When you move your practice – what to do about your electronic patient records

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If you’re like most physicians, you’ll move your practice at least once in your career. Wherever you go, the responsibility for the security and accessibility of your patient records goes with you. A simple concept if you’re in solo practice, but what if you’re leaving a multi-practitioner clinic with a shared EMR? Here are some suggestions.
Make the transition as easy as possible for your patients. As a custodian of your patient records, you don’t need patient consent to transfer those records to a new practice. However, always consider your patients’ best interests in deciding whether others need access too. Are your patients likely to move with you, or to stay with the clinic you are leaving? In either case, you need to ensure your patients’ medical records are secure and accessible to the patient’s primary physician.

Sign an agreement with your co-practitioners in advance. In a shared practice, it’s always best to work out the fine points of records custody and access before these issues arise out of necessity. Sooner or later, every practice arrangement will end – what is everyone’s understanding about what happens then? At minimum, your agreement should identify:

  • the legal status of each practitioner (e.g., partner, associate, cost-sharing arrangement, etc.),
  • who will retain custody of your patient records if you leave – you, the clinic or both – to ensure continuity of care,
  • if you, or both you and the clinic will retain custody, who will be responsible to pay the costs of copying/transferring your records to your new practice (may depend on the circumstances of your leaving), and
  • if the clinic will retain sole custody, how you will gain access to your records if necessary (i.e., for medical-legal reasons).

Be prepared for a time-consuming process to transfer your records. EMR systems are generally incompatible with each other, and do not support record-to-record transfer. Ask your EMR vendor for advice.

Understand your options and obligations under the Health Information Act. The HIA provides detailed direction regarding patient consent and the rights and responsibilities of health information custodians.

These are just a few of the many arrangements that may be negotiated for specific situations.
Three scenarios

  • Physician #1 is leaving a full-time practice at a multi-practitioner clinic with a shared EMR to move to a similar clinic across town. She will take an electronic copy of the complete record for every patient for whom she was the primary physician. The clinic’s health records agreement allows her former colleagues to also retain the records in their EMR to facilitate continuity of care for her patients who decide to stay with the clinic. The physician who is leaving loses access to the clinic EMR on her departure.
  • Physician #2 is leaving a part-time practice at a walk-in clinic to work in solo practice in another city. As per his agreement, the owner of the walk-in clinic remains the custodian of all the information in the EMR and accepts responsibility for meeting the College’s 10-year Standard of Practice for record maintenance and retention. The physician is allowed access to the records for his former patients on request, with 48 hours notice.
  • Physician #3 is leaving a cost-sharing arrangement with three other physicians in which each maintained their own, distinct practice and patient records in the clinic EMR. Their agreement places full responsibility for maintaining patient records on the physician who created them. However, the agreement allows the departing physician access to the EMR for a transitional period of 3 months before the records are archived by the clinic.

These are just a few of the many arrangements that may be negotiated for specific situations.

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