Abstract
This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and on-site risk management audits, and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other health care professionals so “clinician” is used to indicate all treatment team members.
Question:
I recently made the decision to close my medical office and practice telepsychiatry from my home. Now I need to figure out what to do with the 30+ years of medical records I was keeping in the basement of my office. How long am I required to keep records, what is the proper way to destroy them once that period has passed, and how do I safely store them in the meantime?
ANSWER:
You pose a question many psychiatrists have been asking of late. Your medical records are your most important practice asset, and it is imperative that they be maintained and disposed of properly. I have addressed each part of your question below, but please remember to seek the advice of your own malpractice carrier before destroying records.
RETAINING RECORDS
Many (but not all) states have statutes and/or regulations governing the creation and maintenance of patient records, including the time period for which records must be kept. Federal statutes and/or regulations may also address record maintenance. The time periods mandated in these statutes and regulations represent the minimum amount of time you are “legally” required to keep patient records. Additionally, if you are a participating provider with any insurance plans, you might be contractually obligated to retain records for a specific period of time. If the statutory/regulatory retention period is different from that of an insurance plan, you should keep the records for whichever time period is the longer (at a minimum).
That answers the question of how long you are required to keep records, but there is still the question of how long you should keep records, and to that there is no clear answer. Patient records exist for a reason—to support good patient care. A good record substantiates clinical judgment and choices; it demonstrates the knowledge and skill exercised during treatment; it provides a contemporary assessment of the patients’ needs and behaviors; and it documents explanations of your decisions, significant events, and revisions to the treatment plan. Importantly, it allows someone else (e.g., another psychiatrist) to know and understand what happened during treatment and why. Psychiatric patients might see many providers over time, and it is often beneficial for subsequent treating providers to have access to earlier treatment information.
A secondary benefit derived from a patient record is the ability to provide a defense in an adversarial situation, such as litigation or an administrative or ethics complaint. The importance of patient records in these types of situations cannot be overemphasized. Because of this, records should be kept until well after your state’s statute of limitation for medical malpractice actions has run. You cannot, however, absolutely rely on these statutes to protect you from litigation. Depending on the nature and wording of a complaint, an action might be brought against you even though it is not brought within the limitations period. State law usually also contains provisions for “tolling” the statute of limitations in cases where the patient (i.e., prospective litigant) is a minor or suffers under some other legal disability or incompetence. This means that for some patients, the time in which a suit can be filed is extended.
Additionally, your state’s statutes of limitations, that limit the time during which malpractice actions might be filed against you, might not limit the time litigation resulting from allegations involving fraud, conspiracy, or criminal acts might be brought against you. Remember, too, that these laws are not applicable to professional and ethical complaints or allegations involving federal laws, rules, and regulations (e.g., Medicare billing complaints). Some physicians believe that actions cannot be brought against them if they no longer have records. That is absolutely untrue, but what is true is that they cannot defend themselves without their records.
Due to the variety of statutes, regulations, legal principles, and professional obligations affecting psychiatric records, the most conservative risk management advice dictates that records be kept indefinitely, or as long as reasonably possible.
DESTRUCTION OF MEDICAL RECORDS
If after careful consideration (and consultation with your malpractice carrier) you do decide to destroy and discard patient records, you should establish and follow written policies and procedures for doing so. The ability to demonstrate that you have followed an established procedure might help to defend against potential allegations that a record was destroyed to conceal unfavorable information. As part of your policies and procedures, consider creating a log of what records were destroyed, how and when they were destroyed, the dates of treatment covered, what method of destruction was used, a statement that the records were destroyed in the normal course of business, and the signatures of the individuals supervising and witnessing the destruction. You should maintain destruction documentation permanently.
Utilize a method of destruction that will completely destroy all records and copies of records selected for discarding. Different media require different methods of destruction: shred, burn, or pulverize paper records; recycle or shred microfilm or microfiche; purge and destroy computerized records. Whatever method is used, ensure that third parties cannot discern or reconstruct patient information from destroyed records.
MEDICAL RECORD STORAGE
Psychiatrists are legally and professionally obligated to ensure the physical security of patient records wherever those records might be stored. This means that records must be reasonably protected from natural disasters (e.g., food or fire), unauthorized access (e.g., theft), or inadvertent disclosure (e.g., lost or mislaid files). Records should always be stored somewhere safe and secure and should be accessible only to authorized individuals. If you have determined the number of files you plan to retain is not voluminous, storing them in your own home might be an option; however, you must carefully consider their placement. Files should be kept locked either in filing cabinets or a locked room (preferably both) and kept away from potential harm, e.g., pipes that could burst or basements that might food.
Should you have a larger number of records to store, you might want to consider using a professional record storage company. Such companies can be found online or through the records department of the local hospital or medical society. Your personal attorney or accountant might also be able to suggest a company. If a storage company is used, it should have experience handling confidential medical information, guarantee the security and confidentiality of records, and allow access by authorized individuals.
Make certain that you have a written agreement with the storage company that ensures the security and privacy of your records. If you cannot go to your assigned space and retrieve records directly, the contract should indicate the time frame in which records can be retrieved. (Remember, if you are provided with a valid record request, you will only have so much time in which to respond so you must ensure that records can be obtained in a timely manner.) Pay close attention to provisions in the agreement that outline the facility’s remedies in the event of your nonpayment of storage fees. Some contracts provide that the facility retains the right to destroy the contents or even to sell the contents. Although it might seem unlikely that this would ever occur, consider the consequences in the event that something happened to you that caused payment to be overlooked.
If you are a covered-entity under the Health Insurance Portability and Accountability Act (HIPAA) and the storage facility will have access to patient information, you must ensure that the facility is willing to enter into a Business Associate Agreement (BAA). Failure to have a BAA in place is a violation of the HIPAA Privacy Rule and could result in fines being assessed against you, even if there is no evidence of a breach.
For additional information on retaining and discarding records, contact your state licensing board, and other professional organizations to which you belong. The American Health Information Management Association (AHIMA), a professional healthcare information organization, is an invaluable resource.
Author Guidelines
Submission requirements for Innovations in Clinical Neuroscience (Online ISSN 2158-8341, Print ISSN 2158-8333) are in accordance with the International Committee of Medical Journal Editors (ICMJE). See Uniform Requirements for Manuscripts Submitted to Biomedical Journals.
EDITORIAL PURPOSE
Innovations in Clinical Neuroscience is a peer-reviewed electronic-only journal (www.innovationscns.com) designed to provide healthcare clinicians and researchers with upto- date, evidence-based information in a straightforward “how-to” fashion on new or emerging treatment options, drug development trends, theoretical concepts, drug trial methodology, and practice management issues in the field of neuroscience, including psychiatry, neurology, pain, and Alzheimer’s, to improve patient outcomes.
SCOPE OF MANUSCRIPTS
Manuscripts that meet our editorial purpose include but are not limited to: (1) reports of preclinical and clinical research studies that expand existing knowledge in the field of neuroscience; (2) case reports, case series, and case studies that stimulate research and the exchange of information beyond what is currently found in the literature in the field of neuroscience; (3) in-depth reviews that synthesize new or emerging information on treatment options, drug development, drug trial methodology, practice management, reimbursement, education, ethics, and legal issues in the field of neuroscience; (4) reports on contemporary issues in neuroscience that may affect drug or device development, delivery of services, reimbursement, and clinical practice of psychiatry, neurology, or related fields; and (5) commentaries that offer unique, substantiated discussions on theorectical concepts, current or emerging trends in clinical practice (including treatment and diagnosis issues), trial methodology, drug development, regulatory issues, or other topics related to neuroscience that affect patient outcome.
Original Research. Reports of investigations that address questions about clinical care or clinical trial methodology or expand existing knowledge. References and abstract are required. Illustrative material is recommended. Recommended length: up to 6000 words, not including references.
Review Articles. Comprehensive articles that synthesize and summarize the latest research to facilitate the clinician’s approach to diagnosis and treatment and articles highlighting emerging diagnostic and therapeutic modalities. May also include in-depth reviews of clinical practice, pracice management, drug development, trial methodology, reimbursement and educational, ethical, or legal issues. References (at least 25 current references are recommended) and abstract required. Illustrative material is preferred. Recommended length: up to 6000 words, not including references.
Case Series, Studies, or Reports. Short presentations of actual cases that stimulate research and the exchange of information beyond what is currently found in the literature and illustrate the signs and symptoms, diagnosis, and treatment of a disorder. Case presentations should provide unique or new information that is not well-covered in the current literature. References (at least 15 current references are recommended) and abstract required. Illustrative material is preferred. Recommended length 1000 to 3000 words, not including references.
Brief Reports. Short reports of original studies, trial methodology, or case series. Must include abstract. Recommended length: 1000 to 1500 words (not including references).
Commentaries. Essays that address important topics in neuroscience and generally are not linked to a specific article. Commentaries should offer unique perspectives that are well focused, scholarly, and clearly presented. Include approximately 20 references. Recommended length: 1500 to 2000 words.
Letters to the Editor. Opinions on cases or articles published in Innovations in Clinical Neuroscience, opinions on other current topics, or short reports of clinical interest. Must be concise and to the point. Text should not exceed 600 words (not including references), with no more than 10 references. Letters regarding a specific article published in Innovations in Clinical Neuroscience should be received within four months of the article’s publication release and may be sent to the original author for reply. Submission of a letter does not guarantee publication or response. Notify editor if letter is not intended for publication should be The editor reserves the right to edit the material for style, clarity, and size.
MANUSCRIPT SUBMISSION
Submissions for consideration may be submitted online via Editorial Manager available at http://www.editorialmanager.com/icns/default.aspx. Emailed submissions no longer accepted.
Corresponding Author. Each manuscript submission should have a designated corresponding author. The corresponding author will be the editor’s single point of contact and will be responsible for communicating any information from the editor regarding the submitted manuscript to the coauthors.
Cover Letter. Manuscripts should be submitted with a cover letter indicating the article type. The cover letter should give details on any previous or duplicate publication of any of the content and should state that the paper is not under consideration for publication elsewhere. In the cover letter, authors should disclose any potential financial confficts of interest relevant to the submitted manuscript. For Letters to the Editor, please indicate whether the letter is intended for publication.
Conflict of Interest Disclosures. All authors should disclose any potential financial conffiicts of interest relevant to the submitted manuscript in the cover letter of the submitted manuscript.
Author and Copyright Forms. Upon submission, corresponding author will receive an acknowledgement email with author and copyright forms attached. It is the responsibility of the corresponding author to distribute the author and copyright forms to all of the coauthors. All authors for each submission are required to complete, sign, and return these forms prior to publication. The corresponding author may not sign on behalf of any coauthor. If the manuscript is accepted and published in Innovations in Clinical Neuroscience, authors must transfer copyright to Matrix Medical Communications.
Registration of Clinical Trials. As recommended by the ICMJE, Innovations in Clinical Neuroscience requires as a condition of consideration for publication registration of all clinical trials in a public trials registry that requires the minimum registration data set as determined by the ICMJE, which can be accessed via http://www.icmje.org/index.html#clin_trials. Please include the trial registry name, registration number, and the url for the registry in the abstract.
Protection of Research Participants. When reporting research involving human data, authors should indicate whether the procedures followed have been assessed by the responsible review committee (institutional and national), or if no formal ethics committee is available, were in accordance with the Helsinki Declaration as revised in 2013. If doubt exists whether the research was conducted in accordance with the Helsinki Declaration, the authors must explain the rationale for their approach and demonstrate that the institutional review body explicitly approved the doubtful aspects of the study. Approval by a responsible review committee does not preclude editors from forming their own judgment whether the conduct of the research was appropriate.
Patient Consent. Identifying information, including names, initials, or hospital numbers, should not be published in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that an identifiable patient be shown the manuscript to be published. Authors should disclose to these patients whether any potential identifiable material might be available via the Internet as well as in print after publication. Patient consent should be written and archived with the authors. The authors must provide the journal with a written statement that attests that they have received and archived written patient consent. Nonessential identifying details should be omitted. Informed consent should be obtained if there is any doubt that anonymity can be maintained. For example, masking the eye region in photographs of patients is inadequate protection of anonymity. If identifying characteristics are de-identified, authors should provide assurance, and editors should so note, that such changes do not distort scientific meaning.
Animal experiments. Manuscripts will be considered for publication only if the work follows international, national, and/or institutional guidelines for humane animal treatment and complies with relevant legislation; has been approved by the ethics review committee at the institution or practice at which the studies were conducted where such a committee exists; and for studies using client-owned animals, demonstrates a high standard (best practice) of veterinary care and involves informed client consent. Prior to acceptance of a manuscript, to verify compliance with the above policies, the authors must include a signed statement that legal and ethical requirements were met with regard to the humane treatment of animals described in the study. Author must also describe in Materials and Methods section(s) of the manuscript the ethical review committee approval process and the international, national, and/or institutional guidelines that were followed.
Inclusion of Previously Published Materials. Any material submitted to Innovations in Clinical Neuroscience that is reproduced from previously published copyrighted material must be accompanied by a letter of permission from the copyright holder UPON SUBMISSION. All such material should include a full credit line (e.g., in the figure or table legend) acknowledging the original source. The author is responsible for obtaining the permission and is responsible for any associated fees.
AUTHOR GUIDELINES
MANUSCRIPT PREPARATION
Title Page. The title page should contain the following elements: title, author names and institutional afliations, sources of financial support, name of corresponding author with his or her complete contact information (mailing address, telephone and fax numbers, e-mail address), and word count (text only).
Spacing and Pagination. The manuscript should be typed using double spacing throughout. Do not use a running head. Pages should be numbered beginning with the title page. Manuscripts should NOT contain any automatic formatting, except for the page number at the top right corner of each page.
Abstract. Include a structured abstract with all articles, except letters to the editors. Original research abstracts should be organized using the following categories: Objective, Design, Setting, Participants, Measurements, Results, Conclusion. Abstracts of clinical trials must include trial registry information (registry name, registration number, and url for the registry). Review article, case report, and brief report, abstracts should be organized using the following categories: Objective, Method, Results, Conclusion. Abstracts of commentaries should include the following categories: Objective, Main Points of Discussion, Conclusion.
Keywords. Include all relevant keywords following the abstract.
Abbreviations/Acronyms. All abbreviations and acronyms should be spelled out at first mention.
References. PLEASE NOTE: Manuscripts with incorrectly formatted or incomplete references will be returned to the author and will not be entered into the peer-review process until references are corrected by the author. Citation accuracy is the responsibility of the author. Requirements are in accordance with the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. References must be cited in text in numerical order and must appear as a complete enumerated list at the end of the manuscript. (See Uniform Requirements.) Do not superscript reference numbers in the text; place the numbers at the end of the corresponding sentences or paragraphs between brackets and after ending punctuation. Abbreviate names of journals according to Index Medicus style. Specific reference formatting requirements are as follows (please see Uniform Requirements for reference types not included below):
Books. The sequence for book references should be author(s) or editor(s) (last name followed by first name initial; up to four author/editor names; for five or more authors/editors, list the first three, followed by et al), title of book, edition number, location of publisher, publisher, copyright year, volume, and specific page numbers for quoted material (if applicable). Example:
Stahl SM. Stahl’s Essential Psychopharmacology, Fourth Edition. New York, NY: Cambridge University Press;2008:15–23.
The sequence for chapters of a book should be: author(s) (last name followed by first name initial; up to four author names; for five or more authors, list the first three, followed by et al), chapter title, editor(s) (last name followed by first name initial; up to four editor names; for five or more editors, list the first three, followed by et al), book title, edition, place of publication, publisher, year, page numbers. Example:
Holland JC, Gooen-Piels J. Principles of psychooncology. In: Holland JC, Frei E (eds). Cancer Medicine, Fifth Edition. Hamilton (Ontario): Decker;2000:943–958.
Journal articles. The sequence for a journal article should be: author(s) (last name followed by first name initial; up to four author names; for five or more authors, list the first three, followed by et al), title of paper, journal name abbreviated as in the Index Medicus, year of publication, volume number, issue number and first and last page numbers. Example:
Stark D, Kiely M, Smith A, et al. Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol. 2002;20:3137–3148.
Proceedings. The sequence for conference proceedings is author(s) (last name followed by first name initial; up to four author names; for five or more authors, list the first three, followed by et al), name of presentation, name of meeting, year month day, location. Example:
Heller T. Promoting healthy aging and community inclusion of adults with developmental disabilities. Presented at the National Association for the Dually Diagnosed; 2003 Oct 24; Chicago, Illinois.
Websites. The sequence for website listings is author(s) (last name followed by first name initial; up to four author names; for five or more authors, list the first three, followed by et al) or if no author is available, the name of the organization responsible for the site, title of the specific item cited (if none is given, use the name of the organization responsible for the site), name of the website (use “website” not “Web site”), URL (provide URL and verify that the link still works), published date (if available), updated date (if available), accessed date (Tip: Include as much relevant information as possible). Example with author:
Rainie L. The rise of the e-patient. Pew Research Center Internet and the American Life Project website. http://www.pewinternet.org/Presentations/2009/40-The-rise-of-the-e-patient.aspx. October 7, 2009. Accessed January 11, 2012.
Example with no author:
Air Pollution and Respiratory Health. Centers for Disease Control and Prevention website http://www.cdc.gov/Environmental/. Updated January 9, 2012. Accessed March 2, 2012
Authors are responsible for ensuring that the list contains all references cited in the text, in order, accurately.
Tables and Figures. All illustrative material must be numbered consecutively according to citation in text. If a figure or table has been previously published, the complete reference information must be cited, and written permission from the publisher to reproduce must be submitted with the manuscript prior to peer review. Obtaining permission (and any associated fees) to include previously published materials in a Innovations in Clinical Neuroscience submission is the responsibility of the author. Photographic illustrations may be submitted as color or black-and-white electronic .jpg, .tif, or .pdf files (min. 300 dpi). Any drawings must be professionally executed and submitted electronically. Tables and graphs must be provided in Word or Excel. Symbols and abbreviations should be defined/spelled out. For black-and-white or color photographs, the required resolution is at least 300 dpi. For line drawings, the resolution must be at least 600 dpi.
EDITORIAL PROCESS
Peer Review. All submissions undergo a single-blind, peer-review process to ensure that the material is clinically relevant and concise. A minimum of two reviewers will assess each submision. Strict confidentiality regarding the submitted manuscript is maintained. Based on the reviewers/editors’ comments, manuscripts may be accepted, rejected, or recommended for revision. Reviewers’ comments that are considered constructive will be shared with the corresponding author. The editor reserves the right to reject an article at any time, including previously accepted articles or after revisions have been made by the author. The corresponding author will be notified when an article is accepted or rejected or requires revisions.
Editing and Page Proofs. Articles accepted for publication will be edited for grammar, syntax, and style consistent with journal requirements. Galley proofs will be sent to the corresponding author prior to publication for approval. The corresponing author may be asked to make minor revisions at this stage. The author will be given no more than 48 hours to respond with changes/corrections. The author is responsible for all changes in the manuscript, including those of the copy editor.
Upon publication. The corresponding author of each article receives a PDF of his or her article. The PDF is copyright protected and is for the corresponding author’s files only. Corresponding author may email PDF to co-authors and colleagues who request it for research purposes. The PDF may not be mass distributed in any way (including e-mail or print) or posted on any website (including internal sites) without express written permission from the publisher (fees may apply). Electronic and printed reprints are available at a discounted price to the corresponding author. Contact Elizabeth Klumpp for pricing at eklumpp@matrixmedcom.com.
INDEXING
Innovations in Clinical Neuroscience is indexed with PubMed Central, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature®), CINAHL® Plus with Full Text, Scopus, and Embase.
MANUSCRIPT CHECKLIST
Original manuscript (double-spaced)
Cover letter afrming the manuscript’s originality and stating any financial disclosures
Corresponding author’s name, address, phone number, fax number, and e-mail address on the title page
References cited in consecutive order in text and conformed to Uniform Requirments style
Black-and-white or color figures supplied as electronic .jpg or .tif files with a minimum 300dpi
Professionally executed drawings, algorithms, graphs, charts, etc, with all symbols and abbreviation/acronyms defined and supplied as electronic .jpg or .tif files with a minimum 300dpi
Copies of permission letters to reproduce previously published and unpublished material.
Submissions for consideration may be submitted online via the ICNS Editorial Manager available at http://www.editorialmanager.com/icns/default.aspx. Emailed submissions no longer accepted.
Editorial Queries. Elizabeth Klumpp, Executive Editor, MMC, eklumpp@matrixmedcom.com (hard copy and email submissions are no longer accepted.) Phone: (866) 325-9907 (toll-free), (484) 266-0702, Fax: (484) 266-0726