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Wed Sep 5 14:33:00 BST 2007

3 points on the comments below:

PI is not PI as Pret says unless it is labelled as PI with the appropriate
language disclaimer. We in general don't do that.

Hospital CEOs and Boards probably have no knowledge whatsoever of the
trauma-list or any other medical listserve and therefore ca not have a sense
of the legal or fiscal hazard.

The whole area of internet law is a developing morass so all pontificating
about what we can and can't do is just conjecture.

The reality is, that if a patient can be identified by circumstantial
references, and they take offense to being discussed w/o their consent, they
can find an attorney to take the case, especially if the attorney sees a
deep pocket (e.g. university) associated with the listserve, and that case
may have legs.  

Having said all that, I think we can have our cake and eat it too. Just need
to be careful and judicious. 

Jeffrey Hammond MD, MPH

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Tuesday, September 04, 2007 4:23 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Interhospital Quality Improvement and HIPAA

These file sharing services were a) commercial enterprises, and b) were
demonstrated to be constructed expressly for the systematic violation of
intellectual property rights.

I'm no lawyer, but I think Karim's exposure is minimal.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
Sent: Tuesday, September 04, 2007 3:52 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Interhospital Quality Improvement and HIPAA

While I essentially agree with you Pret, I will point out that Napster,
Limewire, et al WERE held liable for the criminal use of their services.
The courts seem to hold "the internets" to a different standard
occasionally.

Bill

>>> "Bjorn, Pret" <pbjorn at emh.org> 09/04/07 3:40 PM >>>
Let's not make this unnecessarily terrifying.  PI is PI, and its protections
are federal.  Interstate or interhospital agreements, while comforting and
perhaps useful for other purposes, are superfluous to HIPAA in precisely the
same manner that regional transfer agreements are redundant to EMTALA.  

I've used advice from whole other hemispheres in our PI: if the discussion
is properly protected and maximally sterilized, it's a perfectly advisable
approach.

That said, an internet discussion group is NOT BY ANY MEANS a performance
improvement construct.  It is by definition unprotected, requiring that
cases need be not only sterilized, but thoroughly anonymous (or
appropriately consented).  We've been over that ad nauseam.

I am very doubtful that trauma.org can be held accountable for misuse of its
services any more that AT&T would be liable for indiscrete telephone
conversations, or Bushnell for voyeurism.

Above all, I'm certain that hospital CEOs and Boards have clearer sense than
to believe that the Trauma-List represents any unique sort of legal or
fiscal hazard.  

The problem is ignorance of privacy, not exchange of ideas.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Connie Potter
Sent: Tuesday, September 04, 2007 2:39 PM
To: Trauma &amp; Critical Care mailing list
Subject: Interhospital Quality Improvement and HIPAA

Dear Trauma.org members:

Patient privacy and hospital/caregiver liability are both serious issues.
Unfortunately, discussions of this type will likely result in more hospital
CEOs and Boards deciding that being a trauma center poses too great a legal
and fiscal risk, particularly if some of the trauma.org "lurkers" might be
plaintiff attorneys or regulatory bodies.

HIPAA does forbid this type of disclosure, there is NO interstate protection
of PI anywhere in this nation, and only a few state trauma systems have
statutory interhospital protection of these types of discussions.  

We need an interstate trauma care system, to include PI with all of the
protections afforded peer review within the hospital, as well as Good
Samaritan protection for those who deal with the final result of these
problems.  Until then, we should beware of such in-depth critiques of
clinical and systems care issues on this website, particularly since emails
are subject to disclosure.  I actually wonder if trauma.org might be liable
for patient privacy or HIPAA violations.  Just my personal opinions.

Connie Potter, RN, MBA 

-----Original Message-----
From: Ronald Gross [mailto:Rgross at harthosp.org]
Sent: Monday, August 20, 2007 9:12 AM
To: KMATTOX at aol.com; ccm-l at ccm-l.org; Trauma &amp; Critical Care mailing
list
Cc: SURGINET at listserv.utoronto.ca
Subject: RE: [ccm-l] Fwd: Interhospital Quality Improvement

Pret,

You were the first to come to my mind when I read Jeff's post but decided to
remain silent for your sake!  ;-)

Ron

>>> "Bjorn, Pret" <pbjorn at emh.org> 8/20/2007 10:54 AM >>>
Thanks, and well stated.  

Last time I noted this, I was flame bait for weeks.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Jeffery Hammond
Sent: Monday, August 20, 2007 10:47 AM
To: KMATTOX at aol.com; trauma-list at trauma.org; ccm-l at ccm-l.org
Cc: SURGINET at listserv.utoronto.ca
Subject: RE: [ccm-l] Fwd: Interhospital Quality Improvement

Aside from the clinical and systems implications, there is also a
ethical/legal issue here involving HIPAA. My understanding is that HIPAA
prohibits discussion of cases in which the patient can be identified by
date/time/location/circumstances etc. For our legal eagles, does the QI
shield/exemption apply to discussions such as these by parties who are not
directly involved in the QI process? In short, can these discussions legally
take place on the internet?

Jeffrey Hammond MD, MPH
New brunswick, NJ

  _____  

From: ccm-l-bounces at ccm-l.org [mailto:ccm-l-bounces at ccm-l.org] On Behalf Of
KMATTOX at aol.com
Sent: Sunday, August 19, 2007 2:44 PM
To: trauma-list at trauma.org; ccm-l at ccm-l.org
Subject: [ccm-l] Fwd: Interhospital Quality Improvement

My friends on CCM-L and Trauma-list,   this case was sent to me from the
SurgiNet list server.   I have not commented yet, but I will to them.
I
was wondering if any of you have any comments.   The City was BOSTON.
The
sending hospital was a MAJOR hospital in the region.    There are
patient
care, EMS, trauma system, and even legal issues here, to say nothing of
ethical.     

I can and will forward to SURGINET at listserv.utoronto.ca any comment sent to
me which does not have surginet in its sending list.     

k

  _____  

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