Perspective on Practice

The need for adequate privacy protections in health-information technology systems is one of the major issues that hundreds of psychology leaders are taking to Capitol Hill this month during the APA Practice Organization (APAPO) State Leadership Conference.

With the promise of significant health-care system reform on the horizon, Congress and the new administration are focusing on the infrastructure needed to support a reformed health-care system. President Obama intends for all Americans' medical records to be computerized within the next five years. He firmly believes that an electronic records system will improve quality, lower costs and save lives by reducing preventable medical errors. Such information systems are generally community-wide or statewide electronic interoperable records networks that allow access to all users—consumers, providers, hospitals, insurers, etc. In 2004, President Bush formed the Office of the National Coordinator for Health Information Technology by executive order with the goal of having a national interoperable health-information technology infrastructure by 2014. Congressional support for making these networks nationwide has steadily increased. Considering both the president's and Congress's interest in the area, legislation could be enacted early this year, for example as part of the economic stimulus package.

Since 2004, our congressional advocacy efforts have focused on two points. First, any health-information technology legislation must contain the strongest possible patient records privacy protections. State privacy laws should remain in place, while strong minimum federal privacy protections should apply to health records in such systems.

The Health Insurance Portability and Accountability Act model provides a good precedent for protection. Providers, insurers and patients are already familiar and compliant with this model. A critical aspect of HIPAA's privacy protection is the additional protection afforded psychotherapy notes. We believe that sensitive psychological testing data need the same heightened protection, and we will advocate for that provision in any health-information law.

Maintaining privacy will be central to ensuring success of these electronic networks since without strong protections, people may not seek the psychological services they need. Even though we achieved a major legislative victory for patients with last year's passage of the mental health parity law, stigma still surrounds the use of mental health and substance abuse treatment services. We do not want onerous health-information technology rules to further impede access to psychological care and we need to assure our patients that their privacy will be protected. APAPO has worked to ensure strong privacy safeguards, and federal bills have become more protective of privacy. The Health-e Information Technology Act of 2008 (H.R. 6898) contains strong privacy standards and has served as a model for legislation this year.

Second, legislation should also address the potential costs to psychologists who must integrate their record-keeping practices into health-information technology systems. In many cases, the use of electronic records may be a critical factor in a psychologist's ability to participate in a health-care system. Current legislation makes incentive payments, grants and loans available to physicians for adopting health-information technology. We will continue to stress the need for Congress to provide funding for psychologists and other key providers to help them implement such systems. Such assistance will be particularly important for practicing psychologists in solo independent settings who lack any administrative staff.

In addition to our legislative advocacy, the APA Board of Professional Affairs has convened a Health Information Technology Workgroup to focus on this issue and its relevance to psychology practice. Among recent activities, the group responded to a call for comments from the American Health Information Community concerning a draft document related to clinical encounter notes.

Stayed tuned for more developments in the PracticeUpdate e-newsletter, or feel free to contact me (via e-mail), with your questions or concerns.