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----- 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 CPI Directions, Inc. 10 West 15th Street,
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Message----- 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, it’s up to the client/patient as to whether to accept a
summary in lieu of copies. Cheri -----Original
Message----- 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 is that
it may give mental health providers the ability to provide greater
protection to that information that they want to fit into
the psychotherapy definition. It would require the provider to keep the
records separate from the medical record (Q: can a provider keep them in the
medical record -- but just under a separate section?) and then do a summary of
the notes into the main section of the medical record. What is
your understanding of most current state laws on the issue of mental health
records? My understanding in WV is that the mental health provider is not
required to provide access to the entire mental health record and is only
required to provide a summary. There is language in the WV Code that seems to
indicate that this access is only allowed after termination of the treatment
program. Do other states have similar provisions? Thanks,
bob coffield ****************************************************** ******************************************************* -----Original
Message----- 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, there’s no reason they should. As I understand the concept, such
notes are virtually useless to anyone but the author. However, I’ve 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----- Psychotherapy
notes are defined very specifically in the regulations including that
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
records separate -- not have HIPAA psychotherapy notes? If so, can
the provider release 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 ****************************************************** ******************************************************* --- --- --- --- 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 |
- Psychotherapy Notes Coffield, Robert L.
- RE: Psychotherapy Notes Huber, Cheri
- RE: Psychotherapy Notes Coffield, Robert L.
- RE: Psychotherapy Notes Huber, Cheri
- Re: Psychotherapy Notes DKHGRMI
- RE: Psychotherapy Notes Matthew Rosenblum
- Huber, Cheri