Violations
Discussion: In what ways do you think record guidelines are often violated that may at first appear to be harmless.
Leaving a folder out, discussing clients with anyone not involved with treatment, and computers facing clients are all examples.
True or False: Privacy rules only apply to electronic and physical data of an identifiable individual
False: It includes all information within the practice, including oral, written, and typed information
What is the APA's stance on the inclusion of financial information on informed consent?
The APA Ethics Code includes “fees” as essential elements required at the earliest time possible.
True or False: As a clinician, you do not have to worry about how client records are stored.
False; the APA holds psychologists responsible fore protecting records.
What is the required plan that ensures continuity of treatment and preservation of confidentiality?
a record transfer plan
Dr. G only keeps online records. They are stored in an encrypted database on a secure server. Patient files are deleted after 5 years of inactivity. Access to patient files are password protected. Is Dr. G's online storage ethical?
No. Records must be maintained for 7 years for adults or 3 years after a minor reaches the age of maturity.
True or False: The HIPAA privacy rule only applies to living patients.
False: While exception may be made both dead and living patients are covered.
You are running a private practice, and a client has just learned that the fees for treatment have increased (15%). He threatens to sue because this was not the agreed upon price. What steps should you have taken to protect yourself?
Include information in the informed consent (prices may change, have a set date for change), have an advance notice. “Psychologists do not misrepresent their fees.”
When taking client notes on paper, how should you store those notebooks/documents?
Psychologists should keep documents filed under lock and key (ex: locked cabinet)
A private practice that has been practicing for 25 years has decided to transfer their client files into a new EHR system. What should they do after transferring client information to electronic format?
Arrange for secure disposal of paper records in a way that preserves confidentiality (ex: hire specific company)
You discover that a colleague is selling the personal information of one of his clients. When confronted, he says that he is only selling data on clients who cannot pay for treatment and the money helps to cover what they cannot afford. The clients do not know this. Should you do anything? If so, why?
Yes. Companies often sell user data, but health information is protected.
True or False: A Notice of Disclosure (a document detailing what information is disclosed for treatment) does not cover psychotherapy notes.
True: The psychologist must obtain additional authorization for process notes to be released
If despite precautions, a client cannot pay for treatment, what options are available to address this concern?
Paying balance in full, payment plan agreement, increasing the amount of time between treatment sessions, agreeing to a reduced fee, referring the client to another professional or to a facility that offers a sliding fee scale or pro bono services
I have completed my new client's intake interview and saved it on my laptop. It is under my documents folder. What should I do next?
save file in folder/drive that is fully-encrypted; encrypt file
Your practice is involved in a fire, and many client records are lost. Would this incident fall under "damage" or "destruction" of records?
"damage" = involves fire, water, mold, infestation involving paper records
To ensure the confidentiality of your clients, you decide to write your notes in a shorthand that is easy for you to recognize, but not others. Is this an appropriate way to maintain your records?
Records must be maintained and organized in a way that anyone who should have legitimate access can understand.
A colleague keeps her passwords on sticky notes she has attached to her in her office computer. Is this a risk to patients' privacy. If so, what can be changed?
Passwords should be secured in a safe location or in approved online resources.
If a patient would like a treatment summary sent to another psychologist, can a treating psychologist refuse because of an unpaid bill?
Psychologists may not withhold records because payment has not been received.
What federal law also enforces secure storage of protected health information?
The Health Insurance Portability and Accountability Act (HIPAA)
What situation would fall under "destruction" of electronic client records?
A. A psychologist's office bathroom floods, and multiple cabinets are damaged.
B. You accidentally delete your last client's folder holding all of their therapy information.
C. Your practice administration clicked on an unknown link, and her computer received a virus.
B. You accidentally delete your last client's folder holding all of their therapy information.
*You should have multiple backups for electronic records.
You are working in the counseling center. A client mentions a student's name that you recognize as another client for the counseling center. After the session, you decide to access the second student's file to see if you can find something that may help your client. Did a violation occur? What?
The second student is not your client, and you are providing information about one client to another. Both are violations.
Dr. Q is concerned about the information in Mrs. K's record that she had an affair and fears that it could be damaging to her. Should he delete this information?
Never tamper with records.
How do you determine what price to charge for fees?
Ensure that fees are fair, reasonable, and commensurate with the services provided. Consideration should be given to the clients’ ability to pay.
You finish a video-recorded therapy session. You have to remember to show the recording to your supervisor tomorrow. After the client leaves, you have to quickly finish your notes so you can make your dentist appointment. You finish your SOAP note, save it on your encrypted drive, lock up your handwritten note, lock the door, and leave. What did you forget to do?
Securely store the video-recording.
DOUBLE JEOPARDY
What are the consequences for failing to comply with HIPPA?
DHHS may take administrative action; the psychologist may be fined up to $100 for each violation with a cap of $250,000 and/or imprisonment for up to 10 years.