Physician Practice

HIPAA Q&A: You have questions. We have answers

Physician Practice Insider, July 14, 2015

Q: What types of records are covered entities permitted to share through a health information exchange or health information organization? For example, psychotherapy notes are often thought to be sensitive, and I am wondering whether these notes should be among the records that are shared electronically.
 
A: Check your state statutes on health information exchanges, as they vary considerably from state to state.
 
HIPAA does not exclude mental health information sharing unless the notes meet the criteria to be considered psychotherapy notes. This is a point of confusion for many, because only those notes kept separately from the medical record and not used to substantiate payment are considered psychotherapy notes, and most mental health notes therefore do not fall into that exclusion.
 
Many would argue that excluding mental health-related information contributes to the stigma of mental illness and that patient safety is negatively impacted by having incomplete information. Add to that the fact that much mental health treatment is provided in the primary care setting, and you realize that attempting to exclude such information becomes practically impossible, even if it were a good idea. Remember also that in most health information exchanges, patients retain the right to opt out of participation should they choose to do so. Bottom line: If the information is needed for treatment, I believe it should be included, and there is no federal law forbidding you to do so.
 
Editor's note: Chris Simons, MS, RHIA, the director of health information and the privacy officer at Cheshire Medical Center/Dartmouth-Hitchcock in Keene, New Hampshire, originally answered this question in Medical Records Briefing. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions.

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