As the clinician who is primarily responsible for Ministry Health Care’s Electronic Health Record, I deal with a number of thorny issues. None is thornier than providing access to clinicians who are treating patients but yet preserve patient confidentiality. There are a number of built in safeguards that allow user access to patient records on a need to know basis.
One of the thorny issues is determining who outside our organization should have even basic access. In general, we allow outside organizations to access our EHR if the information is utilized for active patient care. Ambulatory surgical centers, nursing homes, medical clinics and emergency rooms at other health care organizations are good examples. We know timely access to health information allow clinicians to make more informed health care decisions. We do monitor their access to make sure they are exercising their privilege appropriately.
Our thorniest issue involves access to mental health records. Federal law places restrictions on mental health records and Wisconsin law goes several steps further. I am over simplifying this a bit, but from an EHR perspective, patient records generated by our mental health specialists are totally segregated from the rest of the patient’s record and not readily accessible to non-mental health clinicians. Even though a patient’s family physician may refer a patient to psychiatrist, the family physician does not have direct on-line access to the psychiatrist’s evaluation.
We often get pulled in two directions; primary care clinicians saying they need access to all of a patient’s record while mental health professionals say their records need to be restricted.
Our primary care clinicians rightly feel that inadequate patient care is provided without full access to patient records. A recent study is proving them right.
A team from Johns Hopkins compared outcomes at several health care systems where mental health records were accessible or not accessible. They found health care systems that had online psychiatric health care records readily available to clinicians had fewer psychiatric readmissions than systems that either had paper records or restricted online access. Click here to see a summary of the study.
We have a terrible shortage of mental health professionals. Shared EHRs containing mental health records accessible to all clinicians is vital to providing quality care, reducing health care costs and ensuring appropriate utilization of our scare mental health professionals. Our current restricted environment is also preventing greater collaboration between our primary care clinicians and mental health professions that would improve care to patients. It is time for State and Federal law to change allowing clinicians to access mental health records.