RE: Psychotherapy Notes
Matthew, Thank you for the clarification and the corroboration. I sure wish the HIPAA authors had used the term process notes instead of psychotherapy notes as it would have created far less confusion. Cheri -Original Message- From: Matthew Rosenblum [mailto:[EMAIL PROTECTED] Sent: Friday, April 04, 2003 8:19 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: Psychotherapy Notes Cheri, Bob, et al: Among most behavioral health professionals process notes (referred to by HIPAA as psychotherapy notes) are those pieces of documentation that therapists write, basically for their own use, to remind themselves of what the patient has said, for example, the content of a dream, or the experience of guilt associated with a forbidden feeling. HHS has given us the opportunity to strictly limit the availability of this information by providing a higher order of protection for these process notes, and with few exceptions, disclosures may be made only if the CE obtains a signed-authorization. Under HIPAA psychotherapy notes are defined as those notes: 1) Recorded by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session, and, 2) Maintained separate from the medical record, and 3) That exclude: a. Medication prescription and monitoring b. Counseling session start and stop times c. The modalities and frequencies of treatment furnished d. Results of clinical tests e. Any summary of diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date Note, that #3 (above) delineates most of the information that we normally put into our progress notes to substantiate treatment, and consequently, we must separate that information from the psychotherapy or process notes (that is, if we want to further protect the process information.) I hope that this helps. Your questions are always welcome. Matt Matthew Rosenblum Chief Operations Officer Privacy, Quality Management Regulatory Affairs http://www.CPIdirections.com CPI Directions, Inc. 10 West 15th Street, Suite 1922 New York, NY 10011 (212) 675-6367 [EMAIL PROTECTED] CONFIDENTIALITY NOTICE: This E-Mail is intended only for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you have received this communication in error, please do not distribute it. Please notify the sender by E-Mail at the address shown and delete the original message. Thank you. AVISO DEL CONFIDENCIALIDAD: Este email es solamente para el uso del individuo o la entidad a la cual se dirige y puede contener información privilegiada, confidencial y exenta de acceso bajo la ley aplicable. Si usted ha recibido esta comunicación por error, por favor no lo distribuya. Favor notificar al remitente del E-Mail a la dirección mostrada y elimine el mensaje original. Gracias. -Original Message- From: Huber, Cheri [mailto:[EMAIL PROTECTED] Sent: Wednesday, April 02, 2003 5:17 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: Psychotherapy Notes Bob, My understanding from various published items as well as from some statements that were part of well-respected individuals presentations is that to qualify as and be defined as psychotherapy notes, and to therefore enjoy greater protection from access/disclosure, the notes must be maintained entirely separate from the medical record. As for state laws pertaining to MH records, here in CA we have somewhat similar provisions to yours in WV in that the patient is permitted access to his/her records, subject to the approval of the treating clinician, and may obtain copies. There is no restriction as to when - a patient may access the record during or after treatment, as long as we are maintaining the record (minimum of 7 years here in CA). The only portion of the record that is never accessible is any third party information that was imparted in confidence; for example, statements made to the clinician by a family member that are relevant to the treatment and therefore included in the record. Under CA law we are permitted to supply a summary rather than a copy of the entire record but HIPAA trumps CA in that respect and now, although we can still offer a summary, its up to the client/patient as to whether to accept a summary in lieu of copies. Cheri -Original Message- From: Coffield, Robert L. [mailto:[EMAIL PROTECTED] Sent: Wednesday, April 02, 2003 1:10 PM To: WEDI SNIP Privacy Workgroup List Subject: RE: Psychotherapy Notes Cheri, I appreciate your response and feedback. Based upon conversations with a limited number of mental health providers I have reached much of the same conclusion on the extent to which these notes are created. My read of the regulations
RE: Psychotherapy Notes
Based on an informal poll it appears most psych professionals do not create or maintain the sorts of notes that are defined by HIPAA as psychotherapy notes. The HIPAA exception evidently arose out of requests for special protection by those few professionals who do create such notes. Not all schools of psychiatry and psychology promote the concept but those who are of that discipline consider such notes their own property for their sole use and obviously not part of the patient record. One doc I spoke with describes his psychotherapy notes as his little black book. In it he jots down his informal impressions during patient sessions, usually using a sort of personal shorthand and not identifying patients by name. His chronological series of little black books, which contain notes on virtually all patients, is locked in his desk drawer. Personally, I think it makes sense for a doctor or psychotherapist to have such notes simply as a means to retain the gist of conversations and create a reference source for the thoughts that come to mind during a session that are not appropriate for inclusion in the actual record. It likely assists them to maintain a higher level of familiarity and, therefore, a better relationship with each patient. I just wish the authors of HIPAA had used a term to identify such notes that would create less confusion. As an example of the degree of misunderstanding, about a year ago I asked a HIPAA beginner/intermediate level seminar audience from facilities with psych units whether their clinicians created psychotherapy notes. All raised their hands. After a detailed explanation of the true HIPAA definition of psychotherapy notes I asked the question again. No one raised their hands. It is possible, though, that some were just unaware of the existence of such notes in their facility. I have it on good authority that there are some psychotherapists who keep such notes but simply do not make it known, and frankly, theres no reason they should. As I understand the concept, such notes are virtually useless to anyone but the author. However, Ive decided that as a precaution we will include in our role-based training for the psych clinicians the requirement that if they do create such notes that they do so in a manner that is as unidentifiable as possible, maintain them securely, and destroy them as soon as practicable. Cheri Huber County Privacy Officer County of Napa 1195 Third Street, Room 301 Napa, CA 94559 707-253-4523 -Original Message- From: Coffield, Robert L. [mailto:[EMAIL PROTECTED] Sent: Tuesday, April 01, 2003 9:06 AM To: WEDI SNIP Privacy Workgroup List Subject: Psychotherapy Notes Psychotherapy notes aredefined very specifically in the regulations includingthat the records are separated from the rest of the individual's medical record. Does the definition imply that a mental health provider who does not keep the recordsseparate -- not haveHIPAA psychotherapy notes? If so, can the providerrelease the records under a general HIPAA authorization and not be required to obtain a separate authorization for release of what may be classified as psychotherapy notes had such records been kept separate and apart from the other medical records. Basically was the definition designed to allow two ways to handle such records. It is my understanding from discussion with some mental health care providers that they like to keep some records separate and from others that they put all the records into the full medical record. Thoughts. bob coffield ** Robert L. Coffield Flaherty, Sensabaugh Bonasso, PLLC 200 Capitol Street (P.O. Box 3843) Charleston, WV 25338-3843 (304) 347-3791 Fax: (304) 345-0260 Work Email: [EMAIL PROTECTED] *** --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-privacy as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions
