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Section 9
Confidentiality and Electronic Health Records

Question 9 | Test | Table of Contents

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From a legal point of view, the correct answer would be C, the therapist should first warn the other client, because duty to warn the other individual is first.

Probably the second best answer would be D, the social worker should tell the police, because, as indicated earlier, you need to notify the individual who is to be harmed as well as notifying the police.

Obviously, B is wrong, to do nothing, because the Tarasoff Decision supersedes client confidentiality.

Answer A, to alert the supervisor, might be something that you might do on an informal basis.

The best course of action would be C.

♦ E-Care Technology
Today, individual health and medical data can be collected, collated, stored, analyzed and distributed in unprecedented quantities and put to diverse uses. Payers can not only tap patient data for claims payment; They use it for utilization review, underwriting and coverage decisions.

Employers use health data to reduce their health care and workers compensation costs, as well as to identify employees who may be costly in the future. Health care providers use the data for research, to collect reimbursement, coordinate diagnosis and treatment, conduct quality assurance and monitor other providers. Clinical data repositories and management systems will likely reduce health care costs and improve patient care.

Clinical data management (CDM) systems and increasing automation of the electronic medical record ("EMR") also present significant patient privacy and confidentiality issues, among others, which executives and planners must recognize. Understanding these issues ensures that CDM and EMR systems are effective without exposing its hosts and users to liability.

We trust that you'll keep our thoughts, our malfunctions -- our secrets -- safe and sound. In a recent Gallup poll, commissioned by the nonprofit MedicAlert Foundation, 90 percent of consumers said they trust their doctor to keep their personal health information private and secure. That's a lot more trust than people put in hospitals (66 percent), insurers (42 percent), or managed care companies (35 percent).

Few of us, however, are ready to trust putting our health records online. Only 7 percent in the Gallup survey were "very willing" to store or transmit personal health information on the Internet. The overwhelming majority (84 percent) were "very" or "somewhat" concerned that the data could be made available to others without their consent.

Like it or not, however, we are picking up speed as we plunge into the age of electronic information. Consider the growth in online banking, shopping, investing, and vacation planning. It will happen in health care, as well; earlier this year, San Francisco geriatrician Forrest Martin predicted that all medical records would be online within five years.

The federal government is now putting the final touches on a set of rules for the secure electronic transmission of health information.

"E-care" is probably a few years down the road; secure messaging between doctors and patients is available now. You see the day, not far off, when regular monitoring of patients with high blood pressure, congestive heart failure, and diabetes will occur remotely and electronically rather than through periodic office visits.

One cardiologist has built an immense database of files for each patient that he keeps on his computer in the office, at home, and now on his palmtop. If he's summoned to the hospital, he can first call up and print out that patient's complete record. And, wherever he goes with his handheld computer, he can instantly retrieve whatever information he needs -- meds, procedures, problems, previous visits, referrals, etc.

- Regan, P. M., PhD. (2002). Technology, Social Values, and Public Policy. North Carolina: The University of North Carolina, Press.

Guide to Privacy and Security of Electronic Health Information
- The Office of the National Coordinator for Health Information Technology. (april 2015). Guide to Privacy and Security of Electronic Health Information. U.S. Department of Health and Human Services, 1, 4-21.
Reviewed 2023

Peer-Reviewed Journal Article References:
Cleveland, K. C., & Quas, J. A. (2018). Parents’ understanding of the juvenile dependency system. Psychology, Public Policy, and Law, 24(4), 459–473.

Erickson Cornish, J. A., Smith, R. D., Holmberg, J. R., Dunn, T. M., & Siderius, L. L. (2019). Psychotherapists in danger: The ethics of responding to client threats, stalking, and harassment. Psychotherapy, 56(4), 441–448.

Franeta, D. (2019). Taking ethics seriously: Toward comprehensive education in ethics and human rights for psychologists. European Psychologist, 24(2), 125–135.

Lustgarten, S. D. (2015). Emerging ethical threats to client privacy in cloud communication and data storage. Professional Psychology: Research and Practice, 46(3), 154–160.

Nielsen, B. A. (2015). Confidentiality and electronic health records: Keeping up with advances in technology and expectations for access. Clinical Practice in Pediatric Psychology, 3(2), 175–178. 

Rigg, T. (2018). The ethical considerations of storing client information online. Professional Psychology: Research and Practice, 49(5-6), 332–335.

QUESTION 9
If an attorney requests the record of a client and the therapist has received a verbal okay to release the record from the client, the therapist should:
a. release the record as requested
b. wait until the record is subpoenaed to court
c. get the client's consent in writing
d. assert professional privilege and refuse to release the record as you believe it might be harmful to your client's case
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