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.
I attended an ethics workshop recently where the presenter related a story of a colleague who had died suddenly. Several of the remaining office partners went into his office to try to determine which clients needed to be notified. According to the presenter, the deceased therapist’s records were “a mess.” They found a paper appointment book that looked like what the therapist had been using for scheduling. However, entries just said, “Joe” or “A.G.” – mostly likely as a HIPAA privacy precaution. Although nice for confidentiality, the colleagues had no way of knowing which calendar entries might be clients and which might be other types of appointments. Furthermore, since no contact information was listed in the calendar, they had no way of contacting anyone. They saw evidence of some charts, but they were scattered. A few were sitting out in a pile on the desk – but were these current clients or ones who had recently terminated? There were two locked filing cabinets that they suspected held additional charts, but none of the colleagues knew where to find the keys. Financial records were found in an online accounting program, but again, there was no way to know which entries were clients and specifically, which ones were current clients who would need to be contacted.
As therapists, in addition to HIPAA’s privacy and security laws, we also have ethical mandates. Although ethical guidelines vary a bit depending on your state and also your discipline, most require us to have some sort of plan for the appropriate transfer of records in situations that would otherwise result in an interruption of service for our clients. The therapist in the example above appears to have been making some attempts to comply with HIPAA (with the possible exception of the charts that were sitting out) but seems to have given no thought to the ethical obligations he also had to his clients. Imagine how traumatic it must have been for those clients who couldn’t be notified to show up for their appointments and then find out that their therapist had died.
EHRs offer a perfect solution to this problem. With an EHR, all data pertaining to all clients can be stored in one place. Although it’s typically not wise to share your username and password with others, better EHRs will have the ability for you to add users to your account. A user would have their own username and password, and you would have a record of when they access your account and what they do there. Making one or more colleagues users on your account would allow them to access your records in emergency situations and see both your calendar and all client charts. In the situation described above, the colleagues would have been able to see at a glance which clients were scheduled for the next few weeks and have a way to contact them. Although learning that their therapist had died would still most likely be difficult, hearing the news in a personal way from someone who knew their therapist and who might be in a position to offer to see them is certainly better than just having a note on the door when they arrive for their appointment.