you don't have your card).  While this does occasionally delay admission to inpatient areas it does not delay the provision of emergency treatment. We don't put you in a "slow-line" until we figure out if you actually have insurance or not. 

[Eagle1993]

Nearly every camp my son or daughter participate in have some sort of medical form.  BSA is the only one that is on paper sitting in some leader’s office.  They all have the same expectations of ensuring youth safety.  BSA is the only one who has been too cheap or incompetent to move this into the digital world and take some burden off of their unit leaders.

The GSUSA forms are all online.  We filled them out last year, very easy and quick entry. This year we had to refresh our data and we didn’t have to start over.  The online form was available then to any camp or leader who needed our information.  

BSA should have this info; however their collection, storage and distribution methods of the info are antiquated and result in additional burden on adult leaders.  

For an organization that supposedly supports LNT we kill a lot of trees.

[malraux]

In this world of cyber hacking, I actually find the paper forms more secure. 

[Sentinel947]

6 minutes ago, Eagle1993 said:

Nearly every camp my son or daughter participate in have some sort of medical form.  BSA is the only one that is on paper sitting in some leader’s office.  They all have the same expectations of ensuring youth safety.  BSA is the only one who has been too cheap or incompetent to move this into the digital world and take some burden off of their unit leaders.

The GSUSA forms are all online.  We filled them out last year, very easy and quick entry. This year we had to refresh our data and we didn’t have to start over.  The online form was available then to any camp or leader who needed our information.  

BSA should have this info; however their collection, storage and distribution methods of the info are antiquated and result in additional burden on adult leaders.  

For an organization that supposedly supports LNT we kill a lot of trees.

I'd rather them be on paper. Do you really trust the BSA to create a secure online portal for med info, given the state of other bsa web resources? 

[Eagle1993]

1 minute ago, Sentinel947 said:

I'd rather them be on paper. Do you really trust the BSA to create a secure online portal for med info, given the state of other bsa web resources? 

There are third party suppliers who already do this.  Vaccine records, medical history, your height and weight are already electronically stored in multiple areas... my state has an online vaccine record for all residents.  Yes, I trust it (if they use an existing supplier) and the info anyone could hack would have fall less value than 99% of my data that exists elsewhere. 

[RememberSchiff]

On 3/28/2019 at 8:42 PM, mds3d said:

I have one of these https://www.mydogtag.com/military/army-medical-warning-tag hanging with a normal dogtag/silencer

My name, DOB, emergency contact is on the normal with more medical information on the medical tag.  The red medical tag has more space (19char/line, 6 lines) than a normal sized dog tag.   As far as I am concerned it has all the medical information needed in an emergency situation. I wear them when ever I am in the wild. My suggestion is to summarize the important info on one or two tags. 

The point about my epilepsy is that it doesn't change appropriate seizure first aid.  You don't need to know that I have a history of seizures to provide first aid. Your example actually supports my point a little.  Without that information you would have overreacted. That isn't great but it certainly isn't as bad as under-reacting. 

I like this idea a lot, but I think laser engraved characters would be more readable than metal stamping. I am still researching. 

[willray]

1 hour ago, Eagle1993 said:

The GSUSA forms are all online.  We filled them out last year, very easy and quick entry. This year we had to refresh our data and we didn’t have to start over.  The online form was available then to any camp or leader who needed our information.  

BSA should have this info; however their collection, storage and distribution methods of the info are antiquated and result in additional burden on adult leaders.  

For an organization that supposedly supports LNT we kill a lot of trees.

I'm not big on the tree-killing aspect of paper, but GSUSA pretty much relies on the girls never being much further than across the street from a starbucks where someone can access the required information electronically.    This doesn't work so well for BSA troops that can be several days' hike from the nearest cell or wifi signal.

Additionally, as has been pointed out, paper is fundamentally more secure than online databases.  This is part of why the Security portion of HIPAA rules only apply to electronic records.

Finally, and whether this is appropriate could be argued, it seems like BSA organizationally thinks that "starting over" every year is actually useful to the mission.  It appears that they believe that regularly reviewing one's health information, helps promote introspection about that "physically strong, mentally awake" health part of scouting.

[willray]

1 hour ago, RememberSchiff said:

I like this idea a lot, but I think laser engraved characters would be more readable than metal stamping. I am still researching. 

I dunno - I have a number of modern tools with laser-engraved information that is already completely unreadable due to minor surface wear, and a lot of century-old tools where the stampings can still be read.    There are certainly advantages to laser engraving - like density of the information that could be provided, and the fact that the tags could easily be double-sided if they were laser engraved, but, I'm not sold on its durability.

[willray]

1 hour ago, Eagle1993 said:

There are third party suppliers who already do this.  Vaccine records, medical history, your height and weight are already electronically stored in multiple areas... my state has an online vaccine record for all residents.  Yes, I trust it (if they use an existing supplier) and the info anyone could hack would have fall less value than 99% of my data that exists elsewhere. 

You might want to look at the frequency of reported data breaches for the electronic systems before you trust them too much.  And that's just the reported ones.  Living on the side of the fence that has access to those databases, and can watch who else has access and what they're doing, I can assure you that there are an order of magnitude more unreported breaches than reported ones.  

[mrkstvns]

18 minutes ago, willray said:

You might want to look at the frequency of reported data breaches for the electronic systems before you trust them too much.  And that's just the reported ones.  Living on the side of the fence that has access to those databases, and can watch who else has access and what they're doing, I can assure you that there are an order of magnitude more unreported breaches than reported ones.  

You are very conservative in your estimates.

It is astounding how little the average American knows about information quality or cyber-security.  All of us could benefit from learning a bit more about issues surrounding privacy and cybersecurity. As technologies like AI and data mining become more prevalent, the issues only become more important.

 

[Eagle1993]

51 minutes ago, willray said:

You might want to look at the frequency of reported data breaches for the electronic systems before you trust them too much.  And that's just the reported ones.  Living on the side of the fence that has access to those databases, and can watch who else has access and what they're doing, I can assure you that there are an order of magnitude more unreported breaches than reported ones.  

I work in medical devices, been part of threat models, responded to ICS-CERT advisory’s, worked with white hat hackers and other aspects of cyber security.  I’m not an expert but know enough.  

Most of not all of the info being collected is already in BSA or healthcare providers databases.  BSA already stores much info, including DOB and addresses electronically.  Your medical history is stored in multiple databases already.  Most people really interested in this data will be people who know you... paper will be easier for them to access than a BSA secure database.  

As far as the comment ... GSUSA doesn’t do the same level of camping as BSA.  Ok, but these forms are required for Cub Scouts and Boy Scouts who don’t do HA. Also, if you need paper, there should be an option for the leader to print out a report prior to leaving on a trip.