MANAGEMENT OF EMPLOYEE HEALTH RECORDS

MANAGEMENT+OF+EMPLOYEE+HEALTH+RECORDS%0d%0aHIPAA+COW+Privacy+%26+Security+Webinar%0d%0aFriday%2c+March+2%2c+2007%0d%0a%0d%0a1%0d%0a%0d%0a%0cAGENDA%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aBackground+of+Employee+Health+Records.+Key+Definitions.+Federal+and+State+Regulatory+Influences+(ADA%2c+FMLA%2c+OSHA%2c+Workers%e2%80%99+Compensation%2c+Wisconsin+Employment+Regulations).+Management+of+Employee+Health+Records.+Disclosure+of+Employee+Health+Record+Information%2fCopies.+Retention+and+Disposal+of+Employee+Health+Records.+Questions+and+Discussion.%0d%0a2%0d%0a%0d%0a%0cEMPLOYEE+HEALTH+RECORDS%0d%0aEmployee+health+records+are+created+and+maintained+for+the+following+reasons%3a%0d%0a%ef%81%ac%0d%0a%0d%0aTo+accomplish+the+mission%2fgoals+of+the+employee+health+department%2ffunction+through%3a%0d%0aPromoting+employee+health+and+wellness+%ef%81%ac+Preventing+illness+and+injuries%0d%0a%ef%81%ac%0d%0a3%0d%0a%0d%0a%0cEMPLOYEE+HEALTH+RECORDS%0d%0aReducing+the+spread+of+communicable+diseases+%ef%81%ac+Creating+a+safe+working+environment+%ef%81%ac+Increasing+operating+efficiencies+through+reduced+absenteeism%0d%0a%ef%81%ac%0d%0a%0d%0aTo+comply+with+federal+and+state+regulations.+%ef%81%ac+To+protect+the+organization+in+litigation.%0d%0a%ef%81%ac%0d%0a4%0d%0a%0d%0a%0cEMPLOYEE+HEALTH+RECORDS%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aThe+organization+must+manage+the+employee+health+records+to+ensure+systematic+control+from+creation+or+receipt+through+processing%2c+distribution%2c+maintenance%2c+retrieval%2c+retention%2c+and+final+disposition.%0d%0a%0d%0a5%0d%0a%0d%0a%0cINTERSECTING+ROLES%0d%0a%0d%0aEmployer+%ef%81%ac+Healthcare+Provider+%ef%81%ac+Health+Plan%0d%0a%ef%81%ac%0d%0a%0d%0a6%0d%0a%0d%0a%0cHIPAA%0d%0a%ef%81%ac%0d%0a%0d%0aThe+Health+Insurance+Portability+%26+Accountability+Act+excludes+employment+records+maintained+by+a+healthcare+organization+in+its+capacity+as+an+employer+from+the+definition+of+protected+health+information.+The+HIPAA+Privacy+Rule+standards+do+not+apply+to+employee+health+records.%0d%0a7%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cHIPAA+%e2%80%93+HOWEVER%e2%80%a6%e2%80%a6..%0d%0a%ef%81%ac%0d%0a%0d%0aMany+Employees+Perceive+That+HIPAA+Protections+Apply+to+Their+Employee+Health+Information.%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aHIPAA+Standards+Have+Become+%e2%80%9cIndustry-Standards%e2%80%9d+for+Safeguarding+the+Privacy+and+Security+of+Health+Information.%0d%0a8%0d%0a%0d%0a%0cEXAMPLES%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aMinimum+Necessary+Access+Authentication+for+Access+to+Electronic+Health+Information%2fPHI+Physical+Security+and+Access+Controls+Administrative+Safeguards%0d%0a9%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%0cFOR+CONSIDERATION%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aValue+of+Information+Collected+Personal+Identifying+Information+%e2%80%93+Threat+of+Identity+Theft+Sequestering+%e2%80%9cLegal%e2%80%9d+Records%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a10%0d%0a%0d%0a%0cFOR+CONSIDERATION%0d%0a%ef%81%ac+The%0d%0a%0d%0arole+of+the+employee+health+staff+person+is+often+a+dual+role+with+other+assigned+functions.%0d%0a%ef%81%ac+Employee%0d%0a%0d%0ahealth+nurse%2finfection+control+nurse+%ef%81%ac+Aware+of+what+role+he%2fshe+is+in+when+accessing+employee+health+or+patient+health+record+information+and+limit+access+accordingly%0d%0a11%0d%0a%0d%0a%0cEMPLOYEE+HEALTH+RECORD+DEFINITION%0d%0a%ef%81%ac%0d%0a%0d%0aAny+health-related+information+created%2c+obtained%2c+or+maintained+by+the+organization+regarding+an+employee%e2%80%99s+physical+or+mental+condition%2c+including%2c+but+not+limited+to%3a%0d%0aResults+of+medical+exams+and+tests+%ef%81%ac+Employee+health+documents+regarding+medical+certifications%2c+re-certifications%2c+or+medical+histories.%0d%0a%ef%81%ac%0d%0a12%0d%0a%0d%0a%0cEMPLOYEE+HEALTH+RECORD+DEFINITION+%e2%80%93+Continued%0d%0a%ef%81%ac%0d%0a%0d%0aOpinions+or+other+recommendations+of+a+healthcare+provider+concerning+the+health+of+an+employee+or+employees+performed+by+or+received+by+employee+health.+Documentation+related+to+participation+in+employee-health+sponsored+wellness+programs.%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a13%0d%0a%0d%0a%0cEMPLOYEE+HEALTH+RECORD+DEFINITION+%e2%80%93+Continued%0d%0a%ef%81%ac%0d%0a%0d%0aEmployee+medical+complaints+relating+to+workplace+exposure+or+injury.+Employee+health+department+health+related+opinions+or+recommendations+sought+out+by+employees+Other+records+maintained+by+employee+health%2c+such+as+ADA%2c+FMLA%2c+OSHA%2c+and+workers+compensation.%0d%0a14%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cPATIENT+HEALTH+RECORD%0d%0a%ef%81%ac%0d%0a%0d%0aRecords+related+to+the+health+of+a+patient+prepared+by+or+under+the+supervision+of+a+health+care+provider+and+subject+to+the+standards+set+forth+in+HIPAA.%0d%0a%0d%0a15%0d%0a%0d%0a%0cFEDERAL+REGULATORY+INFLUENCES%0d%0a%ef%81%ac%0d%0a%0d%0aAmerican+with+Disabilities+Act+(ADA)+%e2%80%93+29+CFR+%c2%a7%c2%a7+1630.14(d)+%26+1630.16(f)+Occupational+Safety+and+Health+Act+(OSHA)+29+CFR+1910+Family+Medical+Leave+Act+(FMLA)+29+CFR+%c2%a7+825%0d%0a16%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cAMERICAN+WITH+DISABILITIES+ACT+(ADA)%0d%0a%ef%81%ac%0d%0a%0d%0aThe+American+with+Disabilities+Act+prohibits+discrimination+against+people+with+disabilities+in+employment%2c+transportation%2c+public+accommodation%2c+communications%2c+and+governmental+activities.%0d%0a%0d%0a17%0d%0a%0d%0a%0cDISCLOSURES+UNDER+ADA%0d%0aThe+employer+may+disclose+the+information+collected+from+ADA+medical+examinations+and+inquiries+to%3a%0d%0aManagement+responsible+for+ensuring+necessary+work+restrictions+and+accommodations%3b+%ef%81%ac+First+aid+and+safety+personnel+who+may+need+to+respond+if+an+employee%e2%80%99s+disability+requires+emergency+treatment%3b+%ef%81%ac+Government+officials+investigating+employer+compliance+with+the+ADA%3b%0d%0a%ef%81%ac%0d%0a18%0d%0a%0d%0a%0cDISCLOSURES+UNDER+ADA%0d%0aThe+employer+may+disclose+the+information+collected+from+ADA+medical+examinations+and+inquiries+to%3a%0d%0aThose+requesting+the+information+in+accordance+with+state+worker%e2%80%99s+compensation+laws%3b+and+%ef%81%ac+Those+requesting+the+information+for+insurance-related+purposes.%0d%0a%ef%81%ac%0d%0a%0d%0a19%0d%0a%0d%0a%0cOCCUPATIONAL+SAFETY+AND+HEALTH+ACT+(OSHA)%0d%0a%ef%81%ac%0d%0a%0d%0aRequires+employers+to+provide+and+report+employee+medical+surveillance+and+to+monitor+and+report+employee+workplace+injuries.+States+that+employees+must+be+informed+of+their+access+rights+to+their+medical+and+exposure+records.%0d%0a20%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cOSHA+AND+RECORDS%0d%0a%ef%81%ac%0d%0a%0d%0aOSHA+defines+a+record+as+%22any+item%2c+collection+or+grouping+of+information+regardless+of+the+form+or+process+by+which+it+is+maintained.%22%0d%0a%ef%81%ac%0d%0a%0d%0aThe+standard+further+differentiates+between+exposure+records+and+medical+records.%0d%0a%0d%0a21%0d%0a%0d%0a%0cOSHA+%e2%80%93+MEDICAL+RECORDS%0d%0a%ef%81%ac%0d%0a%0d%0aMedical+Record%3a+The+standard+defines+an+employee+medical+record+as+%22a+record+concerning+the+health+status+of+an+employee+which+is+made+or+maintained+by+a+physician%2c+nurse+or+other+health+care+personnel%2c+or+technician.%22%0d%0a%0d%0a22%0d%0a%0d%0a%0cOSHA+MEDICAL+RECORDS+INCLUDE%0d%0a%ef%81%ac%0d%0a%0d%0aMedical+and+employment+questionnaires+or+histories.+The+results+of+medical+examinations+and+laboratory+tests+(including+chest+and+other+X-ray+examinations+taken+for+the+purpose+of+establishing+a+baseline).%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a23%0d%0a%0d%0a%0cOSHA+MEDICAL+RECORDS+INCLUDE+-+CONTINUED%0d%0a%ef%81%ac+Medical%0d%0a%0d%0aopinions%2c+diagnoses%2c+progress+notes%2c+and+recommendations.+%ef%81%ac+First+aid+records.+%ef%81%ac+Descriptions+of+treatments+and+prescriptions.+%ef%81%ac+Employee+medical+complaints.%0d%0a%0d%0a24%0d%0a%0d%0a%0cOSHA+MEDICAL+RECORDS+DO+NOT+INCLUDE%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aPhysical+specimens+(e.g.%2c+blood+or+urine+samples)+which+are+routinely+discarded.+Records+concerning+health+insurance+claims+if+maintained+separately+from+the+employer's+medical+program+and+its+records.+Records+created+solely+in+preparation+for+litigation.+Records+concerning+voluntary+employee+assistance+programs+(EAP)+if+maintained+separately+from+the+employer's+medical+program+and+its+records.%0d%0a25%0d%0a%0d%0a%0cOSHA+%e2%80%93+EMPLOYEE+EXPOSURE+RECORDS%0d%0a%ef%81%ac%0d%0a%0d%0aThe+Standard+Defines+an+Employee+Exposure+Record+as+a+Record+Containing+the+Following+Information%3a%0d%0aEnvironmental+Monitoring+of+Toxic+or+Harmful+Substances+%ef%81%ac+Biological+Monitoring+results+%ef%81%ac+Material+Data+Safety+Sheets%0d%0a%ef%81%ac%0d%0a%0d%0a26%0d%0a%0d%0a%0cFAMILY+MEDICAL+LEAVE+ACT+(FMLA)%0d%0a%ef%81%ac%0d%0a%0d%0aThe+Family+and+Medical+Leave+Act+(FMLA)+requires+that+all+covered+employers+provide+their+eligible+employees+with+12+weeks+of+unpaid+leave+during+any+12-month+period+for+one+or+more+of+the+following+reasons%3a+Employee+has+a+serious+medical+condition+%ef%81%ac+the+birth+or+adoption+of+a+child+%ef%81%ac+Provide+care+to+an+immediate+family+member+with+a+serious+health+condition%0d%0a%ef%81%ac%0d%0a27%0d%0a%0d%0a%0cFMLA+CONSIDERATIONS%0d%0a%ef%81%ac%0d%0a%0d%0aRequires+Provider+to+Verify+a+%e2%80%9cSerious+Health+Condition%e2%80%9d+Does+Not+State+That+Specific+Diagnostic+and%2for+Treatment+Information+Need+be+Provided%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a28%0d%0a%0d%0a%0cSTATE+REGULATORY+INFLUENCES%0d%0a%ef%81%ac%0d%0a%0d%0aWisconsin+Family+or+Medical+Leave%0d%0a(WI+%c2%a7+103.10)%0d%0a%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aWorker%e2%80%99s+Compensation+(WI+%c2%a7+102.13)+Wisconsin+Employment+Regulations+%e2%80%93+Records+Open+to+Employee+(WI+%c2%a7+103.13)%0d%0a%0d%0a29%0d%0a%0d%0a%0cWISCONSIN+FAMILY+OR+MEDICAL+LEAVE%0d%0a%ef%81%ac%0d%0a%0d%0aWorks+in+Conjunction+with+Federal+Family+Medical+Leave+Act%0d%0a%0d%0a30%0d%0a%0d%0a%0cWORKER%e2%80%99S+COMPENSATION%0d%0a%ef%81%ac%0d%0a%0d%0aAllows+worker%e2%80%99s+compensation+insurers%2c+state+administrative+agencies%2c+and+employers+to+obtain+health+information+to+the+extent+authorized+under+the+state+worker%e2%80%99s+compensation+law.%0d%0a%0d%0a31%0d%0a%0d%0a%0cWISCONSN+REGULATIONS+%e2%80%93+RECORDS+OPEN+TO+EMPLOYEE%0d%0a%ef%81%ac%0d%0a%0d%0aThis+statute+permits+employee+access+to+employee+(personnel)+records.+Upon+an+employee%e2%80%99s+written+request+for+inspection%2c+the+organization+must+allow+the+employee+to+inspect+or+receive+copies+of+the+personnel+information%2c+including+employee+health%2fmedical+records%2c+within+seven+working+days+of+the+request.%0d%0a32%0d%0a%0d%0a%0cMANAGEMENT+OF+EMPLOYEE+HEALTH+RECORDS%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aMaintenance%0d%0aOrganizational+Access+and+Use+Employee+Access%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a33%0d%0a%0d%0a%0cMAINTENANCE%0d%0a%ef%81%ac%0d%0a%0d%0aEmployee+health+records+shall+be+maintained+separately+by+the+healthcare+organization+in+its+capacity+as+an+employer.+%ef%81%ac+Employee+health+records+and+patient+health+records+shall+be+maintained+in+separate+files%2c+storage+areas+or+systems.+%ef%81%ac+Treat+as+%e2%80%9cconfidential%e2%80%9d+with+access+restricted+to+authorized+workforce+members.%0d%0a34%0d%0a%0d%0a%0cRECORD+%e2%80%9cCROSSOVER%e2%80%9d%0d%0a%ef%81%ac%0d%0a%0d%0aDual+Use+of+Employee%2fPatient+Health+Records%3a+The+organization+must+recognize+the+potential+that+under+certain+circumstances+employee+patient+health+record+documents+may+%e2%80%9ccross+over%e2%80%9d+and+become+part+of+the+organization%e2%80%99s+employee+health+record.%0d%0a%0d%0a35%0d%0a%0d%0a%0cRECORDS+THAT+MAY+CROSSOVER+WHEN%0d%0a%ef%81%ac%0d%0a%0d%0aAuthorized+in+writing+by+the+employee%2fpatient+from+a+healthcare+provider.+Integral+to+the+processing+of+a+Workers%e2%80%99+Compensation+claim.+Part+of+a+short+or+long-term+disability+claim.%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a36%0d%0a%0d%0a%0cRECORDS+THAT+MAY+CROSSOVER+WHEN%0d%0a%ef%81%ac%0d%0a%0d%0aRequired+for+Pre-employment+or+post-offer+physical+examination.+Part+of+the+Employment-related+drug+testing+program.+Necessary+to+process+ADA+disability+accommodations+Supplemental+to+Family+Medical+Leave+Act+(FMLA)+requests.%0d%0a37%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cORIGINALS+OF+RECORD+DOCUMENTS%0d%0a%ef%81%ac%0d%0a%0d%0aThe+record+document+that+is+%e2%80%9coriginal%e2%80%9d+to+the+employee+health+record+or+the+provider+health+record+must+remain+in+the+respective+record.%0d%0a%0d%0a38%0d%0a%0d%0a%0cACCESS+TO+EMPLOYEE+HEALTH+RECORDS%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aRestrict+to+%e2%80%9cNeed+to+Know%e2%80%9d+Minimum+Necessary+Access%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac%0d%0a%0d%0aQuestion+Requests+for+More%0d%0aKnow+When+it+is+Appropriate+to+Disclose+to+Management%2c+Others%0d%0a39%0d%0a%0d%0a%0cOTHER+MAINTENANCE+ISSUES%0d%0a%ef%81%ac%0d%0a%0d%0aPost-Offer+Physicals%2c+Drug+Testing%2c+and+Fitness+for+Duty+Examinations+Release+for+Duty%2fReturn+to+Work+Forms+Organizational+Use+of+Employee+Heath+Information%0d%0a40%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0a%0cDISCLOSURE+OF+EMPLOYEE+HEALTH+RECORDS%0d%0a%ef%81%ac%0d%0a%0d%0aEmployee+health+records+may+be+disclosed%2c+without+employee+authorization%2c+in+the+following+circumstances%3a%0d%0a%ef%81%ac%0d%0a%0d%0a%ef%81%ac%0d%0a%ef%81%ac+%ef%81%ac%0d%0a%0d%0aGovernmental+officials+investigating+employer+compliance+State+agency+processing+a+Worker%e2%80%99s+Compensation+claim+Other+authorized+governmental+agency+in+compliance+with+applicable+law.+Organization%e2%80%99s+legal+counsel+to+be+used+for+defense+for+or+against+an+employee%e2%80%99s+discrimination+claim.%0d%0a41%0d%0a%0d%0a%0cWRITTEN+AUTHORIZATION+RECOMMENDED%0d%0a%ef%81%ac%0d%0a%0d%0aFor+disclosures+which+do+not+fall+into+the+categories+noted+previously%2c+a+written+authorization+is+recommended.%0d%0a%0d%0a%ef%81%ac%0d%0a%0d%0aContent+of+Authorization+%e2%80%93+Consider+%e2%80%9cpatient-type%e2%80%9d+format.%0d%0a%0d%0a42%0d%0a%0d%0a%0cRETENTION+OF+EMPLOYEE+HEALTH+RECORDS%0d%0a%ef%81%ac%0d%0a%0d%0aSeveral+laws+and+regulations+provide+guidance+on+the+retention+schedule+for+employee+health+records.%0d%0a%ef%81%ac%0d%0a%0d%0aOSHA+has+the+most+restrictive+guidance%2c+which+has+become+the+unofficial+standard+for+employee+health+record+retention.%0d%0a%0d%0a43%0d%0a%0d%0a%0cRETENTION+REGULATIONS%0d%0a%ef%81%ac%0d%0a%0d%0aEmployee+Exposure+Records+(referenced+in+OSHA)%0d%0a%ef%81%ac+30%0d%0a%0d%0aYears%0d%0a%0d%0a29+CFR+1910.1020(d)(1)-+AHIMA+%ef%81%ac+29+CFR+1915.1020+%e2%80%93+AHIMA+%ef%81%ac+29+CFR+1926.33+-+AHIMA%0d%0a%ef%81%ac%0d%0a%0d%0a44%0d%0a%0d%0a%0cRETENTION+REGULATIONS%0d%0a%ef%81%ac%0d%0a%0d%0aEmployee+Health+Records%0d%0a%ef%81%ac%0d%0a%0d%0aTerm+of+Employment+%2b+30+Years%0d%0a%0d%0a29+CFR+1910.1020(d)(1)+%e2%80%93+AHIMA+%ef%81%ac+29+CFR+1915.1020+%e2%80%93+AHIMA+%ef%81%ac+29+CFR+1926.33+-+AHIMA%0d%0a%ef%81%ac%0d%0a%0d%0a45%0d%0a%0d%0a%0cDISPOSAL+OF+EMPLOYEE+HEALTH+RECORDS%0d%0a%ef%81%ac%0d%0a%0d%0aHIPAA+Security+Rule+as+a+Standard%3f%0d%0aPaper+Records+%ef%81%ac+Electronic+Recor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