pa-wannabe Posted October 3, 2020 Share Posted October 3, 2020 Hi all, I'm hoping several of you may have some insight into this topic. While I'd especially like to hear from others working in behavioral health, any knowledge you can share would be appreciated. At any given time, who has access to YOUR notes in the EMR? I don't mean just seeing the patient encounter, but the actual "meat" of your note... In particular, I'm wondering how many non-providers or individuals outside of the practice could theoretically be able to access patient info directly from the EMR without needing a signed release from the patient. Billing staff? Admin? Insurance companies during audit? Pharmacy? Additionally, with an EMR such as Epic that uses "break the glass" as a safeguard, who could reasonably access patient info with AND without setting off alarm bells? Thanks for your help! Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted October 3, 2020 Share Posted October 3, 2020 On a practical basis, any user on a facility's EMR can access the chart. From what I've seen across multiple EMR's, that access will be logged. As to whether anyone monitors those longs, I can't say and expect it depends upon the facility's policies. Doing EM, I often "broke the glass" on a patient's chart to see past history on someone I was seeing or about to see. I never received any communication indicating that anyone had any concerns. From what I've seen, e.g. verbatim quotes of my notes usually in hospitalist's H&P's that were strangely similar to mine, I think that's a common practice. This included notes from behavior medicine providers who saw patients I had admitted. I also never got any feedback when I followed my patients' courses after admission. If you're asking about what tracking is done for access by persons not involved in a patient's care, QA, or billing, again it depends upon facility policies and how well they're implemented. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 3, 2020 Administrator Share Posted October 3, 2020 As above, plus the IT guys have 100% access to everything all the time. The internal safeguards are just that--internal to the users of the system--and don't apply to people who do, and hence have access to, the backups. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 5, 2020 Moderator Share Posted October 5, 2020 I am not looking forward to a future in which pts have 100% access to their online charts... Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 5, 2020 Administrator Share Posted October 5, 2020 2 hours ago, EMEDPA said: I am not looking forward to a future in which pts have 100% access to their online charts... You know, I thought that too when Group Health was going that way in 2015, but then I just started writing my notes knowing that my patients would eventually read them. I had a couple of REAL uncomfortable conversations with my L&I patients when I documented behaviors that I felt were suspicious for malingering, but fundamentally I wouldn't say anything behind their back I wouldn't say to their faces, and that's how I reconciled it and started those conversations. 2 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted October 5, 2020 Share Posted October 5, 2020 Doing EM, I agree with Rev. However, I'm not sure of the ramifications for a person receiving mental health treatment. There may need to be an exception there. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 5, 2020 Administrator Share Posted October 5, 2020 9 minutes ago, ohiovolffemtp said: Doing EM, I agree with Rev. However, I'm not sure of the ramifications for a person receiving mental health treatment. There may need to be an exception there. I was actually just looking at the WA state medical records laws and regs for an unrelated reason, and I do recall seeing an exception when the access would cause harm to the patient. If unfettered access by those struggling with serious mental health disorders don't fall within that, I'm not sure what else would Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 5, 2020 Moderator Share Posted October 5, 2020 12 hours ago, rev ronin said: You know, I thought that too when Group Health was going that way in 2015, but then I just started writing my notes knowing that my patients would eventually read them. I had a couple of REAL uncomfortable conversations with my L&I patients when I documented behaviors that I felt were suspicious for malingering, but fundamentally I wouldn't say anything behind their back I wouldn't say to their faces, and that's how I reconciled it and started those conversations. I use the phrase "presents anxious and dramatic" fairly frequently in my notes. That paints a great picture for the next provider, but is not something one would want to read about oneself. Other things like "this pt clearly has cannabinoid hyperemesis syndrome given their 5x daily marijuana use and relief of sx with hot showers. Pt is in complete denial of this and demanding a GI referral for further evaluation". That makes them sound like a nutbag, because they are. 2 Quote Link to comment Share on other sites More sharing options...
DogLovingPA Posted October 6, 2020 Share Posted October 6, 2020 On 10/4/2020 at 10:11 PM, EMEDPA said: I am not looking forward to a future in which pts have 100% access to their online charts... As of Oct 1, the system I work in went live with all labs/notes being immediately visible to patients. This is apparently based on a federal law that was passed that goes into effect Nov 1. Exceptions are psych, abuse, pregnant minors. Quote Link to comment Share on other sites More sharing options...
CAAdmission Posted October 6, 2020 Share Posted October 6, 2020 I never had an expectation of privacy regarding notes. A patient could show up any time and ask for a copy to bring to another provider. Honesty is the best policy. Sometimes for patients the truth hurts. 1 Quote Link to comment Share on other sites More sharing options...
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