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What Every Therapist Should Know about Email and Texting

Behavioral health therapists have both legal and ethical guidelines pertaining to email. Some programs do an adequate job of one, but not the other. Even worse, some do neither and yet still claim to be HIPAA compliant. While that's probably a truthful statement, the part they're not telling you is that their programs aren't 100% end-to-end encrypted. In other words, they're not safe ALL the time. If you use those programs, your email and texts can be hacked.

The Convoluted Maze of HIPAA-Compliant Email and How to Navigate It

Email could arguably be one of THE most misunderstood aspects of HIPAA. Part of the confusion stems from the fact that there is no ONE place in HIPAA that says "Do email like this." However, email is referenced - directly or indirectly - in a variety of places throughout the vast HIPAA documentation. What causes some of the misunderstanding is that people will find a guideline that pertains to email from ONE place in HIPAA and assume if they do that one thing, they're good. Unfortunately, that conclusion is not unlike what you get when several people with visual impairments are put in front of an elephant and asked to describe it. We may get a beautiful description of an elephant's trunk but to assume that's ALL an elephant is would be incorrect.

Good Faith Estimates and the “No Surprises Act”

Were you surprised when you first heard about the "No Surprises Act"? We were. I'd like to be able to tell you that we had been actively tracking and planning for this legislation since it was first issued on October 7, 2021. Unfortunately, that's not the case. However, we got lucky because we were already working on a new tool called Custom Forms which, when it launches (est. Feb 2022), will work beautifully in helping you comply with this bill in ways that are easy, HIPAA compliant, and give you a significant amount of automatic documentation and tracking.

Am I Required to Comply with HIPAA? ALL of It???

Not too long ago, I conducted a workshop on telehealth. During the Q & A period at the end, a woman said that she had been told she was exempt from HIPAA and wanted to check with me to see if that was true. I was caught off guard. I used to get that question a lot, but I hadn’t heard it for a while, so it took me a moment to gather my wits. Finally I said, “Do you only use landlines when talking with your patients?” She replied that she did. I continued, “And are they always only on landlines as well?” She assured me that they were. “And you’re not doing any video sessions, only in person?” That was true, too. My last question was, “And I assume you don’t take insurance at all, that you’re only private pay?” She was. I replied, “Ok, then yes, I guess you’re fine. No need to worry about HIPAA.”

She left relieved. I left unsure of my answer.

Integrated Products for Mental Health: Save Time, Money, Errors

Mental health therapists are beginning to talk about wanting “integrated products” to help manage their practice tasks. But what do they mean by “integrated product?” More importantly, if you wanted to look at some, how would you go about finding them? Googling “integrated product” isn’t likely to produce the results you want.

One of the problems is that these types of products go by more than one name, which may be why people have begun referring to them as “integrated products.” Common names are Electronic Health Record (EHR), Electronic Medical Record (EMR) or Practice Management System. To complicate matters, just being called one of those titles doesn’t automatically mean the product is well-integrated.

All Patient Notes in ONE Place – You Don’t Have to Go Looking

Recently, a top journal in the field of Electronic Health Record (EHR) development posted this quote from an anonymous doctor who was dissatisfied with his EHR:

“I firmly believe this EHR makes important information difficult to find and interpret, and it is very inefficient.” He went on to say, “It creates superfluous and difficult-to-navigate notes and information that are not centralized. That makes it easy for care providers to disregard notes, and they often do. That affects patient safety. . . . It is difficult and arduous to document in the EHR, and providers’ efforts to do so still yield subpar results with erroneous, irrelevant information.”

This doctor is pointing out a very real problem inherent in some EHRs. However, he was referring to one of the "ONC Certified" EHRs which we've discussed previously. Those types of EHRS are inherently much more difficult to use than most EHRs that have been specifically created for the mental health professions, such as PSYBooks.

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.