Home Forums Discussions General Discussion Confidential Tab Use

Can anyone tell me if the data or reminders that I put in a patient's encounter under the Confidential Tab becomes part of the patient's health record (is viewable by the party that requests the patient's records such as another doctor that has requested records to or an insurance company (or even an attorney-such as when records are requested for MVA)?

Hi Dr. Dinosaur,
The information in the Confidential Tab does not show up as part of the Patient's Record. Even if you print the entire Formal Health Record, this information will not show up. You can always print this information, if you need to, by hitting the 'Print Confidential' button next to the field.
I hope this helps!

-Darryl@AC

I wonder if it isn't stored in the metadata. I hear attorneys have learned to request such data (everything is logged in AC) for cases, and thus EMR's can carry increased risk for us.

That's a great point. Can Darryl@AC address this please?

Hi LaurerDO,
Any information entered into the Confidential Tab is not tracked by the Audit Log.
The information is added to the database, only those users with Provider level access will see the data.

-Darryl@AC

Thank you Darryl for the reply. I'm wondering though if an attorney subpoenas the entire medical record, would we have to surrender that portion of the EMR?
I realize this is a legal question for an attorney, not one you need to reply to.
In a malpractice case I had, the lawyer told me specifically not to make any additional notes to myself (personally) about the case as those documents would be forfeit to the court.

I am not a lawyer, but here is my opinion:
My understanding is that the law does not recognize that any part of a record is "confidential" from discovery, whether it is a paper chart or electronic. As Adam points out, lawyers will tell you that ANY notes you keep (hand written in the margins, on scraps of paper in the chart...or in your desk); all must be produced in response to a subpoena.

If the patient's record is subpoenaed, you will likely produce a paper copy which would not include the confidential portion. And then?

and then we can tell the lawyers to go F*#@ themselves.

Sorry I am slow in joining this thread. It is a followup from another thread.

I tried the confidential tab, and it looks potentially useful; however, I am not sure how to actually put it to use. It is just one data field in a particular chart entry. The real problem I see is how to tell yourself at a later date in a confidential manner that it exists.

Example: A patient comes in asking to be checked for STD's because of an extramarital sex encounter. You are clearly going to want to remember this in future visits. Now, it is not going to further the cause to have the CC: "Extramarital Sex", and the HPI : "Patient states he became intoxicated and had unprotected sex......" if the patient really REALLY does not want anyone finding out about this and assuming the tests are negative. That could all go in the Confidential tab, but there is no confidential pointer shown to the provider to look there, and it won't help to say " See the confidential tab for further information" in the HPI. I guess you could have an encounter that was otherwise entirely blank, or some secret code for the HPI ("Patient reports urethral irritation after eating artichokes"), but that isn't going to help insurance, and probably is fraudulent anyway. So, how would someone proceed to make this tab useful?

My personal policy is that confidentiality of the record is governed by state law, not myself. It is the patient's responsibility to restrict access to their records (to the extent allowed by law). What they tell me, I record.

When patients start to discuss very personal stuff with me I warn them that their medical record may be acquired by any number of entities, including their insurance, their pharmacy (now with medicare requiring office notes to approve some one's glucometer strips) and possibly their employer. Every thing they tell me, if important, goes into the main record. I apologize and tell them I am unhappy with it but I cannot help it. I have tried using the confidential tab but find it too burdensome.

Huh? Why would they need (or even want) office notes to approve glucometer strips? There's only one thing you can do with them and you must have a specific illness to need to do that. oh, well I guess you could also sell them on the black market--if there is one for those.

You know, if the Flag system had a few different colors, then if there was at least 1 confidential entry then you could set a special colored flag for that chart. But even if it is "confidential" it is part of the medical record and if you print out the entire record it should be automatically included. But it would be handy to not be accessible to just any MA in the office.

To emphasize and expand on this a little: I cannot see how this is supposed to work. Once you enter something in the confidential tab, the only way I can find to see it is to open a new note and look in the "confidential" tab. If you change the information, or erase it, it is gone. At that point, I don't see ANY way to view it. It does not show up in prior encounters or anywhere else.
And as David pointed out, if you don't know to look for it, you would have no idea that it is there.
Has anyone made this work for them?

I thought to Wayne's reply, and how about this? To make a confidential note, create a new, blank note. Put the information under the confidential tab, and don't enter anything else. Set a flag for Confidential note, so when you bring up the patient, it will show the flag, and you can look for (apparently) blank notes in the past encounters section. It's clumsy, I don't know how you will handle insurance billing and superbills, but it is SOMETHING anyway.

Perhaps someone from AC can ask the designer of the confidential tab (presumably Jon B) what the intention was, and how it was to be used. It seems to have us users stymied.