Keep Out!Privacy, Collaboration and

Behavioral Health IntegrationSusan D. Wiley, MD

Vice Chairman, Department of PsychiatryLehigh Valley Health Network

Gail Stern, MSN, PMHCNS-BCAdministrator, Department of Psychiatry

Jamie Bongiovi, LCSWProgram Director, The Guidance Program

Collaborative Family Healthcare Association 14th Annual ConferenceOctober 4-6, 2012 Austin, Texas U.S.A.

Session # B6bOctober 6, 2012

Faculty DisclosureFaculty Disclosure

We We have nothave not had any relevant financial had any relevant financial relationships relationships

during the past 12 months. during the past 12 months.

ObjectivesObjectives

Participants will be able to:Participants will be able to:

1. Identify two legal mandates for 1. Identify two legal mandates for patient privacy protection.patient privacy protection.

2. Name 3 benefits of sharing patient 2. Name 3 benefits of sharing patient information. information.

3. Identify 2 key elements of patient 3. Identify 2 key elements of patient privacy protection in Behavioral privacy protection in Behavioral Health Integration.Health Integration.

Learning AssessmentLearning Assessment

We welcome your questions during the We welcome your questions during the session and will leave 10 minutes at session and will leave 10 minutes at

the end of our presentation for the end of our presentation for questions and discussion. questions and discussion.

Who We AreWho We AreWho We AreWho We Are Largest academic Largest academic

community hospital community hospital in PAin PA

Largest Level 1 Largest Level 1 Trauma Center in Trauma Center in regionregion

Certified Stroke Certified Stroke CenterCenter

Employees – 10,200Employees – 10,200 Medical Staff – Medical Staff –

1,200+1,200+ Nurses – 2,334Nurses – 2,334

Largest academic Largest academic community hospital community hospital in PAin PA

Largest Level 1 Largest Level 1 Trauma Center in Trauma Center in regionregion

Certified Stroke Certified Stroke CenterCenter

Employees – 10,200Employees – 10,200 Medical Staff – Medical Staff –

1,200+1,200+ Nurses – 2,334Nurses – 2,334

Magnet HospitalMagnet Hospital 163,000 ED visits163,000 ED visits 68,602 admissions68,602 admissions 981 acute care beds981 acute care beds 3 hospital campuses3 hospital campuses Revenues over $1 Revenues over $1

BillionBillion

Magnet HospitalMagnet Hospital 163,000 ED visits163,000 ED visits 68,602 admissions68,602 admissions 981 acute care beds981 acute care beds 3 hospital campuses3 hospital campuses Revenues over $1 Revenues over $1

BillionBillion

Advantages of the EMRAdvantages of the EMR

Automation improves access to recordsAutomation improves access to records

Reduces medical errorsReduces medical errors

Facilitates screening and tracking of patient Facilitates screening and tracking of patient progressprogress

Fosters collaboration between medical and Fosters collaboration between medical and behavioral health providersbehavioral health providers

Shared information reduces duplications of Shared information reduces duplications of effort and saves money and timeeffort and saves money and time

Why do we need to respect patient Why do we need to respect patient privacy?privacy?

““Whatsoever things I see or hear Whatsoever things I see or hear concerning the life of man, in any concerning the life of man, in any attendance on the sick or even apart attendance on the sick or even apart therefrom, which ought not to be therefrom, which ought not to be voiced about, I will keep silent voiced about, I will keep silent thereon.” (Oath of Hippocrates) thereon.” (Oath of Hippocrates)

““Effective psychotherapy depends Effective psychotherapy depends upon an atmosphere of confidence upon an atmosphere of confidence and trust in which the patient is and trust in which the patient is willing to make a frank and complete willing to make a frank and complete disclosure of facts, emotions, disclosure of facts, emotions, memories and fears. For this reason, memories and fears. For this reason, the mere possibility of disclosure the mere possibility of disclosure may impede development of the may impede development of the confidential relationship necessary confidential relationship necessary for successful treatment.” for successful treatment.” B. RockB. Rock

Elements of privacy, and Elements of privacy, and confidentialityconfidentiality

Privacy vs ConfidentialityPrivacy vs Confidentiality Qualifiers:Qualifiers:

• Real RiskReal Risk• Serious HarmSerious Harm• Imminent RiskImminent Risk• Effective InterventionEffective Intervention• Public Interest/HealthPublic Interest/Health

What are the legal responsibilities, What are the legal responsibilities, mandates for privacy?mandates for privacy?

Confidentiality of mental health records is Confidentiality of mental health records is governed by:governed by:

HIPAA (the Health Insurance Portability & HIPAA (the Health Insurance Portability &

Accountability Act) of 1996;Accountability Act) of 1996;

Various CMS and Joint Commission Various CMS and Joint Commission regulations; regulations;

Your state Department of Health standards; Your state Department of Health standards; and and

Your state mental health laws.Your state mental health laws.

““Sensitive Information” and Sensitive Information” and “Sensitive People”“Sensitive People”

Is behavioral health information Is behavioral health information different than other clinical different than other clinical information and how? Should it be? information and how? Should it be?

What are the pros and cons of What are the pros and cons of handling behavioral health handling behavioral health information differently than other information differently than other kinds of medical information? kinds of medical information?

Are there “sensitive people” that Are there “sensitive people” that require a higher level of privacy?require a higher level of privacy?

Provider Concerns:Provider Concerns:

MedicalMedical Behavioral Health Behavioral Health

• Traditional Traditional • IntegratedIntegrated

Patient Privacy ConcernsPatient Privacy Concerns

Access: Who can access my records?Access: Who can access my records? Personal Issues: Can I protect sensitive Personal Issues: Can I protect sensitive

information I don’t want anyone to know? information I don’t want anyone to know? Stigma: I don’t want people to discriminate Stigma: I don’t want people to discriminate

against me. against me. Can my employer see my records?Can my employer see my records? Can my records be used by the criminal justice Can my records be used by the criminal justice

system or affect my insurance benefits?system or affect my insurance benefits? What if someone unauthorized sees my records? What if someone unauthorized sees my records?

Survey ResultsSurvey Results

LVHN Story: LVHN Story: Our experience and processOur experience and process

• Confidentiality CommitteeConfidentiality Committee• Physician review and inputPhysician review and input• Policy formationPolicy formation• Patient privacy protectionsPatient privacy protections• EducationEducation• Audit and enforcementAudit and enforcement

Documentation in Collaborative Documentation in Collaborative CareCare

For the provider to trigger their own For the provider to trigger their own memorymemory

For the patient to understand their For the patient to understand their carecare

For other providers to understand the For other providers to understand the care you are givingcare you are giving

For billing and compliance purposesFor billing and compliance purposes For the attorney who may defend youFor the attorney who may defend you

Key Steps in Developing an EMR Key Steps in Developing an EMR • Establishing a multidisciplinary Establishing a multidisciplinary

Confidentiality CommitteeConfidentiality Committee• Determination of what information is Determination of what information is

to be retrievable for PIto be retrievable for PI• Identification of critical information Identification of critical information

categories to be shared for patient categories to be shared for patient safetysafety

• Identification of critical information Identification of critical information categories to be held privatelycategories to be held privately

• Identification of information to be Identification of information to be shared for the promotion of public shared for the promotion of public healthhealth

Key Steps in Developing an EMRKey Steps in Developing an EMR

• Means to handle sensitive information Means to handle sensitive information sensitivelysensitively

• Determine access level and entry Determine access level and entry privileges by job descriptionprivileges by job description

• Provider EducationProvider Education• Patient Education and Consent ProcessPatient Education and Consent Process• Audit and Enforcement Audit and Enforcement • Evaluation and RevisionEvaluation and Revision

Discussion and questions: Discussion and questions:

How does sharing information How does sharing information change the information that is change the information that is shared? shared?

Who is the owner of the health Who is the owner of the health records, patients or providers?records, patients or providers?

How do we juggle sensitive How do we juggle sensitive medical and BH information in the medical and BH information in the examination rooms?examination rooms?

References and ResourcesReferences and Resources

SAMHSA SAMHSA http://www.samhsa.gov/healthIT/

PCPCC PCPCC http://www.pcpcc.net/health-it

AHRQAHRQ

http://www.ucguide.org/index.htmlhttp://www.ucguide.org/index.html

References and ResourcesReferences and Resources

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References and ResourcesReferences and Resources5.5. Ward L; Innes M. Electronic medical summaries in general Ward L; Innes M. Electronic medical summaries in general

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7.7. Myers J; Frieden TR; Bherwani KM; Henning KJ. Ethics in public Myers J; Frieden TR; Bherwani KM; Henning KJ. Ethics in public health research: privacy and public health at risk: public health health research: privacy and public health at risk: public health confidentiality in the digital age. American Journal Of Public confidentiality in the digital age. American Journal Of Public Health [Am J Public Health] 2008 May; Vol. 98 (5), pp. 793-801. Health [Am J Public Health] 2008 May; Vol. 98 (5), pp. 793-801. Date of Electronic Publication: Date of Electronic Publication: 2008 Apr 01. 2008 Apr 01.

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References and ResourcesReferences and Resources

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Questions?Questions?

Contact Information:Contact Information:

Susan D. Wiley, MD Susan D. Wiley, MD Susan.Wiley@LVHN.ORG

Gail Stern, MSN, PMHCNS-BCGail Stern, MSN, PMHCNS-BCGail.Stern@LVHN.ORG

Jamie Bongiovi, LCSWJamie Bongiovi, LCSWJamie.Bongiovi@LVHN.ORG

Session EvaluationSession Evaluation

Please complete and return thePlease complete and return theevaluation form to the classroom evaluation form to the classroom

monitor before leaving this session.monitor before leaving this session.

Thank you!Thank you!