Clipboard: Who should have access to mental health records?

Liz Kowalczyk writes in today’s Globe about how the issue of protecting people’s privacy as electronic health records are more widely used is complicated by mental health information.

Kowalczyk tells the story of a patient whose medical records at Massachusetts General Hospital included more then 200 pages of detailed notes from her psychiatrist. The patient was outraged when she visited a new internist and learned that other doctors had access to the notes. Representatives from Partners HealthCare, Mass. General’s parent organization, said it is important for doctors to have a full picture of a patient’s history.

The dispute highlights patient fears about how much will be shared and with whom, Kowalczyk writes.

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Between 35 percent and 45 percent of doctors in Massachusetts now use electronic health records with at least basic functions, such as storing doctor notes and ordering tests. And Massachusetts is moving toward a system that allow records to be shared between hospitals.

Kowalczyk writes:

Under federal health privacy laws, patients must sign a standard permission form for providers to share their medical information for purposes of treatment and billing. Policies on sharing psychiatric notes vary.

At Beth Israel Deaconess Medical Center, for example, psychiatrists decide whether to put notes in a locked area of the record, which other doctors can see only if they provide written justification.

At Partners, patients can ask that notes be restricted, but the organization evaluates the requests on a case-by-case basis. In the case of Julie — who does not want her full name published because she’s worried about being stigmatized — Partners eventually agreed to restrict access to the therapy notes written between 2002 and 2009. But the provider network would not automatically sequester future notes.

Julie told her story during the International Summit on the Future of Health Privacy, held in Washington, D.C. earlier this month and sponsored by advocacy group Patient Privacy Rights and Georgetown University Law Center’s O’Neill Institute for National and Global Health Law.

There is a push in health care policy toward more integration of mental and medical health services to better serve patient needs in all settings. Dr. Thomas Lee, head of the Partners’ physician organization, points to it in this story.

“Schizophrenia and Parkinson’s disease are both biochemical disorders of the brain,” he told Kowalczyk. “Why is one considered mental health and the other medical?’’

The catch is that privacy—trust, really—is paramount in serving people with sensitive mental health concerns. So, what’s the solution? How should records be handled to protect patients and provide the best possible care?