Hear from experts across the System about how clinicians and team members can ensure they are in compliance with the new statute. You must be on the UMMS network or connected via VPN to view this webinar.
Patient Handout: OpenNotes and Lab Results (PDF)
Patient Handout: MyPortfolio Overview (PDF)
Suggestions for Implementing Open Notes (PDF)
Your Patient is Now Reading Your Note (PDF)
Open Notes: Documentation Using a New Lens by Jill RachBeisel MD (PDF)
UMMS Compliance: “Do the right thing” Flier (PDF)
What sections of an adolescent patients chart are visible to proxies in My Portfolio patient portal?
Is it true that patients previously did not have access to their medical records, but now will when the Information Blocking Statute becomes effective?
No. Patients have had the right to request and view their entire medical record since 1970. When the Information Blocking Statute becomes effective on April 5, 2021, health care providers will be required to put into place electronic processes so that it is easier for patients to have access to their medical records as quickly as possible.
Did UMMS patients have access to their medical records even before the enactment of the Information Blocking Statute?
Yes. UMMS patients have had access to their entire medical record by requesting a copy of their medical records. In 2020, UMMS fulfilled at least 93,000 requests for medical records. Since 2016, all UMMS test results have been automatically released to patients via MyPortfolio. Test results are generally released as soon as they are resulted, but certain “sensitive” results are released after a lag of 3 days. Also since 2016, ambulatory practitioners have been able to share their notes via MyPortfolio. Making these notes and test results available to patients via MyPortfolio as quickly as possible is an important part of the Information Blocking Statute that goes into effect on April 5, 2021.
What is going to change when the Information Blocking Statute becomes effective?
Traditionally, medical record request processes have certain barriers and delays. As of April 5, 2021, such practices will be deemed as “information blocking.” This will be unlawful and may result in penalties for the institution and the individual health care provider.
Will changes be made to the UMMS version of Epic (Portfolio) to facilitate workflows that prevent information blocking?
Yes. These changes will become effective on April 1, 2021 in Portfolio. Broadly, patients across all care areas (inpatient, outpatient, ED etc.) who have a MyPortfolio account will have access to components of their medical record as soon as they are completed. In general, notes written by all health care providers (attending physicians, residents, fellows, advanced practice providers, nurses, physical therapists, case managers, social workers, etc.) will be available to patients as soon as they have been signed (or as soon as they are co-signed if a co-signature has been requested). Unless specifically marked for a delay by the provider, laboratory results will be available to patients as soon as a final result is available in the medical record. Problem lists, medications and diagnosis will be available as soon as they are entered in the medical record.
I treat many adolescent (12+ to 17-year-old) patients. Does this mean that all notes and lab results related to the adolescent’s health care will have to be shared with the adolescent’s proxy?
No. Implementation of this statute does not change the existing state and federal privacy laws related to health care records for any patient groups. As a result, existing proxy settings in Epic MyPortfolio are not going to change.
I believe that my patient will be harmed if they see a particular note. Is it OK not to share this particular note with the patient?
Yes. Under the “preventing harm exception,” it will not be “Information Blocking” if a clinician engages in practices that are “reasonable and necessary to prevent harm to a patient or another person.” The threshold for determination of “harm” is relatively high, therefore the instances when this justification is used to block information from patients should be infrequent. Causing “stress or anxiety” to the patient does not qualify as “harm,” but risk to life or physical safety does qualify as “harm.” For example, if reading a note is likely to increase the risk of suicide or homicide, this would be an appropriate reason for not sharing that note with the patient.
I have determined that releasing a particular note to the patient may truly cause a risk to the life or physical harm to this patient (example: reading this note will increase the risk of suicide in this patient with a psychiatric diagnosis). How do I prevent this note from being released to the patient in MyPortfolio?
Beginning April 1, 2021, the button “Share w/ Patient ” in a note will be automatically checked. For note types that currently do not have this button (and are sharable via MyPortfolio), this button will appear on these notes on April 1, 2021. If a health care provider does not want a particular note to be shared, they would unclick this button. The provider should document the reason for blocking that particular note from the patient.
Click here to see screenshots of this functionality in MyPortfolio. Note: you need to be within the UMMS Network or logged into the UMMS VPN to view this example.
UMMS will run audits on blocked notes. When queried by UMMS compliance or by the governmental regulatory agencies, the provider should be able to justify the reason for not sharing a particular note with the patient.
My department treats patients with complex psycho-social issues and sharing these notes with the patients can be detrimental to staff and patients. Can we make changes in the electronic medical record so that all notes created by me or my department are not shared by default with the patients? If that is not possible, can we, as a practice, decide to always “unclick” the “share with patient” button when we write a note?
No. The “preventing harm exception” is designed to cover only those practices that are “no broader than necessary” to reduce a risk of harm to the patient or another person. The decision of not releasing a note to prevent harm to the patient has to be made strictly on a case-by-case basis.
When queried by UMMS compliance or by the governmental regulatory agencies, the provider should be able to justify the reason not sharing a particular note with the patient.
Open Notes: Documentation Using a New Lens by Jill RachBeisel MD (PDF)
Currently UMMS automatically releases most test results to patients’ MyPortfolio accounts as soon as they are available. For certain “sensitive” tests this release is automatically delayed by three calendar days. Will this continue on and after April 1, 2021?
No. A blanket delay for the entire group of tests deemed sensitive will no longer be compliant with the law starting April 5, 2021. For UMMS, starting on April 1, 2021, when a provider orders any test, the result will be defaulted to release immediately (as soon as results are available in Portfolio). This will be applicable in every care setting (ED, inpatient, outpatient). There will be an option of delaying the results on a case-by case basis (please see section below).
Will there be situations where patients may see test results in MyPortfolio before the ordering provider is aware of it?
To make the patient aware of this possibility, results being released in MyPortfolio will include the following explanatory language: “Test results are released to patients through MyPortfolio automatically. In some cases, the provider may not have reviewed them yet. Please be aware that reference ranges are guidelines and do not necessarily reflect an abnormal result for a particular patient. Please contact your provider if you have concerns.”
Click here to see a screenshot of this functionality in MyPortfolio Note: you need to be within the UMMS Network or logged into the UMMS VPN to view this example.
I have determined that releasing a test result to a patient will cause harm. Is there a method to delay the release of the test results?
Yes. If a provider determines that immediate release of a test result will be harmful for the patient, it is reasonable to delay the release of test results in Epic. When a test is being ordered in Epic, additional options of “Immediate” or “release after 3 days” will be presented to the ordering provider.
Will all components of medical records created before April 1, 2021 also get released to My Portfolio accounts on April 1, 2021?
No. At this time, components of medical records that have been finalized before April 1, 2021 will not be automatically released in MyPortfolio.
Will incomplete notes be released to patients’ MyPortfolio portal?
No, to provide the most accurate information to our patients, incomplete notes will not be released to patients’ MyPortfolio portal.
The following are classified as incomplete notes:
If incomplete notes are being used to make health care decisions about an individual, then delaying the release of such notes may constitute “information blocking.” It is extremely important that notes awaiting co-signature should be co-signed and released in a timely manner.
Will telephone encounter notes be shared by default to patients in their MyPortfolio portal?
All notes that are “sharable” via MyPortfolio will have a button “share w/ patient” associated with it. If a healthcare provider determines that a particular note should not be shared (to prevent harm to the patient, another person or to protect the patent’s privacy), the provider should unclick the “share w/ patient” button.
I understand that providers may not release a note to the patient’s MyPortfolio portal if doing so would cause harm to the patient. I feel that my patient will be unduly anxious after reading a note. Is it OK to block this note?
No, harm refers to physical harm to a patient or another person. In mental health, if reading a note is likely to increase the risk of suicide or homicide, this would be considered appropriate to block his note. Providers should always document the reason why a particular note was blocked from release.
The threshold for determining “patient harm” is high. For example, these conditions are not considered “harm”: “A patient may disagree with content, a patient may get angry, a patient may get confused, the therapeutic relationship may be harmed, and the patient may terminate treatment.”
Please refer to the ONC website for the exact definition of the exceptions.
If the patient is a child (12 years or younger), do their proxies have full access to the patient’s chart in MyPortfolio?
Yes. There is no change to this needed to comply with the new Information Blocking regulations.
Do proxies of adult patients have full access to the patients’ chart in MyPortfolio?
Yes, adult proxies have had full MyPortfolio access. Yes. There is no change to this needed to comply with the new Information Blocking regulations.
For adolescents in the ambulatory setting, parent proxies are not able to view most sections of their child’s records (notes, labs, problem list, medications). Will this also be true when an adolescent patient is admitted as an inpatient, for example to an OB-GYN unit? Will all records associated with that inpatient encounter be blocked from the proxy?
Yes. Starting on a child’s 12th birthday, parents with proxy accounts will only have very limited access to their child’s medical information to protect the confidentiality rights of the adolescent patient.
Will communication between providers (for example, via MyPortfolio inbox message, sticky notes, Tiger-Connect messages) be released to a patient’s My Portfolio portal?
No, these are not parts of the patient’s legal medical record and will not be released to the patient’s MyPortfolio portal. However, if any of these get copied into a “sharable note” (for example a progress notes), those will be viewable via MyPortfolio.
In light of the increased data sharing with patients through the MyPortfolio Patient Portal as part of the Prevent Info Blocking initiative, do I still need to continue to complete the Quick Disclosure process when releasing information directly to a patient from their EMR?
Yes. Even though we will be sharing more data with patients via their MyPortfolio patient portal, the completion of the Quick Disclosure process is still a requirement. Under HIPAA, we continue to be mandated to track all disclosures from the patient’s medical record so that we can successfully complete an Accounting of Disclosures if requested. To find the Quick Disclosure Tip Sheets, please navigate to the UMMS Insider, enter “Portfolio Tip Sheet Library” into the Search Bar, and the Quick Disclosure Tip Sheets can be located under the “Clinical & Admin Support Staff” section of the Portfolio Tip Sheet Library.
Will all requests for copies of patient records after the April 5, 2021 go-live of the 21st Century Cures Act /Prevent Info Blocking initiative go-live now come strictly from the MyPortfolio patient portal?
No. Patients with a MyPortfolio account can request a copy of their medical records in one of two ways: either via their MyPortfolio account or through the Hospital HIM Department or respective Physician Office as they have always been able to do. All Third-Party requestors (i.e., attorneys, insurance companies, etc.) will continue to request records through the formal HIM process.
If a patient requests copies of their medical records via the MyPortfolio Patient Portal, will the records only be released back to the patient through the portal?
No. Although it will be easier and more timely to release an electronic copy of the requested records back to the patient via the patient portal, the patient has a right to request a copy of their records in whatever format or manner they wish (paper copies, flash drive, CD ROM, etc.).
Does the “sensitive” button on top of a note control the release of that note to the patient’s MyPortfolio portal?
No. The “sensitive” button is available when notes are being written in some specialties, for example, psychiatry. This button can be used by the health care provider who is writing the note to block other health care providers from accessing the note. This button does not control the release of that note to the patient’s own MyPortfolio portal. This functionality of the “sensitive” button is not changing on April 1, 2021.
For adolescents in the ambulatory setting, proxies are not able to view most sections of their child’s records (notes, labs, problem list, medications). Will this also be true when an adolescent patient is admitted as an inpatient, for example to an OB-GYN unit? Will all records associated with that inpatient encounter be blocked from the proxy?
Yes. Starting on a child’s 12th birthday, parents with proxy accounts will only have very limited access to their child’s medical information to protect the confidentiality rights of the adolescent patient.
If the patient is a child (12 years or younger), do their proxies have full access to the patient’s chart in MyPortfolio?
Yes. There is no change to this needed to comply with the new Information Blocking regulations.
Updated: 5/13/2021
Samuel M. Galvagno, DOUMMS Sepsis Program Clinical Sponsor 2014-2021
Medical School: New York College of Osteopathic Medicine of New York Institute of Technology, 2000
Internship: St. Clare’s Hospital, 2001
Residency: Brigham and Women’s Hospital, 2008
Fellowships:
Certifications:
UMMS Sepsis Program Executive Sponsor
Medical School: Virginia Commonwealth University School of Medicine, 1978
Internship: St. Joseph’s Hospital Health Center, 1979
Residency: Upstate Medical Center, 1983
Fellowship: New York Medical College – Surgical Critical Care, 1984
Certifications: