User Guide — Lock Patient Data

athenaClinicals

To help protect patient privacy, you can mark some exam and chart information as confidential, including:

  • Diagnoses and diagnosis notes

  • Orders

  • Problems

  • Results and result documents

  • Medications

  • The note field in the HPI, ROS, and PE sections

  • The assessment note field in the A/P section

Confidential information can be hidden from:

  • Patients and family members

  • Health data exchanges

  • Both patients and family members and health data exchanges

Marking information 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.

Hiding information from patients and family members

If you hide information from the patient and family members, it is 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.

 

Hiding information from health data exchanges

hidden from providers who access patient records through Patient Record Sharing. Information marked as confidential is not included in CCDAs or HL7 messages sent through Patient Record Sharing and select HIEs. Patient Record Sharing allows providers to exchange medical records with practices across the athenahealth network and with external care sites via CommonWell and Carequality.

 

Currently, information hidden from health data exchanges is not included in CCDAs and HL7 interface messages sent through the HIEs listed here: https://success.athenahealth.com/s/article/000128154. This list will be updated as additional HIEs will support the filtering of confidential data over time.

 

 

  • Data cannot be marked as confidential in the athenaOne Mobile app; however, data marked confidential in athenaOne Desktop will appear locked in athenaOne Mobile.

  • Prescription orders within encounters can only be marked as confidential prior to signing the order. Once the order is signed, you should mark the medication as confidential via the Medication list in the patient’s chart.

 

 

When information has not been marked as confidential, a icon displays with the words "Visible to everyone."

 

When information is marked as confidential (locked), a icon displays with the words "Not visible to patient and family," "Not visible to health data exchanges," or "Not visible to patient& family; health data exchanges."

 

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

 

There are instances where data points are locked or unlocked automatically. For example, if a problem in a patient’s chart is locked and you add it as a diagnosis in an encounter, the diagnosis will automatically be locked as well. In these scenarios where items automatically lock, if you click the icon or any of the text next to it, you will see who locked the original item as well as “(automatic)” next to it, indicating this item was automatically locked.

 

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 view this list of confidential information by clicking Manage confidential patient information in the demographics section of the patient banner.

 

 

When you lock confidential information, 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.

 

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 > Success Community > Contact Client Support Center.

 

  • Hover over a diagnosis or diagnosis note to access the icon and lock it.
  • If you lock or unlock a diagnosis, the diagnosis note is also automatically locked or unlocked.
  • If you lock a diagnosis note, the diagnosis is not automatically locked.
  • If you unlock a diagnosis note, the diagnosis is also automatically unlocked.
  • Locking or unlocking a diagnosis does not lock or unlock associated orders.
  • If a diagnosis was added to the Assessment & Plan from the Problem List or vice versa (indicated by next to the diagnosis), locking or unlocking one does the same to the other automatically, and the same reason is applied to both.

 

  • If you lock or unlock an order, associated results are also automatically locked or unlocked.

  • If you lock or unlock a result, associated orders are not automatically locked or unlocked, and any future change to the order confidentiality status will not affect the result confidentiality status.

  • Locking or unlocking an order does not lock or unlock an associated diagnosis.

  • Click an order to view details including the reason an order was locked.

 

  • Hover over a problem to access the icon and lock it.

  • If a problem was added to the Problem List from the Assessment & Plan or vice versa (indicated by next to the problem), locking or unlocking one does the same to the other and the same reason is applied to both.

  • To view the reason a problem was locked, click the icon.

 

  • If you lock or unlock an order, any result that it is tied to is also automatically locked or unlocked.
  • If you lock or unlock a result, any order that it is tied to is not automatically locked or unlocked. Any future change to the order confidentiality status will not affect the result confidentiality status and you must manage the confidentiality of the order and result separately.
  • In the multi-result document view for multiple results, results are treated as a group, and confidentiality status will be consistent across all results in the document. If one result in the multi-result document inherits a lock or unlock status change from an order that it's tied to, all results in the multi-result document will inherit that change.

 

  • Prescription orders within encounters can only be marked as confidential prior to signing the order. Once the order is signed, you should mark the medication as confidential via the Medication list in the patient’s chart.
  • All medications can be locked or unlocked except compound medications and medications that can’t be ordered, which is not common.
  • If a medication is locked or unlocked, all medications with the same active ingredients that are present on the Medications List or prescribed in the future will also be automatically locked or unlocked.

    For example, if amitriptyline 50 mg and amitriptyline 10 mg are both on the Medications List, when amitriptyline 50 mg is manually locked by a provider, amitriptyline 10 mg is also automatically locked because they have the same ingredients.

    If you lock a combination medication, only combination medications that have the exact same active ingredients will be automatically locked. For example, Bactrim contains the active ingredients trimethoprim and sulfamethoxazole. If Bactrim is locked, combination medications such as Trimethoprim-SMZ DS 160 mg-800 mg tablet or Sulfamethoxazole-Trimethoprim 400 mg-80 mg/5mL intravenous solution would also be locked.
  • You cannot lock or unlock prescriptions from the document view, and you cannot view the lock status of prescriptions from the document view.
  • Hover over a medication in the Medications List to access the icon and lock it.
  • To view the reason a medication was locked in the Medications List, click the icon.

Confidential Clinical Patient Data Report

A Confidential Clinical Patient Data Report provides visibility into who marked information as confidential (locked it) or removed the confidential marking (unlocked it).

 

 

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 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

 

  1. Next to a field that can be marked as confidential, click .

  2. Select a reason for marking the information confidential. If you select Other, you must enter a reason in the text field.

  3. Click Lock Item.

  4. The field is marked confidential, and the icon changes to .

 

  1. Click next to a field to unlock it.
  2. Select a reason for unlocking the information.
  3. If you select Other, you must enter the reason in the Note field.
  4. Click Unlock Item.
    The icon changes to and the field is no longer marked as confidential.

 

  1. Click the currently documented reason or select a reason.
  2. Select a new reason from the list. If you select Other, you must enter a reason in the text field.
  3. Click Lock Item.

 

  1. Display the Report Library: On the Main Menu, click Reports. Under General, click Report Library.
  2. Click the Clinicals tab.
  3. Click run next to Confidential Clinical Patient Data in the Standard Reports section of the tab.

  4. 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.

      Note: You must apply at least one type of date filter.

    • 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.
    • 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.

  5. Click Run Report.

 

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