What Does the Open Notes Mandate Mean for Psychiatrists and Mental Health Clinicians?


In April 2021, the federal rule of the bipartisan 21st Century Cures Act (2016) was implemented, mandating fast, complete access to test final results, medication lists, referral information and facts, and clinical notes in electronic formats, on request (so-named “open notes”).1,2

This new open notes regulation “constitutes a substantial culture change for both patients and physicians.”3 Does this mandate advantage or harm patients — or each? What influence does it have on physicians in basic, and psychiatrists in distinct? What are its possible medicolegal implications? To shed light on these complicated concerns, we spoke to John Torous MD, MBI, director of the digital psychiatry division, Department of Psychiatry, Beth Israel Deaconess Medical Center, a Harvard Medical School-affiliated teaching hospital, exactly where he also serves as a employees psychiatrist and assistant professor.

Is patient access to chart notes a thing considerably new?


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Dr Torous: Open notes is not a revolutionary notion. Even ahead of this new mandate, patients had a correct to request and acquire copies of their records — a legal correct that was mandated by the Health Insurance Portability and Accountability Act (HIPAA) in 1996.4 But to do so was cumbersome and usually high-priced.5 What open notes did was to make it simpler and facilitate access for patients. And in the VA [Veterans Affairs], patients have been in a position to access their notes for outpatient major care and specialty visits, inpatient care, emergency division visits, and even for mental and behavioral well being visits considering the fact that 2013 by means of a website launched in 2003 named My Healthevet.6

Is the United States the only nation exactly where patients can have access to their notes?

Dr Torous: Other nations, not only the US, provide patients with complete on line access to their electronic healthcare records. For instance, Sweden, has been providing this access as far back as 2012-2018, and Estonian patients have had complete access considering the fact that 2005.7 Australia and Canada also permit patients access to their healthcare records8 and Germany is in the midst of a digitization project that will pave the way for patient access to healthcare records.9

Are psychotherapy notes incorporated in mental well being notes?

Dr Torous: Psychotherapy notes are exempt, and the clinician can engage in “information blocking” if he or she feels that denying access to the information and facts will “substantially reduce the risk of harm” — which means, physical harm to the patient or a different individual or if there is a privacy exception.1 All licensed well being care experts, not only mental well being experts, can determine what constitutes a “substantial risk” when they are working “in the context of a current or prior clinician-patient relationship.”1 Examples of this could be domestic violence, youngster abuse, or elder abuse circumstances.

Although physicians and mental well being experts are mandated reporters, they could not want patients they suspect of engaging in abusive acts to have access to notes that alert them to the truth that the clinician has issues about their abusive behavior. Or maybe if a patient is delusional and could potentially misinterpret notes for the duration of an episode of acute psychosis, it could be far better to wait till the episode has resolved. Of course, this concern has to be balanced against the concern that the patient could turn out to be suspicious when access to the notes is denied.

John Torous MD



Originally published in www.psychiatryadvisor.com