Articles on Topics You Need
Does the Open Notes Rule Apply to Me?
The term "Open Notes Rule" is a popular term coined to depict the legislation enacted by the 21st Century Cures Act that is more accurately referred to as the ONC's final program rule on Interoperability, Information Blocking, and ONC Health IT Certification (OpenNotes, 2020). It is a continuation of the legislation originally enacted as part of the HITECH act of 2009 to promote EHR interoperability (with the ultimate goal being a national database for healthcare information on all U.S. Citizens) and open access to records. The Open Notes Rule does NOT apply to PSYBooks users but there are some important things to understand about the current iteration of this legislation, partly in an attempt to help prepare us for what might be coming in the future.
Why Do People Hate Electronic Health Records (EHRs)?
Actually, most patients don't. A recent study conducted by Catalyst Healthcare Research found that 93% of adults would prefer to go to a doctor that offers email communication, even if there was a $25 fee (Pai, 2014). Encrypted email is incorporated into most, if not all present-day EHRs that also have patient portals. By being integrated with the entire medical record, it's relatively easy for doctors to correspond with patients right from their electronic chart. Leaders in prominent health care groups in Houston, encouraged patient enrollment in their EHR system and have found similar results. Dr. Robert Dickinson, Kelsey-Seybold's medical director for executive health and wellness says, "They think it's the coolest thing they've ever seen. It's like online banking. People love this kind of access. Before, it was kind of mysterious" (Hines, 2014).
However, when you ask doctors if they like EHRs, you often get an entirely different story. You mostly hear dislike, frustration and irritability. There are actually excellent reasons for this.
More Than a Three-Room House
Imagine a two-room house whose occupants have outgrown it. They decide to solve the dilemma by tacking another room on the back. Great! The siding doesn't quite match - nor does the roof. Some of the existing old-growth trees had to be felled to make the new room fit, and when you're inside, you have to remember to step down and duck a bit as you enter the new room. But hey! The owners still have that extra room! If they decide to put their home on the market, they can advertise it as having three rooms.
Unfortunately, some EHRs are built like this.
Why Get an Integrated Product?
As a therapist, you can amass your digital tools one at a time or you can invest in a well-integrated bundled product. For example, let's say right now you're mostly looking for a video platform so you can do telehealth. There are companies that ONLY offer subscriptions to video platforms. But is that the best choice?
Depends.
For example, what happens if, after you sign up for your standalone video product, you realize that you also need a way to collect your fees from your telehealth clients. And maybe you need encrypted email so you can contact people in a way that's secure. Or maybe now you need HIPAA-compliant file storage, as your clients begin to send you documents via their new encrypted email. Or perhaps a way to schedule clients online. Or maybe a way to efile and also to send statements and receipts digitally. That's a LOT of tools and we're just getting started!
Do I Have to use HIPAA-Compliant Video?
Right now is a stressful time as COVID-19, more commonly known as coronavirus, continues to spread. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have both emphasized how now it’s more important than ever for us to maintain “social distancing.” How do we do that and maintain our ethical and legal obligations to our clients – not to mention keeping our income relatively intact?
Doing Telehealth? You Need a Portal.
Think you're not doing telehealth? Think again. Although there's no one-size-fits-all definition that cuts across state and/or discipline lines, most agree that telehealth basically involves any electronic method you use to communicate with or about your clients. This can include common things like phones, email and electronic file storage, in addition to video sessions, which is what we typically think of with the term telehealth.
Are We Becoming Outdated?
In the not too distant past, a therapist with some kind of note pad in hand was the norm. It was expected. We were doing our jobs and interested enough in the client to take notes on what they were saying. I was part of that crowd. Although I preferred to write my notes after the client left, I definitely felt that paper notes were the way to go and I burned through many legal pads in the early years of my career.
Encrypted Email:
Your Role in Keeping it Safe
Some people like to point out that encrypted email isn’t all it’s cracked up to be. “After all,” they warn, “as soon as someone has access to your username and password, it no longer matters whether your email is encrypted or not.” Well . . . yes. That’s an accurate statement. However, to use that line of reasoning would be like telling us not to bother locking our homes or cars. After all, as soon as someone gets access to your keys, those locks become useless.
Encrypted Email – Just How Safe Is It?
PSYBooks’ email not only meets but actually surpasses the HIPAA specifications for encrypted email. HIPAA’s rules for email encryption are broad, giving developers the maximum amount of freedom. This is as it should be. Those who are responsible for writing and maintaining HIPAA/HITECH laws cannot also be expected to keep up with rapid changes in the world of technology the way developers do. Therefore, although HIPAA wisely states that email containing client PHI (Protected Health Information) should be encrypted, it doesn’t specify exactly how that should be done.
Introduction to the PSYBooks Portal
The portal is the web-based interface between you and your clients. In a sense, it allows your clients (or anyone else you designate) to have their own “mini” version of PSYBooks that contains just their own data – no one else’s. You can view data they enter on your side and interact with the client about their data, all through the portal.
Calendar Displays
Like most online calendars, PSYBooks has Daily, Weekly and Monthly views. You can customize your display even further with the Calendar Settings tool, which is accessed by clicking the down arrow by Calendar Settings on the left nav of all pages in the calendar:
Cancel Client Appointments
PSYBooks makes cancelling appointments a breeze. Clicking an existing appointment will open a window like the one below where you can cancel one or, for repeating appointments, a series of appointments:
Add Client Appointments
We started with the Google calendar design and tailored it for mental health. For example, when you click a time block to add an appointment, the window you get has a dropdown box with all of your clients listed. You don’t have to type a name, just select the name you want.
Why Do People Hate Electronic Health Records (EHRs)?
Actually, most patients don't. A recent study conducted by Catalyst Healthcare Research found that 93% of adults would prefer to go to a doctor that offers email communication, even if there was a $25 fee (Pai, 2014). Encrypted email is incorporated into most, if not all present-day EHRs that also have patient portals. By being integrated with the entire medical record, it's relatively easy for doctors to correspond with patients right from their electronic chart. Leaders in prominent health care groups in Houston, encouraged patient enrollment in their EHR system and have found similar results. Dr. Robert Dickinson, Kelsey-Seybold's medical director for executive health and wellness says, "They think it's the coolest thing they've ever seen. It's like online banking. People love this kind of access. Before, it was kind of mysterious" (Hines, 2014).
However, when you ask doctors if they like EHRs, you often get an entirely different story. You mostly hear dislike, frustration and irritability. There are actually excellent reasons for this.
World’s Easiest Efile: Just Save the Session
Efiling is a 2-step process:
- Tell us which insurance company your client has (you only have to do this once)
- After that, each time you add a session, PSYBooks automatically efiles the information to the client’s insurance company unless you tell us not to
Managing ERAs with PSYBooks
When you sign up to receive ERAs in PSYBooks, allocating the data to your client charts is easy. When we receive ERAs, we parse them for you. That means that by the time you see them, we already have the client’s name filled in and the correct amount entered in each of the fields (session date, amount allowed, deductible, amount paid, etc.). The screenshot below shows you what an ERA you receive might look like when we deliver it to you:
Round it Off with an EFT
EFT, which stands for electronic funds transfer, is the third “E” in “Efile, ERA and EFT”. Once you’ve signed up for EFTs with an insurance company, they will deposit the payments they send you directly into your bank. Since EFTs only involve the transfer of money, PSYBooks isn’t actively involved. However, whether or not you want to go the EFT route instead of receiving paper checks, you may want to sign up for ERAs, which are the electronic equivalent of EOBs. Receiving ERAs in PSYBooks means that you no longer have to enter insurance payments by hand. You just have to look over the ERA to see if it seems correct and click Save.
Why Get an Integrated Product?
As a therapist, you can amass your digital tools one at a time or you can invest in a well-integrated bundled product. For example, let's say right now you're mostly looking for a video platform so you can do telehealth. There are companies that ONLY offer subscriptions to video platforms. But is that the best choice?
Depends.
For example, what happens if, after you sign up for your standalone video product, you realize that you also need a way to collect your fees from your telehealth clients. And maybe you need encrypted email so you can contact people in a way that's secure. Or maybe now you need HIPAA-compliant file storage, as your clients begin to send you documents via their new encrypted email. Or perhaps a way to schedule clients online. Or maybe a way to efile and also to send statements and receipts digitally. That's a LOT of tools and we're just getting started!
What Will Happen to Your Clients?
Most of us have documents like a will, power of attorney and other estate planning instruments either already in place or at least on our “I’ll get to that eventually” list. Far fewer have given much thought to how we would want our clients to be taken care of in the case of our demise or anything else that would cause a sudden interruption in our ability to provide services.
Encrypted Email:
Your Role in Keeping it Safe
Some people like to point out that encrypted email isn’t all it’s cracked up to be. “After all,” they warn, “as soon as someone has access to your username and password, it no longer matters whether your email is encrypted or not.” Well . . . yes. That’s an accurate statement. However, to use that line of reasoning would be like telling us not to bother locking our homes or cars. After all, as soon as someone gets access to your keys, those locks become useless.
Encrypted Email – Just How Safe Is It?
PSYBooks’ email not only meets but actually surpasses the HIPAA specifications for encrypted email. HIPAA’s rules for email encryption are broad, giving developers the maximum amount of freedom. This is as it should be. Those who are responsible for writing and maintaining HIPAA/HITECH laws cannot also be expected to keep up with rapid changes in the world of technology the way developers do. Therefore, although HIPAA wisely states that email containing client PHI (Protected Health Information) should be encrypted, it doesn’t specify exactly how that should be done.
Are Digital Records Better Than Paper?
At it’s simplest, digital record-keeping could simply mean a Word doc, Excel sheet or PDF that you’ve saved on your computer, tablet, phone, thumb drive or other type of digital storage device. There are advantages to digital record-keeping even at this elementary level. For example, with digital records, you no longer have to contend with bulging filing cabinets, finding adequate long-term storage, or shredding – all of which are factors with paper health records. Additionally, it’s relatively easy to make backup copies of digital files to guard against some type of disaster, whereas making copies of paper records is costly, both in terms of time and money and also, effectively doubles the number of filing cabinets or other physical storage space you need.
Types of EHRs: The Shared Chart Model
At it’s simplest, digital record-keeping could simply mean a Word doc, Excel sheet or PDF that you’ve saved on your computer, tablet, phone, thumb drive or other type of digital storage device. There are advantages to digital record-keeping even at this elementary level. For example, with digital records, you no longer have to contend with bulging filing cabinets, finding adequate long-term storage, or shredding – all of which are factors with paper health records. Additionally, it’s relatively easy to make backup copies of digital files to guard against some type of disaster, whereas making copies of paper records is costly, both in terms of time and money and also, effectively doubles the number of filing cabinets or other physical storage space you need.
Doing Telehealth? You Need a Portal.
Think you're not doing telehealth? Think again. Although there's no one-size-fits-all definition that cuts across state and/or discipline lines, most agree that telehealth basically involves any electronic method you use to communicate with or about your clients. This can include common things like phones, email and electronic file storage, in addition to video sessions, which is what we typically think of with the term telehealth.
Business Associate Agreements:
Do We Really Need Them?
I sometimes hear therapists mention specific software programs they’re using in their practices for tasks like notes, calendar/schedulers, online file storage, billing, video sessions or email and then add something like, “They’re HIPAA compliant. They just don’t – you know – have Business Associate Agreements.”
HIPAA/HITECH
There are no HIPAA compliant products or services, because by definition, only HIPAA covered entities (e.g., you) and business associates (e.g., PSYBooks) can be compliant. In other words, it’s not a product or service that’s compliant, it’s how you, as a covered entity, or we, as a business associate, write and implement our policies and procedures to utilize those products.
Your Personal File Storage
In addition to being able to store files for each client, you can also upload and store your own digital records in an area set aside just for you. It’s important to note that files are maintained separately. Client files are stored in their charts – separate from all other clients and also separate from your personal files. This is one of the ways PSYBooks adheres to HIPAA/HITECH guidelines.
File Storage for Each Client
Each of your charts in PSYBooks has a Files tab where you can upload files specifically to that client’s chart. For example, initially you might want to upload scanned copies of their intake forms, insurance cards and/or driver’s license. Later on, you may want to upload copies of releases and consents, EOBs, reports or testing results. If you want, you can also keep copies of routine things you generate such as statements, insurance claims or receipts. Should your client request a PHI report, you can also upload that to their chart so you’ll have a record of what you gave them. There are several advantage to storing these kinds of documents in PSYBooks:
User Accounts
User Accounts can be established for anyone you need to grant access to some or all of your PSYBooks records. For example, you might want to create User Accounts for billing personnel, scheduling personnel, supervisees or a colleague who is covering for you. You can allow the user to access the records of all of your clients or just certain ones.
Why Do People Hate Electronic Health Records (EHRs)?
Actually, most patients don't. A recent study conducted by Catalyst Healthcare Research found that 93% of adults would prefer to go to a doctor that offers email communication, even if there was a $25 fee (Pai, 2014). Encrypted email is incorporated into most, if not all present-day EHRs that also have patient portals. By being integrated with the entire medical record, it's relatively easy for doctors to correspond with patients right from their electronic chart. Leaders in prominent health care groups in Houston, encouraged patient enrollment in their EHR system and have found similar results. Dr. Robert Dickinson, Kelsey-Seybold's medical director for executive health and wellness says, "They think it's the coolest thing they've ever seen. It's like online banking. People love this kind of access. Before, it was kind of mysterious" (Hines, 2014).
However, when you ask doctors if they like EHRs, you often get an entirely different story. You mostly hear dislike, frustration and irritability. There are actually excellent reasons for this.
Doing Telehealth? You Need a Portal.
Think you're not doing telehealth? Think again. Although there's no one-size-fits-all definition that cuts across state and/or discipline lines, most agree that telehealth basically involves any electronic method you use to communicate with or about your clients. This can include common things like phones, email and electronic file storage, in addition to video sessions, which is what we typically think of with the term telehealth.
Business Associate Agreements:
Do We Really Need Them?
I sometimes hear therapists mention specific software programs they’re using in their practices for tasks like notes, calendar/schedulers, online file storage, billing, video sessions or email and then add something like, “They’re HIPAA compliant. They just don’t – you know – have Business Associate Agreements.”
Types of EHRs: Introduction
Let’s face it. There are LOTS of EHRs on the market and most of us simply don’t have the time, energy, or frankly – interest – to put a lot of effort into researching them. Some therapists have told me that although they’d sort of like to explore EHRs, they begin looking at all the options, get overwhelmed, and decide to put the whole thing off. Although it doesn’t have to be overwhelming, it IS an important decision. An EHR that’s designed well, with attention paid to usability issues so it’s easy to use, can simplify your life enormously and save you a lot of time and money. On the other hand, an EHR that’s poorly designed will have you pulling your hair out and cursing EHRs in general – possibly not realizing that not all EHRs are the same and that there might be better options.
What is an EHR Anyway?
The acronym EHR stands for Electronic Health Record. Originally the term EHR was supposed to mean a very specific thing. It was to be a type of digital (i.e., computerized) practice management system for health care professionals that could “talk to” (i.e., share data with) EHRs of other health care providers and organizations, such as laboratories, specialists, school and workplace clinics, medical imaging facilities, pharmacies, emergency facilities – essentially anyone that might be involved in a patient’s care. Similar products that did NOT automatically have the “talk to everyone” feature were to be referred to by other names, such as EMR (Electronic Medical Record) or simply, practice management system.
Types of EHRs: Scope
To begin this series of posts, let’s look at a concept I’m calling “scope”. In reference to EHRs, scope doesn’t refer to the number of users a particular EHR has, but rather, to the number of different roles for which it’s designed. For example, a large scale medical EHR needs different roles or tracks for each of the various personnel that might need to add something to a patient’s chart. That could mean, for example, different tracks for scheduling, billing, intake, nurses and other mid-levels, doctors, lab technicians, social workers, etc. Additionally, such EHRs are designed primarily for hospital settings. Doctors who are affiliated with the hospital can typically access the EHR from their office, but the EHR itself was developed with hospitals in mind.
Does the Open Notes Rule Apply to Me?
The term "Open Notes Rule" is a popular term coined to depict the legislation enacted by the 21st Century Cures Act that is more accurately referred to as the ONC's final program rule on Interoperability, Information Blocking, and ONC Health IT Certification (OpenNotes, 2020). It is a continuation of the legislation originally enacted as part of the HITECH act of 2009 to promote EHR interoperability (with the ultimate goal being a national database for healthcare information on all U.S. Citizens) and open access to records. The Open Notes Rule does NOT apply to PSYBooks users but there are some important things to understand about the current iteration of this legislation, partly in an attempt to help prepare us for what might be coming in the future.
Are We Becoming Outdated?
In the not too distant past, a therapist with some kind of note pad in hand was the norm. It was expected. We were doing our jobs and interested enough in the client to take notes on what they were saying. I was part of that crowd. Although I preferred to write my notes after the client left, I definitely felt that paper notes were the way to go and I burned through many legal pads in the early years of my career.
Displaying Notes
Each client’s chart has a Notes tab on the top right:
Add Notes in PSYBooks
PSYBooks has fields where you can add notes to almost any form in a client’s chart. For example the area on the Add Session form for adding notes looks like this:
Your Personal Psychotherapy Notes (Hint: These Are NOT Part of the Client’s Medical Record)
PSYBooks does not store Psychotherapy Notes in the same way it stores notes that are part of the client’s medical record. Psychotherapy notes are meant to be places for you to record your personal thoughts or ideas about a client so they are stored separately. There is one note type in PSYBooks that is always in the Psychotherapy note category and four others that you can designate as Psychotherapy or Medical Record notes:
Medical Record Notes
Almost all forms in PSYBooks have a section where you can enter notes. Most of these notes automatically become part of the client’s medical record, although a few allow you to designate the note as a personal psychotherapy note (i.e., not part of the medical record). PSYBooks breaks medical record notes into two categories: clinical medical record notes and admin medical record notes. This is done to allow you to give permission for a User to see one type of note but not others. For example, you might want your front office staff to be able to see your admin medical record notes (e.g., a note you might have attached to a client payment), but not your clinical medical record notes or your personal psychotherapy notes.
Creating Custom Reports
Each report in PSYBooks has a group of filters at the top of the page. For example, the filter section of the Claim Status Report, which enables you to check the progress of claims you’ve efiled, looks like this:
Activity Log
The Activity Log is designed to meet HIPAA/HITECH specifications for tracking PHI. PSYBooks logs almost everything that takes place within the app and displays it for you in the Activity Log. The filter section of the Activity Log report looks like this:
When You Have to Produce a Medical Record
Before I started using practice management systems, being required to produce a client’s medical record was a bit scary for two reasons:
- First, I typically only received those requests when something important was going on, i.e., a legal proceeding of some sort, a disability or worker’s comp situation, or maybe something having to do with insurance. They were the kinds of things where I felt that a lot might be at stake for my client (and/or for me) so I wanted to make sure I “did it right”.
- Second, although I had my own system for organizing client files, the reality is that my records were scattered everywhere. I kept files on current clients in one filing cabinet – unless a certain file got too big, in which case I moved older portions of it to another filing cabinet, unless there was also large artwork in the file, in which case it had to go in the lateral filing cabinet. When a client terminated, files got moved to a storage area in my basement at home. If the client later returned and their file had been especially large, part of it would be brought back to my office, but older parts remained in my basement at home. Then, of course, some documents were on my computer – a smattering of various Word docs and Excel sheets I had pieced together for special notes I had written on clients, letters I had written on their behalf, and various attempts at coming up with THE perfect method for determining how much a client owed me when insurance was involved. I had also tried efiling for awhile at various insurance company’s websites, so some of my records were on various sites on the Internet, too. Somehow, when I was asked to produce a medical record, even though I knew I had everything I needed, finding it all and pulling it all together into some type of meaningful report was a daunting task.
