Electronic mental health, substance abuse records need special care

I have little sympathy for the millions of people who joined the Ashley Madison website that facilitates extramarital affairs and now are dealing with the exposure of their involvement due to hackers. It is naive in these electronic times to think that there's anything private. 

The National Security Agency monitors our email. Healthcare entities, banking institutions, large retailers and even the federal government all have been victims of cyberattacks. Cellphones have become witnesses to bad public behavior.

But it is disconcerting to think that electronic substance abuse and mental health records are more vulnerable to exposure, as a recent article in The Intercept reports. The article details how the move from paper records to electronic health records caused at least one bipolar patient's data to be readily available to a multitude of physicians in the practice, which the patient did not expect, to her dismay. The article also highlights how easily electronic patient records of Canadians who were treated for attempted suicide ended up in the hands of the U.S. Department of Homeland Security, which used the data against the patients even though they were no threat to anyone.

And these were purposely shared records, not even compromised by user error, a rogue employee or hacking.

This is a disturbing development. Many people still don't seek this help. But we really need and want them to.  

So many of tragic shootings occurring in this country have been perpetrated by people with mental health issues. If more of them had been in treatment, perhaps some of the carnage could have been prevented.

And look at our veterans. So many of our servicemen and women are suffering from post-traumatic stress disorder. They also have higher drug abuse and suicide rates than the national average.

And there have been legal changes that improve access to this treatment. The mental health parity law, which admittedly has run into implementation issues, requires health insurers to cover mental health and substance abuse treatment to the same extent that they cover other medical conditions. So there's more opportunity for treatment to be available and affordable.

In addition, the Patient Safety Movement Foundation has just recommended to lawmakers that federal law (42 CFR Part 2), with its stringent patient consent requirements regarding substance abuse records, be streamlined for EHR-using providers in integrated care settings to improve care coordination care for such patients, who often suffer comorbidities.

But if it becomes common for these records in electronic form to be accessed by third parties, either on purpose or by cybercrime, it may have a chilling effect on treatment. It's one thing for the public--or your family, or boss--to know that you had a kidney stone. It's another to have revealed that you were the victim of sexual abuse, had bulimia during high school or are on anti-anxiety medication.

It's already been determined that patients are more likely to withhold less sensitive information when a provider uses an EHR. One can just imagine what they'll withhold from their psychologist or drug treatment counselor--if they go for treatment at all.  

The privacy and security of patient records is always of paramount importance. But the problem is even more acute with these records that are of such a highly sensitive nature. - Marla (@MarlaHirsch and @FierceHealthIT)

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