Overview
To help protect patient privacy, you can now mark the A/P note field as confidential during the Exam stage of the encounter. Notes that are marked as confidential are not visible to patients and family members or caretakers who have access to their health information, but they are visible to other providers and practice staff members. Confidential information is not included in the:
Patient Care Summary and CCDAs published to the Patient Portal.
Letters addressed to the patient.
Medical Care Record document (Full Encounter Summary) auto-published to the Patient Portal (auto-publishing is enabled by the "Visit Notes Automatically Published to the Patient Portal" feature).
Personal Health Record apps using FHIR R4 endpoints.
For example, a teenage patient might disclose information that they don't want their parents to know, but the provider wants to include it as a note in their chart. The patient's parents currently have access to the patient's information on the Patient Portal, and the patient would like to keep their Patient Portal account, so the provider marks the note as confidential. Or, a behavioral health provider might want to add a note that is not appropriate for a patient or family member to see, so the provider adds the note and marks it as confidential.
Marking a note as confidential does not impact how it appears to other providers when they receive a document. It also does not affect the application of the "Include the assessment note in the patient care summary" user preference. If this user preference is OFF, assessment notes will continue to never be included in the Patient Care Summary.
Limitations
Only the A/P note field can be marked as confidential. In the Fall 2024 release, we will expand this feature to include the ability to lock the HPI, ROS, and PE notes. In the Spring 2025 release, we will expand this feature to include the ability to lock problems, diagnosis, medications, orders, and results.
Data cannot be marked as confidential in the athenaOne Mobile app; however, data marked confidential in athenaOne Desktop will appear locked in athenaOne Mobile.
Visual indicators for confidential information
When a note field in the A/P section has not been marked as confidential, a icon displays with the words "Visible to everyone."
When a note field is marked as confidential (locked), a icon displays with the words "Not visible to patient and family" and the reason it was locked.
If you click the icon or any of the text to the left of it, you can see who locked the information, when it was locked, and the reason it was locked.
Similarly, if a previously locked item was unlocked and you click or any of the text to the left of it, you can see who unlocked the item, when it was unlocked, and the reason (if provided).
Reasons for locking or unlocking confidential information
When you mark information as confidential (lock it), you can select one of the following reasons for doing so.
Risk of harm to patient or others
State/federal law prohibits disclosure
Internal policy/procedure prohibits disclosure
Patient request
Other (please specify) — if you select this option, you must enter a reason in the text field
The selected reason appears next to "Not visible to patient and family."
When you unlock confidential information, you can select one of the following reasons for doing so.
Reason for confidentiality no longer applies
Locked in error
Other (please specify) — if you select this option, you must enter a reason in the text field
Note
By default, selecting a reason for locking or unlocking information is optional. Your practice can require users to select a reason for locking or unlocking information by enabling the "Data Privacy: Reason required for confidentiality" setting. To enable this setting, contact your CSM or the CSC: On the Main Menu, click Support then Create Case or Call.
How confidential information appears in summary views
In the summary, the full encounter summary, and the patient briefing, confidential information is displayed with a gray background and a "not visible to patient and family" label.
The Patient Care Summary, which is provided to the patient, does not display any confidential information.
Confidential information in Chart Export
If a patient's chart contains information that has been marked as confidential, a warning appears at the top of the Chart Export window.
You can click Review confidential data to view a list of the confidential data, which includes where the data was recorded, who marked it as confidential, and when it was marked confidential.
You can also view this list of confidential information by clicking Manage confidential patient information in the demographics section of the patient banner.
Locking and unlocking actions logged in Confidential Clinical Patient Data report
When you mark information as confidential (lock it) or remove the confidential marking (unlock it), the actions are logged. You can view the lock and unlock actions in the Confidential Clinical Patient Data report, which includes:
Information about the patient
Information about the encounter
The user who locked or unlocked the information
The reason for locking or unlocking the information (or a "-" if no reason was selected)
When the action was taken
Note
If a note is locked or unlocked more than once, each action is included in the report, but only the latest lock or unlock reason is displayed. For example, if a note was originally locked with "Patient request" as the reason and then later locked with "Risk of harm to patient or others" as the reason, both lock actions would appear in the report with "Risk of harm to patient or others" in the "Reason (as of Today)" column.
User access and permissions
Users that are assigned the Supervising Provider or Non-Supervising Provider role can lock and unlock items.
Users with roles other than Supervising Provider or Non-Supervising Provider require the Clinicals: Lock Confidential Clinical Data permission to lock or unlock items. Users who are not assigned this permission or the Supervising Provider or Non-Supervising Provider role will see the lock icon next to locked items. They can select the icon to see who locked the item and when but they will not be able to lock or unlock any items.
To mark information as confidential (lock)
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Next to a field that can be marked as confidential, click
.
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Select a reason for marking the information confidential. If you select Other, you must enter a reason in the text field.
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Click Lock Item.
The field is marked confidential, and the icon changes to
.
To unlock information (no longer mark it as confidential)
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Click
next to a field to unlock it.
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Select a reason for unlocking the information.
If you select Other, you must enter the reason in the Note field.
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Click Unlock Item.
The icon changes to and the field is visible to everyone.
To add or change reason for marking information as confidential
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Click the currently documented reason or select a reason.
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Select a new reason from the list. If you select Other, you must enter a reason in the text field.
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Click Lock Item.
To run a Confidential Clinical Patient Data report
On the Main Menu, click Reports > Report Library (under General).
Click the Clinicals tab.
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Next to Confidential Clinical Patient Data, click Run.
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Select the criteria for the report:
- Date range — Enter the start and end dates for the report or select a range from the drop-down menu.
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Report Format— Select the format for your report results.
- HTML table — Display the report results on your screen.
- Text (tab-delimited) — Export the report results to a .csv file in tab-delimited format.
- Text (comma-delimited) — Export the report results to a .csv file in comma-delimited format.
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Report Options— Select report options.
- Suppress Column Headings — Select this option to remove column headings from the report results.
- Suppress Report Name — Select this option to remove the report name from the report results.
- Show Filter Criteria — Select this option to include your selected filter criteria in the report results.
- Run Offline (will appear in your Report Inbox tomorrow morning) — Select this option for very long reports. Reports that are run offline appear in your Report Inbox the morning after the request.
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Click Run Report.