As the 21st Century proceeds, you will notice a change in the method of creating and maintaining patient files. This is evidenced by the increased use of electronic records. While it is true that the government has new requirements about this, it also reflects the change in preference of today’s practicing psychologists. Newer members are coming into the field with no reservations about creating all records in cyberspace, but this can be difficult for practitioners with more established practices.
With the increased use of electronic media, we are finding new areas of concern. When we talk of HIPAA or its electronic corollary, HITECH, we are talking about federal laws. They specifically regulate the methodology and use of electronic data as well as its security. It also means that individual citizens can’t waive the law because they want to.
This creates an issue with the number of non-encrypted emails flowing from psychologist to patients. If called into question, each one may be a violation and subject to a fine. More troubling is the fact that a covered entity must self-report any breach. Even more concerning is the fact that anyone who reports a breach, except the covered entity, may share in the proceeds of the fine.
Telepsychology is a growing area. It will be a much larger portion of the field in the future. It is being studied by both the profession and government to try to find a way to facilitate its inclusion. At the present time, some psychologists are using it without checking on the proper methodology or regulation. A person’s license stops at the border of his or her state. There are some states that allow for short term temporary licenses to out-of-state psychologists, but not all. Technically, you could be fined for practicing without a license if the proper procedure is not followed.
Another aspect of this is the type of platform that is used for the tele-sessions. Not all video conferencing formats are HIPAA compliant. Failure to use an approved format is subject to a fine should there be a report to the appropriate agency. Again, it is a law and can’t be waived by an informed consent. An important question you must ask is why are you doing this? If it is to service a rural area, it may be warranted. If the patient is moving permanently, just because you can doesn’t mean you should.
I have heard recently that audits are being done on old paper files. The older paper files are being held to the standard used in electronic record keeping. Psychologists are being penalized for not having current listings of all the information contained in electronic medical records attached to each note. This is automatically attached to an electronic record by the system being used. The psychologist who had this type of audit told me that was the new standard for all Medicare audits. This is going to be a big problem for the older records.
A key fact is that the records must be encrypted. This is a requirement of the law. Password protection is not enough. You need a HIPAA approved encryption system. These are easy to find and relatively inexpensive. In today’s terms, you can “google” HIPAA compliant encryption systems and you will find more than enough examples.
As we proceed into the future, psychologists will all have to become more tech savvy. While storage of paper files was cumbersome, electronic files make it easier to retain larger numbers of files for a longer time. Physical storage will not be limited by space. Because of their nature, electronic records may be more fragile. They can certainly be easier to misplace and other elements may damage them more readily. But these records do offer an opportunity to create a duplicate record because they can be backed up or stored in a secure environment so that the record may be retrieved if they are misplaced or the original machine is destroyed.
We are in an evolutionary period in the practice of psychology. The practice is being expanded and the tools are becoming more varied and complex. As the profession evolves, the psychologist is going to have to evolve right alongside of it.
Eric C. Marine is vice president of the American Professional Agency Inc. He is responsible for claims avoidance and risk management advice to their clients.