Electronic Health Records Update

MPA’s work with Electronic Health Records issues

MPA is working to find decision-making tools and financial assistance for members to select, acquire, and implement electronic health records. The State Innovation Model grant may provide this assistance.

Timeline to adopt Electronic Health Records

In discussions with state officials, it has been communicated that while the deadline in statute for implementing electronic records is January 2015, they would prefer that mental health professionals get the product that is right for their practice, even if it means that a product is not in place on the deadline. This is in recognition that there are currently few appropriate products for small mental health providers. They prefer that psychologists get something that will meet their needs, rather than purchasing anything for the sake of meeting the deadline. Officials anticipate that more appropriate products will be forthcoming. An electronic health record must eventually be purchased, and consequences for failure to adopt an electronic record will be coming at some point.

Privacy information

Many psychologists have concerns about protecting the privacy of patients’ information. It is important to keep in mind that what is automatically transmitted is a snapshot of an individual, with little specific information. The kinds of information that might be communicated by psychologists include a diagnostic code, portions of a treatment plan, and some historical facts. Case notes and diagnostic assessments would not be automatically shared. MPA hopes to have the state establish a two-tiered model of consent to provide an added layer of protection for more extensive information to be exchanged.

The final HIPAA rule allows for health services paid in cash with no attempt to access third party reimbursement to not have to be made part of the exchange process. This means that if patients have concerns about privacy, and can pay for a health care service totally out of pocket, the information from that encounter does not have to be made available for exchange with other providers. However, based on the Minnesota mandate, this does not remove the requirement for a health professional to have electronic records. Even if a psychologist’s entire practice reimbursement is completely out-of-pocket, having an electronic record is required. The logistics of the interface of these federal and state requirements are complex and not understood at this point. The implications in terms of licensure requirements for record keeping are also not clear. This does create the opportunity for high profile individuals to keep some or all of the information about health care encounters out of the exchange with other providers.

Patients can totally opt out of exchanging health information, but they do so at their own peril. It means that no health information would be available in the event of an emergency. The burden is then on the patient to repeatedly present their history, medications, and information about past health encounters or procedures. This approach significantly interferes with coordination of health care, and we are asked to counsel patients about the very real threat of significant harm or death.

Recognition of Consent (ROC)

A recent survey by the Department of Health finds that providers are confused about this aspect of HIPAA rules. This provision allows for the release of patient records based upon another provider’s attestation that an authorization for release of information has been obtained for the patient. There is no need to mail or fax a copy of the authorization of release; psychologists and other providers can release information based on a provider’s word. This is to ease the process of sharing information for improved care coordination.

Information provided by the Minnesota Psychological Association and the author is not considered legal advice and members are advised to consult with an attorney if they have questions or concerns.

Trisha A. Stark, Ph.D., L.P., MPA, is the chair of the Legislative Committee and Electronic Health Records Task Force for MPA. She is involved in public policy and has a small private practice in Minneapolis.


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Diversity Statement

The Minnesota Psychological Association actively encourages the participation of all psychologists regardless of age, creed, race, ethnic background, gender, socio-economic status, region of residence, physical or mental status, political beliefs, religious or spiritual affiliation, and sexual or affectional orientation.Although we are an organization of individuals from diverse cultures and backgrounds, the Minnesota Psychological Association also recognizes our core unifying identities as Psychologists who practice in America. We also recognize that we may hold unintentional attitudes and beliefs that influence our perceptions of and interactions with others. Within this context of unity and self-exploration, we are committed to increasing our sensitivity to all aspects of diversity as well as our knowledge and appreciation of the unique qualities of different cultures and backgrounds.We aspire to becoming alert to aspects of diversity, previously unseen or unacknowledged in our culture. In this spirit, we are committed to collaborating with multicultural groups to combat racism and other forms of prejudice as we seek to promote diversity in our society. To this end, we are dedicated to increasing our multicultural competencies and effectiveness as educators, researchers, administrators, policy makers, and practitioners.