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  #1  
Unread July 5th, 2009, 11:41 AM
sk8rgrl23 sk8rgrl23 is offline
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Default Record keeping dilemma

I am working on starting a private practice and the issue of where to keep documents and for what services comes to mind.

My first stage I plan to hold a seminar on a particular topic and then extend that into a psychoeducational/therapeutic time limited group, hopefully followed up by clients for individual services.

One option in terms of office space is to sublet or there is also a program called "virtual" office in which you rent office space by the hour. The advantage to either of these is that there is no ongoing committment while I test the market and see if private practice is even feasible, and have some time to build with no pressure of keeping up with office rent.

The disadvantage to this type of option is how to keep records until I can get my own more permanent office space. Is an online documentation service appropriate and feasible? What about a locked briefcase for transporting notes to a place where I could keep them securely?

Obviously if I'm running a therapy group or seeing individual clients these are calls for documentation, but what about psychoeducational groups? Where is the line between education and therapy?
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  #2  
Unread July 6th, 2009, 09:56 AM
William Reid William Reid is offline
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Default Re: Record keeping dilemma

In my view (I'm not a records librarian), clinical records must be (1) safeguarded from unauthorized readers, (2) reasonably available for your review and sharing with authorized persons, (3) reasonably protected from destruction or loss, and (4) kept for a really long time. There may be a minimum time period in your state, but I'd double it.

I would not keep records online. I know that's dark-ages thinking, but (a) there are (a) real confidentiality issues; (b) possible access issues (no Web access sometimes? forgot the password?); (c) possible future format/compatibility issues (I used to write papers in WordStar on a CP/M platform), and, perhaps most important, (d) real probabilities that the website that keeps them will go out of business within a few years. (How many Web companies that existed in 2004 don't exist today, especially small ones?)

I seem to be categorizing things today, (i) because it's early in the day and (ii) because it provides the illusion that I know what I'm doing.

Education vs. group counseling/therapy? I'll leave that to someone else.

Meantime, it might be wise to remember the purposes of clinical records, when thinking about how to create and store them: (#) to document what you've done, (%) to help you remember what's going on with the patient/client as you treat him/her over time (or after a long absence), and (*) to communicate to other treaters -- current and well into the future -- things they need to know as they work with the person. Good documentation can be important for years to come, in clinical, administrative, and forensic settings. Don't skimp: you are far more likely to get into trouble for too-skimpy documentation than for too much, and clarifying details are far more likely to help you (and your patient/client) than to hurt you.
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  #3  
Unread July 8th, 2009, 02:17 PM
Da Friendly Puter Tech Da Friendly Puter Tech is offline
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Default Re: Record keeping dilemma

I have learning disabilities, and I know I need a computer to help me organize something like notes.

As far as online goes - it is feasible. Especially if you use a larger company with plenty of back up computers. The only problem is safety of confidential information. You have to make certain that the notes are locked behind 256 bits of encryption. That is considered military strength, and is the level that banks use. It is also the level required by HIPAA for medical notes.

I know what I would do though. I would use a laptop. Then I would install a software program with 256 bit of encryption. I would make my notes on the laptop, but make certain to encrypt all the notes. I would buy an external flash drive and back up the hard drive at least weekly. With an extra monthly back up to cd roms. There are also online back up options like carbonite. I love that company. Again, if you make absolutely certain that all your files are completely encrypted it should be ok. Personally, my notes laptop would not be connected to the Internet. Just to add another (maybe completely unnecessary) layer of protection to those notes. You can always print out your notes when you get home and keep them locked away there.

Da Friendly Puter Tech
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  #4  
Unread July 18th, 2009, 10:52 AM
sk8rgrl23 sk8rgrl23 is offline
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Default Re: Record keeping dilemma

Quote:
Originally Posted by William Reid View Post
In my view (I'm not a records librarian), clinical records must be (1) safeguarded from unauthorized readers, (2) reasonably available for your review and sharing with authorized persons, (3) reasonably protected from destruction or loss, and (4) kept for a really long time. There may be a minimum time period in your state, but I'd double it.

I would not keep records online. I know that's dark-ages thinking, but (a) there are (a) real confidentiality issues; (b) possible access issues (no Web access sometimes? forgot the password?); (c) possible future format/compatibility issues (I used to write papers in WordStar on a CP/M platform), and, perhaps most important, (d) real probabilities that the website that keeps them will go out of business within a few years. (How many Web companies that existed in 2004 don't exist today, especially small ones?)

I seem to be categorizing things today, (i) because it's early in the day and (ii) because it provides the illusion that I know what I'm doing.

Education vs. group counseling/therapy? I'll leave that to someone else.

Meantime, it might be wise to remember the purposes of clinical records, when thinking about how to create and store them: (#) to document what you've done, (%) to help you remember what's going on with the patient/client as you treat him/her over time (or after a long absence), and (*) to communicate to other treaters -- current and well into the future -- things they need to know as they work with the person. Good documentation can be important for years to come, in clinical, administrative, and forensic settings. Don't skimp: you are far more likely to get into trouble for too-skimpy documentation than for too much, and clarifying details are far more likely to help you (and your patient/client) than to hurt you.
I'm all for categorization.

How bout Puter Tech's suggestion? I think I was thinking more of a cd-rom type program though you're still right about the obsolescence factor. Do you have any suggestions on how to make a sublet office set up work? At this point I"m up to my neck in household expenses per paycheck, and can't see being able to afford to lease an office for quite a while yet. I imagine starting a practice takes about a year or so to even begin to build.

Last edited by sk8rgrl23; July 18th, 2009 at 10:53 AM. Reason: typo
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  #5  
Unread July 21st, 2009, 10:50 PM
Da Friendly Puter Tech Da Friendly Puter Tech is offline
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Default Re: Record keeping dilemma

I wouldnt be too worried about obsolescence. I know in the past this caused a lot of problems, but these days the software makers put effort into making sure newer models of their softwares can read older models copies.

As far as companies going out of business. Sure that happens. You will get a warning from the company though, and the chance to save your own material. Besides if you print out copies of your notes and keep them locked up in your home that takes care of all those worries. This way you can create double redundancy. Save it behind 256 bit encryption on your laptop. Back the laptop hard drive up every week to a cd rom or other external drive or online service. Make sure to keep it encrypted. Print out a copy of each page of notes and keep them locked away. If you ever get in trouble restoring data from the computer you can always scan those pages. It cant be more safe, easily accessible and protected from harm than that.

As far as subletting, I have done it as a massage therapist. It worked fine for me. Find someone you are compatible with of course. You might not be able to decorate the place the way you want it.

I had a lot of freedom with my space. I could always call my corenters and ask if they were using the space during their time. If they werent they would usually let me book something during a different time. I did the same for them of course. It worked out.

good luck

Da Friendly Puter Tech
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