Ah Doctor, What Exactly Does This Entry Mean?

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ivesandre of FL 1:37AM July 22, 2010

Indeed it is clear that you have transference towards physicians.
But you are wrong, whether you have the ability to admit it or not. You have proven nothing about the law other than your own beliefs and bias. The fact of the law is:
The records are the physician's, not the patient's. The physician has the right to not allow the patient to see his/her own personal thoughts. These are his/her intellectual property. They are not the patients. This is the law. It is not twisted. It is indeed the law. Just as it is the law that any physician at any time can give a patient's medical information to another provider, even without the patient's consent, even in a non emergent situation. Yes, that is right. HIPPA does not prevent a doctor or other provider from speaking to another doctor or provider, without the patient's consent, as long as they are both treating providers. This is done to ensure honest and prompt patient care. Also, again, I hope you seek treatment for your clear transference and anger towards physicians.
Good Luck.
So, the law is exactly what I have said. If you have issue with it or believe that it is being mis-interpreted, then I suggest that you speak with a lawyer or your congress person.

charles of PA 2:31PM July 21, 2010

Thoughts about the link to Indiana statute? Nothing?
Unfortunately you've run into someone who has spent the past 5 years studying the interplay between state and federal privacy/security and disclosure laws and then using that information to develop educational efforts and policies intended to bridge the gaps in misunderstanding and to provide a more open and honest discussion between doctors, patients, and other stakeholders.
You are right, I absolutely have issues with doctors that twist the underlying intent of the law to deny patients their right to access the information.
Lets take it all back to the article. There is an innovative program that allows patients to see their health information including their doctor's notes (the notes "belonging" to their doctors, in some states) at their discretion using a health IT application, without having to call the office and ask for the information to be disclosed to them, which they are well within their right to do, and unless it is a specific case (in Indiana anyway) of mental health notes where a second physician has agreed that disclosure of the the full record might cause harm to the treatment of the patient, then and only then is the patient only allowed a summary instead of the full record. This project is a demo to see what the positive and negative outcomes of such a program.
Your original assertion was exactly: "You state that 'patients have the right to review their medical records'. This is incorrect on many levels. First off, they are the physician's medical records, not the patients. Also, in terms of behavioral health records, patients may only ever request a SUMMARY of the record. It is not required to show them the full record, unless by court order. "
I believe I have unequivocally proven your that statement (if I may summarize) that "patients have the right to review the medical records is incorrect" is in fact absolutely false.

SR of IN 1:57PM July 21, 2010

It is no way does anything like that. Nor is it in any violation of any law. The law clearly states exactly what I have said. And again, I am speaking of mental health records. And the patient is allowed access to a summary of their health record, which is all that would be required for them "to be in charge of their health" as you put it. And the physicians records are a record of his/her thinking, not about just patient information. This is not something that would be necessary for any patient, it only for the physician. The physicians thoughts are his/her intellectual property. You very clearly have transference towards physicians. It is not allowing you to be objective. You are being emotional and putting your own beliefs on the subject, rather than what is truly law. You should take time and work through that transference. I truly wish you good luck with that process.

Charles of PA 1:17PM July 21, 2010

Mental health law is governed Federally through the HIPAA Privacy Rule. Only states have more stringent mental health disclosure laws. The reference you provide for P.L.2-1993, SEC.22. IC 16-39-2-2 is in Indiana state statute. http://www.in.gov/legislative/ic/code/title16/ar39/ch2.html.
And I continue to stand by my statement that regardless of who owns mental health or clinical data from state to state, the patient always has a right to request and receive access their information. To argue otherwise is to directly oppose the ruling of the Office of Civil Rights and to degrade the imperative component of the individual patient in taking ownership in their own health and well being.

SR of IL 12:48PM July 21, 2010

Actually I am citing the federal laws not state laws. And yes, I have always been very clear about my disctinction of mental health from other health records.
And again you are wrong, because ownership does infer access. In fact, it is the very reason that patients can be provided with just a summary. Because the provider is the OWNER (of his/her own intellectual property), then the provider has the right to decide what access the patient may have to said intellectual property. And yes, of course, it can be appealed, but the court would have to be given a very compelling reason why a summary would not be suficient and why the entire medical record would be necessary.
So again, please try to learn more about healthcare before you make statements.

charles of PA 12:16PM July 21, 2010

charles of PA:
1. As I mentioned in my post, each state has its own laws governing disclosure of health information. The citation you provide here is a specific state law, and not applicable to any of the readers except those living in the state you are citing. I have already mentioned that the definition of who owns the record is variable among states and frequently open to interpretation even among legal experts. It depends on the state so you can't cite one state and have that backup your entire argument about ownership. I stand by my statement: "Regardless of the interpretation of ownership, a patient absolutely and unequivocally has full right of access to their full and complete health record from any physician at any time".
2. You are citing a mental health law which is, for appropriate reasons, far more restrictive when it comes to disclosure than other types of health information. This is misleading in response to my comments and this article, which is talking about access to doctor's records regarding general clinical information. Even in the example your provide here, there must be clinical reason, substantiated and documented by another physician, why a patient should not be provided their full and unadulterated record upon request. Then and ONLY then, will the patient be supplied a summary of their mental health data (and as your post clearly states, this is only relevant to mental health data, not general clinical data).
3. HIPAA guarantees that patients have access to their records. http://edocket.access.gpo.gov/cfr_2002/octqtr/45cfr164.524.htm
They also have a right to an accounting of disclosures, a right to file a complaint, and right to request a restriction. Please don't confuse the issue of ownership with the right of the patient to access the information, or with general clinical information with other specially protected types of health information.

SR of IL 12:05PM July 21, 2010

Please read below so you can understand the actual laws
Sec. 1. This chapter applies only to mental health records.
As added by P.L.2-1993, SEC.22.
IC 16-39-2-2
Maintenance of records by provider; contents; dominion; time
limits
Sec. 2. A record for each patient receiving mental health services
shall be maintained by the provider. The mental health record must
contain the information that the division of mental health and
addiction, the division of disability and rehabilitative services, or the
state department requires by rule. The PROVIDER is:
(1) the OWNER of the mental health record;
(2) responsible for the record's safekeeping; and
(3) entitled to retain possession of the record.
The provider shall
maintain the original mental health record or a microfilm of the
mental health record for at least seven (7) years.
As added by P.L.2-1993, SEC.22. Amended by P.L.40-1994, SEC.67;
P.L.4-1997, SEC.4; P.L.215-2001, SEC.84; P.L.141-2006, SEC.90.
A patient is entitled to inspect and copy the patient's own
mental health record. However, if the provider that is responsible for
the patient's mental health records determines for good medical
cause, upon the advice of a physician, that the information requested
under this section is detrimental to the physical or mental health of
the patient, or is likely to cause the patient to harm the patient or
another person, the provider may withhold the information from the
patient.The patient would then be provided with only a SUMMARY of their records.
If the provider is a state institution or agency, the patient may
appeal the provider's refusal to permit the patient to inspect and copy
the patient's own record under IC 4-21.5.
IC 16-39-2-6
Disclosure WITHOUT patient's consent; interpretation of records;
immunities
Sec. 6. (a) Without the consent of the patient, the patient's mental
health record may be disclosed as follows:
To individuals who meet the following conditions:
1. the provider at the same facility or agency;
2. another health care provider or mental health care provider,
if the mental health records are needed to provide health
care or mental health services to the patient even in non emergent situations
3. Anyone involved in the planning, provision, and monitoring of services.
4. To a law enforcement agency
5. To a school in which the patient is enrolled if the
superintendent of the facility determines that the information
will assist the school in meeting educational needs of a person
with a disability under 20 U.S.C. 1400 et seq.
6.To another health care provider in a health care emergency.

charles of PA 11:09AM July 21, 2010

Mike of CA and others:
You continue to be incorrect. The medical records are a record of the Physican's thoughts. They are not the patient's, they are they physicians. It is not about physician arrogance. And also by the way, physicians are actually not paid fee for service like other professionals. I wish that physicians could charge for phone calls, emails, photocopies and so on, like a lawyer, but physicians are forced to be charities and take the payment that they are given, whether it covers the overhead of a practice or not.
And for mental health records, patients only need to be given a summary of their records, because much of the record regarding the physicians thoughts are just that, the physicians thoughts - his or her own intellectual property. So, you are most incorrect and should try to be better educated about the management of healthcare before you make statements.

charles of PA 10:55AM July 21, 2010

I support Mike of CA's comments. 1. Some individual state laws may be interpreted by a few to indicate that health records "belong" to the originating physician, but this is mostly related to exchange of records between physicians, an has nothing to do with patient access. Regardless of the interpretation of ownership, a patient absolutely and unequivocally has full right of access to their full and complete health record from any physician at any time. HIPAA provides you with rights over your health information and if any ever tells you differently, you also have the right to file a complaint with OCR.
http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html
2. My toddler was hospitalized with a near fatal case of double lung pneumonia a little over a year ago. Being an engaged patient, I requested and easily obtained a full copy of my son's record once the ordeal was over to ward off any problems or complications in transferring or easily referencing the record later in his life. As I glanced over the record I noticed one physician had entered a note that vaguely indicated potential abuse (a bruise of some sort perhaps). While 5% of me was horrified that anyone might ever consider that I would harm my child, 95% of me understood completely why this was necessary and that it was a routine part of the physician's notes. Thank goodness physicians track this information and that many young lives have potentially been saved due to this simple act.
I have such admiration and gratitude to physicians who embrace open and engaged discussions with their patients, and more and more disgust with those that complain that Health IT might require them to spend more time with their patients or argue that patients are just to stupid to understand the intricacies of their own health care.
Do us a favor, give us some credit and just see how "coming down to our level" might actually engage us toward a better and healthier well-being. Get informed, get engaged, save a life (one might be your own)!
My favorites:
http://www.youtube.com/watch?v=eBFaFyyCRc0&feature=youtube_gdata
http://patientdave.blogspot.com/

SR of IL 9:26AM July 21, 2010