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 It is a continuation of the legislation originally enacted as part of the HITECH act of 2009 to promote EHR interoperability (with the ultimate goal being a national database for healthcare information on all U.S.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.
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.
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.
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?
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!
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?