A story last week caught my eye about a patient, Julie, who was surprised to discover that her psychotherapy notes became a part of her electronic health record at the hospital system that administered her care — Partners in Boston.
She found out that any doctor within the Partners system could access her record — including her sensitive psychotherapy notes — with no reason whatsoever. And she only discovered this privacy issue because her new internist initially refused to prescribe her needed medication because of “concern” about her psychiatric history — a history he had access to and read without the patient’s prior knowledge.
There’s a couple of problems here. But it’s a teaching moment for others implementing system-wide electronic health records. Psychotherapy notes enjoy special status in the health care community, and that special status should continue even in the age of electronic access.
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This is exactly why I do not sign medical record releases at mental health offices.
To answer the question that opens this post: NO!
Confidentiality is the hallmark of good mental health care. Period. You open that alliance to third parties who do not understand or respect that principle, all can be lost.
By the way, meaning to ask, why all these added screens to get to the comment section? Quite annoying!
Yes, I agree, the simple answer is that psychotherapy notes should not be an unprotected component of the electronic health record. If they are to be incorporate in any manner in an EHR, they should be protected and released only by consent of the patient. Just as is done with a paper record.
A lot of times, developers and companies do things just because they can — because the technology makes it possible.
They don’t often enough stop to ask, “Just because we can this thing, should we? There’s a reason the current system exists, and we’re bypassing that system.”
John
The same thing that happened to this woman happened to me — at Mayo Clinic, a leader in just about everything, including electronic records. Heck, they even have an iPhone app where you can order prescription refills, see your upcoming appointments, discover good places in the area for lunch, and about 600 other things.
However.
I did NOT expect a non-MD in the endocrinology department (a dietitian, to be specific) to be able to see my psychotherapist’s notes and ask me about them. I was so taken aback that I didn’t ask why it was relevant to her, and I wish I had. But I assure you that I brought it up to my therapist at our next appointment and had her put a block on her notes.
Personally, I think I should be the one who decides who gets to see that kind of sensitive information. At the very least, it does need to be separated out from the rest of the record and password protected.
Mayo now lets patients access “clinical summaries,” which the MDs write following appointments. They’re supposed to involve the problem the patient came in with, how it was addressed, and ideas for how to proceed from there. I’ve found, however, that they also sometimes include the MD’s perceptions of the patient — which are sometimes less than flattering. I would rather not know. I don’t really want to see my records at all, unless there’s some pressing reason for me to double-check their accuracy. I think the “just because we can” mindset John addressed above is one that really needs to be reconsidered in the case of EHRs…
Candy
I am a physician who receives mental health care at Walter Reed–and so my supervisors, coworkers, and those I supervised all have access to my record. When comments from my supervisors made it clear someone had been accessing the notes from my therapist–including a detailed initial evaluation–I filed a HIPAA complaint, which the hospital refused to investigate. After that my doctor’s notes became very brief and vague but it has taken a toll on the therapeutic alliance. Our system tracks everyone who accesses mental health notes–but out of fear of identifying a service chief violating HIPAA the military chose not to audit. Military health care at it’s best.
What about the information from medical PCP to our charts? Does the referral note with all concerns and medications and illnesses? What of our having access to medical information? Does the same concern hold? Why and why not?Also, about when I see a client in behavioral health and the client may need to see PCP or psychiatrist for medication on same day, why only one of us can bill when in fact both had to do their part in providing service to this client. Is the new code with the add-ons allow for both with good reason to bill? If in a medical setting this is very important consideration and working together. Your thoughts?