Overview
To help protect patient privacy, you can now mark a note field in the HPI, ROS, and PE sections 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:
Patient Care Summaries and CCDAs published to the Patient Portal.
Medical Care Record documents (Full Encounter Summaries) 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 only.
Marking a note as confidential does not impact how it appears to other providers when they receive a document.
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. Their 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.
We're making this change because you requested it. Keep those suggestions coming! For the original suggestion, please see the request on Success Community.
Note
The ability to lock notes in the A/P section of the exam was introduced in the Summer 2024 Release. The same functionality is now being extended to the HPI, ROS, and PE sections.
Limitations
Only the HPI, ROS, PE, and A/P note fields can be marked as confidential. 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 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."
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 (if provided).
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."
If you lock an item in an encounter and select a reason, that reason is automatically applied to other items that you lock in the same encounter. You can change the reason for locking an item at any time (see To add or change reason for marking information as confidential).
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.
Confidential information 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 click View note to display the contents of the note.
Another way to view this list of confidential information is by clicking Manage confidential patient information in the demographics section of the patient banner.
Confidential information in athenaOne mobile
You cannot lock or unlock a note in athenaOne mobile, but you can see which notes are locked and the reason the note was locked.
Confidential notes appear with a lock icon in athenaOne mobile.
To view the full note and see the reason the note was locked, tap the note.
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 can see if an item is locked or unlocked, and they can click or
to see who locked or unlocked an item, when it was locked or unlocked, and the reason (if provided).
To access reports on the Clinicals tab of the Report Library, you must have the Clinicals user permission and the Report: Report Library: Clinicals permission. The Report: Report Library: Clinicals permission is included in the following roles:
Practice Superuser role
Report Reader role
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. You can also enter a note without selecting a reason.
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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.
Click Run Report.