RE: Psychotherapy Notes

[Coffield, Robert L.]

Cheri, I appreciate your response and feedback. Based upon conversations with a limited number of mental health providers I have reached much of the same conclusion on the extent to which these notes are created. My read of the regulations is that it may give mental health providers the ability to provide greater protection to that information that they want to fit into the psychotherapy definition. It would require the provider to keep the records separate from the medical record (Q: can a provider keep them in the medical record -- but just under a separate section?) and then do a summary of the notes into the main section of the medical record.   What is your understanding of most current state laws on the issue of mental health records? My understanding in WV is that the mental health provider is not required to provide access to the entire mental health record and is only required to provide a summary. There is language in the WV Code that seems to indicate that this access is only allowed after termination of the treatment program. Do other states have similar provisions?   Thanks, bob coffield   ****************************************************** Robert L. Coffield Flaherty, Sensabaugh & Bonasso, PLLC 200 Capitol Street (P.O. Box 3843) Charleston, WV 25338-3843 (304) 347-3791 Fax: (304) 345-0260 Work Email: [EMAIL PROTECTED]  *******************************************************          -----Original Message----- From: Huber, Cheri [mailto:[EMAIL PROTECTED] Sent: Wednesday, April 02, 2003 12:41 PM To: Coffield, Robert L.; WEDI SNIP Privacy Workgroup List Subject: RE: Psychotherapy Notes Based on an informal poll it appears most psych professionals do not create or maintain the sorts of notes that are defined by HIPAA as “psychotherapy notes”. The HIPAA exception evidently arose out of requests for special protection by those few professionals who do create such notes.  Not all “schools” of psychiatry and psychology promote the concept but those who are of that discipline consider such notes their own property for their sole use and – obviously – not part of the patient record.  One doc I spoke with describes his “psychotherapy notes” as his ‘little black book’.  In it he jots down his informal impressions during patient sessions, usually using a sort of personal shorthand and not identifying patients by name.  His chronological series of ‘little black books’, which contain notes on virtually all patients, is locked in his desk drawer.   Personally, I think it makes sense for a doctor or psychotherapist to have such notes simply as a means to retain the gist of conversations and create a reference source for the thoughts that come to mind during a session that are not appropriate for inclusion in the actual record.  It likely assists them to maintain a higher level of familiarity and, therefore, a better relationship with each patient.   I just wish the authors of HIPAA had used a term to identify such notes that would create less confusion.  As an example of the degree of misunderstanding, about a year ago I asked a HIPAA beginner/intermediate level seminar audience from facilities with psych units whether their clinicians created psychotherapy notes.  All raised their hands.  After a detailed explanation of the true HIPAA definition of psychotherapy notes I asked the question again.  No one raised their hands.  It is possible, though, that some were just unaware of the existence of such notes in their facility.  I have it on good authority that there are some psychotherapists who keep such notes but simply do not make it known, and frankly, there’s no reason they should.  As I understand the concept, such notes are virtually useless to anyone but the author.  However, I’ve decided that as a precaution we will include in our role-based training for the psych clinicians the requirement that if they do create such notes that they do so in a manner that is as “unidentifiable” as possible, maintain them securely, and destroy them as soon as practicable.   Cheri Huber County Privacy Officer County of Napa 1195 Third Street, Room 301 Napa, CA  94559 707-253-4523     -----Original Message----- From: Coffield, Robert L. [mailto:[EMAIL PROTECTED] Sent: Tuesday, April 01, 2003 9:06 AM To: WEDI SNIP Privacy Workgroup List Subject: Psychotherapy Notes   Psychotherapy notes are defined very specifically in the regulations including that the records "are separated from the rest of the individual's medical record."    Does the definition imply that a mental health provider who does not keep the records separate -- not have HIPAA psychotherapy notes? If so, can the provider release the records under a general HIPAA authorization and not be required to obtain a separate authorization for release of what may be classified as "psychotherapy notes" had such records been kept separate and apart from the other medical records.   Basically was the definition designed to allow two ways to handle such records. It is my understanding from discussion with some mental health care providers that they like to keep some records separate and from others that they put all the records into the full medical record.   Thoughts. bob coffield   ****************************************************** Robert L. Coffield Flaherty, Sensabaugh & Bonasso, PLLC 200 Capitol Street (P.O. Box 3843) Charleston, WV 25338-3843 (304) 347-3791 Fax: (304) 345-0260 Work Email: [EMAIL PROTECTED]  ******************************************************* --- The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. 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