Coordinating Patient Care in the HIPAA Era

Leslie Secrest, MD
Chairman of the Department of Psychiatry at Texas Health Presbyterian Hospital Dallas

In our final post discussing the effect HIPAA policy and regulations have on both individuals living with a mood disorder and their families, we look at the implications of sharing elements of mental health treatment as part of the electronic health record (EHR).

Coordinating Patient Care in the HIPAA Era

Protecting patient privacy has long been a vital, but complicated priority for mental health care providers. In guarding our patients’ privacy, we aim to defend against prejudicial or discriminatory care. We balance those concerns with the realization that a patient’s health could be jeopardized if other providers do not have access to the full health picture. Sharing elements of a mental health record is, at times, in a patient’s best interest.

With the advent of electronic health records (EHR), it has become easier to control who has access to a person’s mental health information, and who does not. For instance, the EHR system that my hospital uses allows me to restrict mental health information to only the providers that I name. Certain keywords in the notes also trigger automatic privacy settings.

When such precautions aren’t taken, however, (and they often are not), EHRs allow mental health information to be available across entire health systems. Access is even available to treating providers who have no medical reason to review psychiatric notes. [Read “Update on Electronic Health Records and Health Care Technology” by Steven R. Daviss, MD, in Psychiatric Times.]

Today’s mental health care providers are navigating a complex sea of privacy and patient-care issues, and I witness providers struggling with it on a near-daily basis. For example, in the acute-care setting where I practice, many patients have co-existing health conditions. These patients are often under the care of multiple physicians. As the treating psychiatrist, I have ability to select who is authorized to access mental health care information. Working collaboratively with the med/surg team, it is fairly easy to determine who has a need to know and who should be added to the treatment team.

There are cases, however, where an acute condition arises and the new provider is not named in the record. It is not difficult to add the provider to the record, but if not done, it can slow care. In limiting access to my patient’s full medical record, I sometimes limit my colleague’s ability to provide emergent care.

Another challenge is protecting the privacy of people who are not under our care. For example, most mental health assessments include a detailed family history. The patient record may contain information about a family member’s mental illness. That information may not add value to the medical record, and in most cases is not relevant to the medical care. But as part of the patient record, this family member information is available to whoever has access to that record.

An additional consideration is EHRs’ portability and very long life. Whatever information we put in the record will be available to many providers throughout the course of a patient’s life. I do not want a patient who is seen for a psychiatric concern to receive prejudicial treatment when he or she seeks unrelated medical care at a later date because of my notes in their record.

While it is possible to protect patient privacy without constructing barriers to care, it requires patience and consideration. I urge providers to be mindful of our patients’ privacy and encourage them to support one another as we work to strike this delicate balance.

Editor’s Note: In 2013, DBSA addressed this topic in an online survey to understand consumers’ views regarding coordination of Care between Mental Health and Physical Health Providers. The survey included both multiple choice questions to assess consumers’ preferences regarding specific issues and open-ended questions to explore consumers’ views and personal experiences.

Your Turn: What is your experience with coordination of EHR?

• How do you ensure that inappropriate information is not included in the permanent EHR?
• Have you experienced prejudicial treatment when being treated for an unrelated medical condition because too much information about your mental health treatment was in the EHR?
• What are the circumstances in which you would want the psychiatric medical record available to clinicians treating you for a physical condition?
• What protections need to be in place to keep family member information out of the EHR?
• Are you concerned that this information could creep into your own permanent medical EHR?

[poll id=”19″]

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