Confidentiality and Electronic Medical Records for Behavioral Health Records: The Experience of Pediatric Psychologists at Four Children's Hospitals

With the advent of electronic medical records (EMR), pediatric psychologists working in medical centers must address how confidentiality of behavioral health records will be defined and integrated into the larger EMR. Pediatric psychologists at four children’s hospitals share their decision-making and outcomes as their home institutions transitioned to an EMR. All four formed committees of relevant stakeholders and legal advisors to define the legal and ethical issues and all four had mechanisms to communicate provider concerns to and share committee opinions with providers. Two of the four required patients to give consent for behavioral health records to be integrated into the larger EMR, one integrated behavioral health records completely without required specific consent, and the fourth differentiated integration based on the type of service provided, with those focused primarily on physical health concerns fully integrated and those focused on behavioral health limited access to only behavioral health providers. The EMR at each institution allowed psychologists discretion to keep individual notes or portions of notes at a heightened level of confidentiality even when integrated. At all four institutions, medical colleagues valued having the behavioral health records fully integrated within the EMR, both the psychologists and their medical colleagues appreciate the improved communication with an integrated EMR (whether by consent or default), and the broader confidentiality protections of each institution has ensured that records are not accessed by those not involved in a patient’s care. Most important, families appear to appreciate the benefits of an integrated EMR.