Protect Patient Confidentiality Research Articles

Trends in Confidentiality and Disclosure.

Confidentiality has long been a core value in medical ethics, but the parameters of this value have rapidly evolved. The principle is now best understood in the context of competing loyalties: Physicians owe patients a broad duty to protect confidences, but that duty is limited-in specific circumstances-by a competing obligation to protect the health of others and the general public welfare. The trend is increasingly toward more disclosure. The author examines three areas in which rules governing confidentiality have rapidly evolved in recent decades-the development of a duty to warn or protect potential third-party victims in the wake of the seminal California case of Tarasoff v. Regents; the establishment of a psychotherapist-patient privilege for the federal courts in Jaffee v. Redmond; and the codification of protections for health information under HIPAA-and how these rules have been implemented. The author also notes the complexities of protecting patient confidentiality in the context of evolving Internet technologies.

Impact of De-Identification on Clinical Text Classification Using Traditional and Deep Learning Classifiers.

Clinical text de-identification enables collaborative research while protecting patient privacy and confidentiality; however, concerns persist about the reduction in the utility of the de-identified text for information extraction and machine learning tasks. In the context of a deep learning experiment to detect altered mental status in emergency department provider notes, we tested several classifiers on clinical notes in their original form and on their automatically de-identified counterpart. We tested both traditional bag-of-words based machine learning models as well as word-embedding based deep learning models. We evaluated the models on 1,113 history of present illness notes. A total of 1,795 protected health information tokens were replaced in the de-identification process across all notes. The deep learning models had the best performance with accuracies of 95% on both original and de-identified notes. However, there was no significant difference in the performance of any of the models on the original vs. the de-identified notes.

Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae: Hospital-Acquired Urinary Tract Infections, Khartoum

A descriptive; cross-sectional study was conducted on 350 Clean-catch, mid-stream urine samples (MSU) from both gender (female and male) patients hospitalized in Academic Charity Teaching Hospital with sign and symptom of UTI. The gram-negative isolates were identified and screened by Kirby-Bauer disc diffusion method. Double-Disc Synergy Test (DDST) was performed for detection and confirmation of ESBLs. Socio-demographic and clinical data were obtained from each participant using close-end questionnaires with palace to sign or stamp (a way to protect patients confidentiality) and check list for practical follow-up work and record.

Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 5: Using Patient Records: Selection, Protection, and Abstraction

ObjectivesThe purpose of this paper is to describe the 4-step process (consent, selection, protection, and abstraction) of acquiring a large sample of chiropractic patient records from multiple practices and subsequent data abstraction. MethodsFrom April 2017 to December 2017, RAND acquired patient records from 99 chiropractic practices across the United States. The records included patients enrolled in a survey e-study (prospective sample) and a random sample of all clinic patients (retrospective sample) with chronic back or neck pain. Clinic staff were trained to collect the sample, scan, and transfer the records. We designed an online data collection tool for abstraction. Protocols were instituted to protect patient confidentiality. Doctors of chiropractic were selected and trained as abstractors, and a system was established to monitor data collection. ResultsIn compliance with data protection protocols, 3603 patient records were scanned, including 1475 in the prospective sample and 2128 in the random sample. A total of 1716 patients (prospective sample) consented to having their records scanned, but only 1475 could be retrieved. Of records scanned, 19% were unusable owing to illegibility, no care during the period of interest, or poor scanning. The abstractor interrater reliability for appropriateness of care decisions was fair to moderate (κ .38-.48). ConclusionThe acquisition, handling, and abstraction of a large sample of chiropractic records was a complex task with challenges that necessitated adapting planned approaches. Of the records abstracted, many revealed incomplete provider documentation regarding the details of and rationale for care. Better documentation and more standardized record keeping would facilitate future research using patient records.

Healthy Data Protection

Healthy Data Protection

Email Communication: ‘Pause Before You Hit Send’

Back to table of contents Previous article Next article Legal NewsFull AccessEmail Communication: ‘Pause Before You Hit Send’Anne Huben-KearneyR.N., B.S.N., M.P.A.Anne Huben-KearneySearch for more papers by this authorR.N., B.S.N., M.P.A.Published Online:8 Mar 2019https://doi.org/10.1176/appi.pn.2019.3b30AbstractEngaging with patients via email is acceptable under certain conditions, but protect yourself and your patients by following a few simple rules.Anne Huben-Kearney, R.N., B.S.N., M.P.A., is the assistant vice president of the Risk Management Group, AWAC Services Company, a member company of Allied World.When emailing with patients, psychiatrists may encounter unique challenges in trying to protect patient confidentiality and ensure appropriate patient and psychiatrist use of email. The following steps can help you evaluate the measures needed to protect patient confidentiality, minimize liability exposures, and engage in appropriate email communication with patients.First, obtain your patient’s written informed consent to use email communication. Document the patient’s informed consent, including acknowledgment of the security and risks associated with the use of email. When using email, the psychiatrist and the patient both have responsibilities.Psychiatrist ResponsibilitiesUse a secure, encrypted email communication system. Encryption software protects messages during transmission and storage by requiring user authentication and linking the person’s identity to the email address.Clarify the permissible purposes for your practice of email communication with patients, such as prescription renewal requests and appointment scheduling. Consider providing a table listing appropriate and inappropriate topics for email communication (see example below left).Consider using a practice-dedicated email address with an automatic response indicating email response time (generally within 24 to 48 hours) that instructs patients to seek immediate help for urgent matters.Inform patients that all email communication is part of the medical record.Advise patients of staff who may view the email.Patient ResponsibilitiesUse email solely according to the practice’s defined purposes.Acknowledge in writing that emails are not to be used for urgent or emergency situations.Use a personal and not a work email address, given that work email may not be afforded confidentiality protections. Again, encrypt all email communications. Although patients can request unencrypted communications, if you send unencrypted emails, advise the patient of the risk to privacy and confidentiality. If a patient still prefers the use of unencrypted email, document that you advised the patient about the potential for unauthorized access to the information and obtain consent to proceed with sending the email unencrypted.As with all patient communication, keep email communication professional. Thus, avoid using slang, medical jargon, and abbreviations and making typographical errors that give the impression of sloppiness. In addition, be mindful of the following questions:Who is reading the email? How do you know that the patient is the only one reading the email?How do you ensure that the patient actually received the email? Consider adding the tag “Request a Read Receipt” as a means to ensure that the patient received the email.Are safety protocols in place? Consider using an “out of office” message when you are away so your patients know you are not available. Ensure that the message includes how to contact your covering practitioner and what to do in case of an emergency (similar to the message you would use on your voicemail system).Be aware that using email communication with patients can be a slippery slope. For example, while you may permit using emails for appointment scheduling purposes, the patient might begin emailing more frequently and for more involved clinical questions. Should this occur, do not ignore the email. Respond to the patient and remind him or her of the permissible information that can be shared via email and ask the patient to schedule an appointment to see you in the office or to telephone you. Address the authorized use of email communication directly with the patient at the next treatment session. Document the conversation.Use emails to supplement face-to-face encounters, not to establish a physician-patient relationship. Beware of inadvertently establishing a physician-patient relationship by answering specific clinical questions via email with individuals not in your care.Another precautionary measure is to confirm that you are sending the email to the patient’s correct email address. Sending confidential information to the wrong person could lead to a breach of confidentiality and/or allegation or complaint to the state Board of Medicine. Consider sending an email to the patient to confirm the address prior to sending any email containing patient health information.Treat email communication as a helpful and critical means of patient engagement and always ascertain that your email communications are appropriate, confidential, and professional. ■This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, GmbH, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. ISSUES NewArchived

‘They need to tell you and not just do it’: Veteran and physician perspectives on point-of-care research in VA

Point-of-care research (POCr) is part of a larger effort to advance the Veterans Health Administration (VHA) as a learning health system. It has the potential to improve health care outcomes and drive down costs of research by evaluating “in-use” medications and therapies. However, patients and physicians must be inclined to participate in this type of research. There is a need to assess patient and physician willingness, decision making, and methods of informed consent with respect to patient and physician participation in POCr. An exploratory study was conducted involving three focus groups, two with VA patients (n=8) and one with physicians (n=6) affiliated with a Midwestern VA Health Care System, to explore attitudes and preferences towards issues in POCr. Emerging themes were captured through qualitative content analysis. Four primary themes emerged from the focus group data: (1) a qualified willingness to participate in POCr; (2) the doctor-patient relationship as a context for POCr; (3) transparency and choice in POCr participation; and (4) protecting patient confidentiality and privacy. Our exploratory study among VA physicians and patients suggests that POCr may be perceived as intervening or undermining the physician-patient relationship in cases where randomization supplants doctor-patient decision making, or where a waiver of informed consent may diminish the need for physician -patient interaction. Informed consent is important in POCr because it offers a way for patients and physicians to establish rapport and trust, particularly in cases where randomization removes the need for clinical decision making.

Practices in security and confidentiality of HIV/AIDS patients' information: A national survey among staff at HIV outpatient clinics in Vietnam.

IntroductionBreach of confidentiality or invasion of privacy from the collection and use of medical records, particularly those of patients with HIV/AIDS or other diseases sensitive to stigmatization, should be prevented by all related stakeholders in healthcare settings. The main focus of this study was to assess practices regarding security and confidentiality of HIV-related information among staff at HIV outpatient clinics (HIV-OPCs) in Vietnam.MethodsA descriptive cross-sectional study was conducted at all 312 HIV-OPCs across the country using an online survey technique.ResultsIn general, the staff practices for securing and protecting patient information were at acceptable levels. Most staff had proper measures and practices for maintaining data security; however, the protection of patient confidentiality, particularly for data access, sharing, and transfer still required improvement. Most HIV-OPC staff had good or moderate knowledge and positive perceptions towards security and confidentiality issues. Staff who were not trained in the practice of security measures differed significantly from those who were trained (OR: 3.74; 95%CI: 1.44–9.67); staff needing improved knowledge levels differed significantly from those with good (OR: 5.20; 95%CI: 2.39–11.32) and moderate knowledge levels (OR: 5.10; 95%CI: 2.36–11.00); and staff needing improved perception levels differed significantly from those with good (i.e., with 100% proper practices) and moderate perception levels (OR: 5.67; 95%CI: 2.93–10.95). Staff who were not trained in the protection of data confidentiality differed significantly from those who were trained (OR: 2.18; 95%CI: 1.29–3.65).ConclusionsTraining is an important factor to help raise the levels of proper practices regarding confidentiality and security, to improve knowledge and raise awareness about change among staff. The operation and management of HIV treatment and care in Vietnam are currently transitioning from separate healthcare clinics (HIV-OPC) into units integrated into general hospitals/healthcare facilities. The findings of this study highlight topics that could be used for improving management and operation of information system and revising guidelines and regulations on protection measures/strategies for data security and confidentiality of HIV/AIDS patients by Vietnam health authorities or other countries facing similar situations. Secure infrastructure and secure measures for data access and use are very important, worthwhile investments. The provision of continuous training and active enforcement and monitoring of the practices of healthcare personnel might lead to an improved understanding and acknowledegement of the importance of national policies/guidelines regarding HIV-related patient information.

Use of text messaging in general practice: a mixed methods investigation on GPs' and patients' views.

Text messaging has become more prevalent in general practice as a tool with which to communicate with patients. The main objectives were to assess the extent, growth, and perceived risks and benefits of text messaging by GPs to communicate with patients, and assess patients' attitudes towards receiving text messages from their GP. A mixed methods study, using surveys, a review, and a focus group, was conducted in both urban and rural practices in the south-west of Ireland. A telephone survey of 389 GPs was conducted to ascertain the prevalence of text messaging. Subsequently, the following were also carried out: additional telephone surveys with 25 GPs who use text messaging and 26 GPs who do not, a written satisfaction survey given to 78 patients, a review of the electronic information systems of five practices, and a focus group with six GPs to ascertain attitudes towards text messaging. In total, 38% (n = 148) of the surveyed GPs used text messaging to communicate with patients and 62% (n = 241) did not. Time management was identified as the key advantage of text messaging among GPs who used it (80%; n = 20) and those who did not (50%; n = 13). Confidentiality was reported as the principal concern among both groups, at 32% (n = 8) and 69% (n = 18) respectively. Most patients (99%; n = 77) were happy to receive text messages from their GP. The GP focus group identified similar issues and benefits in terms of confidentiality and time management. Data were extracted from the IT systems of five consenting practices and the number of text messages sent during the period from January 2013 to March 2016 was generated. This increased by 40% per annum. Collaborative efforts are required from relevant policymakers to address data protection and text messaging issues so that GPs can be provided with clear guidelines to protect patient confidentiality.

Mandatory Reporting of Intimate Partner Violence: An Ethical Dilemma for Forensic Nurses.

Nearly all states and provinces have laws mandating licensed healthcare professionals to report to law enforcement suspicions and allegations of the abuse of children, older adults, and disabled persons and all incidents of violence by a deadly weapon. However, a few states in the United States additionally mandate providers to report all injuries resultant from reported or suspected domestic/intimate partner violence. This can present a challenge to forensic nurses seeking to protect patient confidentiality and autonomy. This challenge becomes further compounded when a patient desiring to remain anonymous reports sexual assault by their partner, accompanied by bodily injury. This case report explores one such scenario that occurred in a rural Colorado Emergency Department, the issues this presents to forensic nurses, and possible responses.

Barriers to access and uptake of antiretroviral therapy among HIV-positive men who have sex with men in Hanoi, Vietnam: from HIV testing to treatment

Little is known about the experiences of Vietnamese men who have sex with men in accessing HIV testing and treatment. We aimed to explore barriers to access and uptake of antiretroviral therapy (ART) among HIV-positive men who have sex with men in Hanoi. During 2015, we conducted qualitative interviews with 35 participants recruited using snowball sampling based on previous research and social networks. Key individual impediments to ART uptake included inadequate preparation for a positive diagnosis and the dual stigmatisation of homosexuality and HIV and its consequences, leading to fear of disclosure of HIV status. Health system barriers included lack of clarity and consistency about how to register for and access ART, failure to protect patient confidentiality and a reticence by providers to discuss sexual identity and same-sex issues. Results suggest fundamental problems in the way HIV testing is currently delivered in Hanoi, including a lack of client-centred counselling, peer support and clear referral pathways. Overcoming these barriers will require educating men who have sex with men about the benefits of routine testing, improving access to quality diagnostic services and building a safe, confidential treatment environment for HIV-positive men to access, receive and remain in care.

Cyber-Security Issues in Healthcare Information Technology.

In 1999-2003, SIIM (then SCAR) sponsored the creation of several special topic Primers, one of which was concerned with computer security. About the same time, a multi-society collaboration authored an ACR Guideline with a similar plot; the latter has recently been updated. The motivation for these efforts was the launch of Health Information Portability and Accountability Act (HIPAA). That legislation directed care providers to enable the portability of patient medical records across authorized medical centers, while simultaneously protecting patient confidentiality among unauthorized agents. These policy requirements resulted in the creation of numerous technical solutions which the above documents described. While the mathematical concepts and algorithms in those papers are as valid today as they were then, recent increases in the complexity of computer criminal applications (and defensive countermeasures) and the pervasiveness of Internet connected devices have raised the bar. This work examines how a medical center can adapt to these evolving threats.

Recommendations for Social Media Use in Hospitals and Health Care Facilities

Recommendations for Social Media Use in Hospitals and Health Care Facilities

Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia.

BackgroundMobile phones have great potential for medical education, as they allow health care providers and students to access resources efficiently at the precise time at the point-of-care to help in informed decision making.ObjectiveThe objective of the study was to evaluate the prevalence of mobile phone usage among medical residents and to explore their attitudes, perceptions, and the challenges they experience when using mobile phones in academic and clinical practice.MethodsA cross-sectional survey was conducted on all 133 residents in 17 different specialties across two large academic hospitals in Riyadh, Saudi Arabia. The Web-based validated questionnaire measured mobile phone platform preferences, and their uses in general and medical practice. The perception of confidentiality and safety impact of using mobile phones for communication and accessing patient’s data was also explored, alongside challenges of use and how residents learn to use their mobile phone.ResultsWith a response rate of 101/133 (75.9%) and mean age of 27.8 (SD 3.0) years, we found that 100/101 (99.0%) of participants were mobile phone users with mean duration of use of 5.12 (SD 2.4) years, and a range from 1 to 12 years. There was no significant difference in use between male and female respondents. A negative linear correlation was found between age and use duration (P=.004). The most common operating system used by participants was the iOS platform (55/101, 54.5%), with English the most commonly used language to operate residents’ mobile phones (96/100, 96.0%) despite their native language being Arabic. For communication outside medical practice, chatting applications such as WhatsApp matched phone calls as most commonly used tools (each 88/101, 87.1%). These were also the primary tools for medical communication, but used at a lower rate (each 65/101, 64.4%). In medical practice, drug (83/101, 82.2%) and medical (80/101, 79.2%) references and medical calculation applications (61/101, 60.4%) were the most commonly used. Short battery life (48/92, 52%) was the most common technical difficulty, and distraction at least on a weekly basis (54/92, 58%) was the most likely side effect of using a mobile phone in medical practice. Practically, all participants agreed with the idea of integrating medical staff mobile phones with the hospital information system. Most residents described themselves as self-learners, while half learned from peers, and a quarter learned from the Internet. Only 7/101 (6.9%) had received formal training on the medical use of mobile phones. Over half of residents thought it was safe to discuss patients over their personal, nonencrypted email.ConclusionsMobile phone use among medical residents has become almost universal in academic and clinical settings. Thus, academic and health care institutions should support proper utilization of these devices in medical training and point-of-care decision making, while continuing to protect patient confidentiality.

Supporting the Patient’s Choice to Open Access Private Health Information

The nurse practitioner (NP) was asked to videotape the surgical procedures of 2 patients so that they could post it on social media. The NP faces many challenges to ensure that patient's rights of disclosure and privacy are addressed when video recording their surgical procedure. There are both federal laws and hospital policies aimed at protecting patient confidentiality. The NP needs to support individuals in making choices that are in line with their personal values and beliefs, with awareness and freedom.

Professionalism as a Social Construct: The Evolution of a Concept.

I n this issue of the Journal of Graduate Medical Education, the article entitled ‘‘Creating a framework for medical professionalism: an initial consensus statement from an Arab nation’’ by Abdel-Razig and colleagues provides another enlightening contribution to our understanding of professionalism in global terms and adds to the literature on professionalism in the Muslim world. Our comments will be directed to 2 areas of interest: (1) the evolution of our understanding of professionalism, and (2) a brief analysis of the consensus definition developed for the United Arab Emirates as compared to definitions in contemporary use within Western cultures. The independent and self-regulating professions, as we in Western society understand them, have their origins in Hellenic Greece, are derived from the guilds and universities of medieval Europe and England, and emerged in approximately their present form in the middle of the 19th century. Their moral foundations are deeply rooted in Judeo-Christian traditions of morality. The Anglo-American world has exerted significant influence on the concept of the medical professional, although the role of individual physicians and the medical profession is very similar throughout Western culture. It is significant that if one consults dictionaries in non-English speaking countries, the references to professions and professionalism almost uniformly relate to differentiating amateurs from professionals. The autonomous and self-regulating professions are largely absent. Definitions of professionalism from dictionaries of the English language stress service and the fact that the professions are granted monopolies over the use of specialized knowledge, with the understanding that they will deliver certain services and behave in prescribed ways. We, and others, have termed this a social contract. There is little question that, until recently, there was an assumption within the English-speaking world that this concept of professionalism was truly universal and applicable to all nations and all cultures. Indeed, the intent of the committee that created the International Charter on Medical Professionalism, to which the authors refer in their article, was to provide a document that would be universally relevant. We can attest to this, as we participated in the creation of the charter. It is difficult to know when social scientists arrived at the conclusion that there were major differences in the interpretation of professionalism in different contexts. Most sociologists believe that society uses the professions as a means of organizing work—in the case of the professions, work of a specialized and essential nature. Thus it is logical to believe that even early sociologists would find it natural for different countries and cultures to choose different means of organizing this work. What is certain is that, for at least the last 2 decades, social scientists have recorded that each country expresses professionalism in a slightly different fashion. In 1993, contributors to a volume edited by Hafferty and McKinley compared professionalism in 15 Western countries and China, and in 1996 Krause studied 5 professions in 5 Western nations. Both seminal works noted, along with many commonalities, significant differences in the nature of professionalism across national boundaries. The contributors to this literature stressed the differences imposed in patterns of medical practice by different health care systems, but did not probe into the impact of culture. The consensus was that professionalism was used to organize the services of the healer, and that there were differences in national organizational approaches imposed by different health care systems. Many assumptions long held by the medical profession in the Western world have been questioned in the course of an ongoing critical appraisal of professionalism in society that has taken place over the past half-century. These include the motivation of the medical profession to pursue its own selfinterest, the profession’s failure to self-regulate with rigor, its neglect of some issues of importance to society, and, of course, the relevance of the concept of the professions to countries with their own histories, cultures, and concepts of morality. Ho and colleagues systematically studied the differences between Western concepts of professionDOI: http://dx.doi.org/10.4300/JGME-D-16-00102.1

'Treating Africans differently': using skin colour as proxy for HIV risk.

This paper examines the qualitative results of two studies of Black African new settler communities in New Zealand. The analysis investigates the issues of stigma and microaggressions and their effects on Black African communities. Previous work that investigated experiences of stigma faced by relatively early Black African new settlers to New Zealand found that new settlers experienced stigma, and their resulting isolation had negative implications for access to health and social services, regardless of HIV status. This paper is a meta-analysis of two published studies, using original qualitative data from each. Researchers for the first study, Standing in the Fire, interviewed 13 Black Africans living with HIV who were new settlers to New Zealand. The second study, AfricaNZ Care, was a national mixed method study which surveyed 703 Black African new settlers, and included 131 participants in 23 different focus groups. The present analysis includes only the qualitative data from the second study. Some, but not most, participants of the second study were living with HIV. Black African identity is used as a proxy for HIV status among non-HIV specialist health care workers. Participants reported experiences of stigma and microaggressions based on their race, and a lack of knowledge about HIV in non-HIV specialist nurses and other health care workers. They also experienced poor health care and education practices, professional prejudice against colleagues living with HIV and institutional challenges including failure to protect patient confidentiality. HIV-related stigma and microaggressions remain significant problems, not only for people living with HIV but also for those perceived to be at high risk for HIV. Experiences of stigmatising behaviour by health care professionals have a broad and significant range of impacts on patients' health outcomes.

HIPAA Compliance with Mobile Devices Among ACGME Programs

To analyze self-reported HIPAA compliance with mobile technologies among residents, fellows, and attendings at ACGME training programs. A digital survey was sent to 678 academic institutions over a 1-month period. 2427 responses were analyzed using Chi-squared tests for independence. Post-hoc Bonferroni correction was applied for all comparisons between training levels, clinical setting, and specialty. 58 % of all residents self-report violating HIPAA by sharing protected health information (PHI) via text messaging with 27 % reporting they do it "often" or "routinely" compared to 15-19 % of attendings. For all specialties, 35 % of residents use text messaging photo or video sharing with PHI. Overall, 5 % of respondents "often" or "routinely" used HIPAA compliant (HCApps) with no significant differences related to training level. 20 % of residents admitted to using non-encrypted email at some point. 53 % of attendings and 41 % of residents utilized encrypted email routinely. Physicians from surgical specialties compared to non-surgical specialties demonstrated higher rates of HIPAA violations with SMS use (35 % vs. 17.7 %), standard photo/video messages (16.3 % vs. 4.7 %), HCApps (10.9 % vs. 4.9 %), and non-HCApps (5.6 % vs 1.5 %). The most significant barriers to complying with HIPAA were inconvenience (58 %), lack of knowledge (37 %), unfamiliarity (34 %), inaccessible (29 %) and habit (24 %). Medical professionals must acknowledge that despite laws to protect patient confidentiality in the era of mobile technology, over 50 % of current medical trainees knowingly violate these rules regularly despite the threat of severe consequences. The medical community must further examine the reason for these inconsistencies and work towards possible solutions.

GPs' approaches to documenting stigmatising information: a qualitative study.

Complete medical documentation is essential for continuity of care, but the competing need to protect patient confidentiality presents an ethical dilemma. This is particularly poignant for GPs because of their central role in facilitating continuity. To examine how GPs manage medical documentation of stigmatising mental health (MH) and non-MH information. A qualitative sub-study of a factorial experiment with GPs practising in Massachusetts, US. Semi-structured interviews (n = 128) were audiorecorded and transcribed verbatim. Transcripts were coded and analysed for themes. GPs expressed difficulties with and inconsistent strategies for documenting stigmatising information. Without being asked directly about stigmatising information, 44 GPs (34%) expressed difficulties documenting it: whether to include clinically relevant but sensitive information, how to word it, and explaining to patients the importance of including it. Additionally, 75 GPs (59%) discussed strategies for managing documentation of stigmatising information. GPs reported four strategies that varied by type of information: to exclude stigmatising information to respect patient confidentiality (MH: 26%, non-MH: 43%); to include but restrict access to information (MH: 13%, non-MH: 25%); to include but neutralise information to minimise potential stigma (MH: 26%, non-MH: 29%); and to include stigmatising information given the potential impact on care (MH: 68%, non-MH: 32%). Lack of consistency undermines the potential of medical documentation to efficiently facilitate continuous, coordinated health care because providers cannot be certain how to interpret what is or is not in the chart. A proactive consensus process within the field of primary care would provide much needed guidance for GPs and, ultimately, could enhance quality of care.

Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records

Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients' privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities.