The laws are passed by legislators and the courts interpret them via
lawsuits. The legislators wanted to impose sanctions on the institiutions in
guarding patient confidentiality.
We have to abide by the law or we are exposed legally. We are private
institutions that rely on competition to florish so any bad PR can impede
business. Any patient dying at our doorstep can also do the same. These are
not government hospitals that can hide anything they want because they are
run by politicians.
They would all run to another hospital.
It is the competition that drives us in being the best otherwise they won't
come here.

If we were coworkers in an elevator we can not discuss anything previlaged
in front of third parties who might over hear us.
We have the daily surgery lists with names and type of operations pinned on
the bulletin board with the page of writing facing in and the back blank
side showing in the work place.
The information can be shared among coworkers as a part of work.
We talk to patients and that info becomes priviliged. Once they leave then
it gets problematic if they call us on the phone and want info.

Laboratory personnel can not legally order any test they want.
Conflict of interest involving monetary gain. We need a written request from
one who is legally able to order a test. Once that is done we give the
results to the ordering party, doctor.
There is a list of low complexity testing that is sold over the counter that
patients may take advantage of. They are more able to understand the results
of those tests. The higher complexity testing  are too complex for the
normal person to understand. They can not order any tests.
They can be given a copy of tests only after red-tape.

We don't know who is a third party in any given situation.  A patient comes
in on one day and returns the next day. How do we know it's not a third
party? The lab is a part of the permanent medical record and medical records
is best in dealing with those issues. It varies between institutions as they
have institutional policies that they have chosen to safeguard HIPAA
compliance.
If a doctor orders a lab test the doctor will get a copy of results and the
doctor can give a copy of the results to the patient.
Any critical value test results that need immedicate attention are called to
the doctor for his immediate action.
It is not just a legal question of HIPAA compliance. We can get fired for
not following hospital or institutional policies.
Make one slight wrong move and foul-up and you can be terminated. It has
happened once that I know of so I won't go into it.

Going in circles. The doctor ordered the test even though the patient is
paying for it. That's why we no longer perform low complexity testing
allowed by CLIA that don't require a doctors order. If he doesn't trust the
doctor then don't go to him. It is ludicrous to think that one will question
the lab result and not the use of the test interpretation.
If the patient wants to see the results he should notify the doctor that he
wants the lab to give him a copy. At our instiution if this is done then we
comply with those wishes. If a request is made after the test is completed
then the regular way of obtaining results is followed.
If the order were for a urine substance abuse would you allow the patient to
see the results?
We don't do out-patient substance abuse testing where you have to watch them
pee and go through all kinds of motions in preparing and labelling. We just
said no. We don't do pre-employment drug screens also same reason.
We don't want to spend time in court and it's not worth it so we say no to
that type of testing whether the patients pays for it or not.

That is also a problem with FAX numbers. There has been on occasion that
wrong FAX numbers have been entered and sent to private household numbers
instead of the doctor.
Risk management has stepped in and proper cover-sheets are in place
threatening you will be thrown in prison if you don't return the info or
something like that.

Bottom line is that lab results are critical to doctors' diagnoses.
Until you set up your own lab in your basement you'll have to trust us.
Doctors seem to trust our results or they wouldn't order so darned many
blood tests! You can crack on lawyers all you want, but when you need
one, no one else will do, will they? I blame a lot of this mistrust on
TV shows that blame mistakes on the lab, but that's another thread....

Home instruments can be fraught with problems also. There are QC
solutions you must buy at extra cost. If your QC is not in range, then
you'll have to troubleshoot your instrument. This is what lab techs do
on a daily basis in their jobs, and they're trained to do this stuff.
The glucose home testing instruments are pretty straight forward, but I
know some of the other ones are a bit more complex. Nurses have an
incredibly difficult time with point-of-care instrumentation (the
hospital jargon for those instruments you take to the bedside or you can
buy at home) and don't understand the need for quality control for them
[if you get an answer, it's got to be right]. Oversight of these
instruments, at least in our institution, remains with the laboratory.
We have two full time techs just making sure the nurses use them
correctly.

Yes, management runs the hospitals and the labs, but management is NOT
down IN the lab actually running the testing. I've never seen any of our
managers do actual testing where I work. Maybe they used to in another
life, but not now. They are involved in overseeing budgets, QC, hiring,
oversight of proficiency testing, making sure governmental regs are met,
etc.

Again, if you guys really want to believe lab techs are somehow
corrupting lab results for pharmaceutical companies, there's nothing any
of us can say to you to change your minds. I've found that when people
don't understand things, especially if they're complex, they start
making up stories to explain the complexities. Labs are busy complicated
places to work, with lots going on in many different departments, with
lots of expensive instruments doing a myriad of testing. If you've never
worked in one, it's difficult to figure out how they work. All of us
have tried to explain to friends and relatives how they work, only to
see their eyes glaze over. Most non-lab hospital people don't have a
clue, either.

I've about knocked myself out on this subject. You're free to believe
whatever you want. Just remember, next time when you have to go to the
ER, some lab person will be testing your blood, urine, or other body
fluid. If you need a blood transfusion, that tech will be crossmatching
your blood to find a compatible unit. Your doctor will be basing your
diagnosis partially on those results. We like what we do. We don't
calibrate instruments to keep pharmaceutical companies happy or in
business, or skew results for the government. We do what we do because
we went to school a long time to do it, and we enjoy it.

Judy Dilworth, M.T. (ASCP) - for 31 years
Microbiology

That's where he should start is with the institution and if he does not
trust the health institution then he should find another.
The LDL is high complexity testing not available over the counter and it
must be done by laboratory professionals and not office aids. High
complexity testing requires very expensive instruments that only large
places can afford. They can afford them by performing a large amount of
testing on them and not just lipid profiles. The large sample of blood
indicates that is not a small drop bed-side test but one in which the sample
of blood will be sent out of the doctors office.
In order to get my state license every year as a CLS I must declare any
felony or misdemeanor convictions and they would investigate if they would
impact on my job or not.
The best answer is to get a small cholesterol meter as he stated.

No one said it was unreasonable as it is done often and there are procedures
in doing so. We are referring to the proper procedure which varies from
institution to institution.

In most

You have national service which allows for a two tier system for a patient
to opt out of and get regular insurance.
The government is immune from legal lawsuits to a great extent. Private
health carriers and health institutions have to protect their butt. It's
like being in the military here with way different standards of conduct.
In this case it is the US government that said "the hospital will be sued
dearly if any information including just a name is revealed without the
patients permission.
If in the above senario the patient with a copy of results and name on the
report is seen by an outside stranger like husband and the patient then
claims that the hospital released it without her permission then they would
be in trouble. Some documentation would be needed in showing the transfer of
information was legal.
Then if the info gets out from the patient then they can blame the patient
and not the hospital.

This doesn't seem to result in suicide or lawsuits due to the

The origins of the law came about from insurance companies and others like
pharm companies obtaining private health information without the patients
knowing anything about it. They were targeted for commercial sales and risk
etc.
The law is meant for institutions and institutions have ways to deal with
upholding that law. In the hospital the medical records department generally
deals with it and not the lab. Some doctors have patients wait for the
results and we then put them on the phone with the doctor after giving the
doctor the results.
If the doctor writes on the form that the patient will get a copy of the
results then we can do that also.

The entire medical record is generally sent from doctor to doctor and I
really doubt that a person looking at it would make much sense.
It is almost impossible for a person without any knoweldge would understand
letters and numbers.
What does ALT 24 mean?
Patients really don't know what "lab results" mean. They think that lab
results are reported out in phrases like " normal labs, nothing to worry
about", or "labs show liver problems".
In the past when they insisted on seeing the lab results I would show them
the letters and numbers and then they would say what does that mean?
HCG less then 5. What does that mean?

HIPAA is a law passed by congress imposed on insitutions.
It can intefere with tumor registries etc.

Well that was a bit harsh on my part but it comes from many untold stories.
Again Canada does not have a two tier system like UK. It banned all options
but the government system.

That's true. I am not defending the US system because there is no national
single taxpayor system. There is no national system. People die without
health insurance but in Canada because of the national insurance they can
die. You can't compare apples and oranges.
The UK system has matured and developed into what is today.
The Canadian system has not and it is similar to Cuba and North Korea in
it's strickly socialistic stance.

It's hardly nothing. Nobody gets something for free. Goods and services have
to be paid for.
If I read correctly, some of your lab testing was being sent out to other
countries to save costs and some controvery over it?

In order to use our HIS or hospital computer we have to logon.
In order to use the LIS obviously and in that way they can keep track. I
think it is a silly rule that is non enforceable in my eyes but supervisors
have instructed us.

Mike, my apologies for the knee jerk nationalistic responses.

What your IT does is not concern to me. I would suggest they read the HIPAA
requirements and interpret them anyway they want and they can get sued just
like anyone else.

And people drive over the speed limit all the time does that mean there's no
speed limit?

The clients are the doctors. We perform testing that the doctors order.
We have tons of people look at the way the lab does things including
billing.

Go for it. Problem solved.

The treatment goals are based on LDL levels and the total cholesterol is
meaningless so go buy the most expensive total cholesterol instrument you
can buy.

I got a note pad and free left-over donuts from some conferences.
I am easy.
They are required to bring sweets when we buy a new instrument or they have
a seminar.
The ladies are knock-outs stunning beauties. I'll take two of those.

LOL.

That's right the aspirin part is pharmaceutical sponsored.
Rather than crushing an aspirin in your mouth you can go to a fish store and
lick the slime off a fish for the fish oil.

Knock yourself out.

http://www.cap.org/apps/cap.portal?_nfpb=true&_pageLabel=proficiency_testing_page