Closing or Moving Your Healthcare Practice

Whether you are at the end of your career, or you are moving or leaving your current practice, you have a number of responsibilities when it comes to protecting the data you've collected from your patients. In the absence of a healthcare provider’s regulatory college requirements, these standards are reasonable best practices that other healthcare providers can adopt for their records management practices.

Secure Storage And Disposition Of Patient Records

Custodians who close or move their private primary care practice are responsible for the secure storage and disposition of their individual patient records. This rule applies whether the custodians manage the data storage themselves or share these responsibilities with other custodians or service providers. The HIA requires custodians to protect individually-identifying health information in their custody or control by making reasonable security arrangements to protect against its unauthorized access, collection, use, disclosure, or destruction.

Patient Access

Under most privacy legislation, including Alberta’s Health Information Act, a patient has the right to access their own records about themselves. The information that a patient provides to the healthcare provider belongs to the patient. The healthcare provider is responsible to maintain the information on paper or in a computer and ‘owns’ the documents.

According to the HIA “An individual has a right of access to any record containing health information about the individual that is in the custody or under the control of a custodian” (section 7).

This means the information in a healthcare record belongs to (and must be provided to) the patient when it is requested. When you close your healthcare practice, you can anticipate many requests to access records. Review, and revise if necessary, your written policies and procedures, to ensure that you have an efficient process that accurately documents these requests for access.

When you close a practice, you must ensure that patient records are accessible to authorized individuals (like the patient him or herself, or a new custodian), while guaranteeing the continued safety of the information from reasonably-anticipated risks. In some cases, a healthcare provider may arrange to transfer patient records to another healthcare provider who will ensure their safekeeping and continue to provide patient access to them.

A custodian may contract a service provider or an information manager (as defined by the HIA) to meet their record management obligations. The Health Information Act also allows a healthcare provider (custodian) to make agreements with information managers to provide information technology and information management services described in s.66. Everything an information manager does on behalf of a custodian must comply with their agreement with the custodian as well as the HIA. Remember, the custodian is ultimately responsible for anything an information manager does on his or her behalf.

The custodian has the right to charge a fee for access requests as defined by the Health Information Act, s.67, and Health Information Regulation, sections 9–12.

Notify the CPSA

A physician must notify the College of Physicians & Surgeons before closing, leaving, or moving a medical practice in Alberta (CPSA, Standard 22, section 1).

Notify the Patient

A physician must provide a minimum of 45 days notice if you are relocating your practice and it is reasonable that you patients could continue to follow you to your new practice.

The leaving healthcare provider may wish to notify patients individually by post, through a community newspaper, in person when the patient attends the clinic, or by any combination of these or other methods. Personal letters to individuals and families demonstrate the healthcare provider’s genuine concern for patients.

Posters in the clinic also advise patients and the general public about the upcoming changes.

Physicians who move must provide forwarding information to their old clinic, and their new location must be provided to any member of the public to asks for it (CPSA Standard 22, section 7).

Ownership of Records

Clinical office records are considered the property of the healthcare provider who produced them.

Ownership of records produced in the course of group practice may require special consideration.

Ideally, healthcare providers in a group practice will have documented their agreement or expectations about records management when the practice was first formed.

Information Management Agreement

Are you part of a group practice? If you didn’t create an information sharing agreement when you opened your practice, we recommend you do this now. See the Top 3 Agreements Your Healthcare Practice MUST Have (and Why).

The following issues should be discussed, and decisions should be documented in writing:

• Will the remaining healthcare providers of the clinic accept the ongoing management of the records?
• If a patient has not been seen recently and individual authorization has not yet been acquired will the records be transferred to the remaining healthcare provider (or, if the practice has been sold, to the purchasing healthcare provider) as an information manager? Will this information manager provide secure custody, as well as transfer or destroy these records when appropriate?
• If the exiting healthcare provider has authorized the transfer of patient records to the remaining healthcare providers, how will the exiting healthcare provider have reasonable access to the relevant patient records, if required?
• If the patient records are maintained in a shared database, as often happens in a group practice using electronic medical records (EMRs), how will the exiting healthcare provider have access to them? In what media (hard copy, electronic)? At what cost? Who will assume this cost, the departing physician, patients, or remaining healthcare providers? These decisions must be included in an exit agreement and/or purchasing agreement. We recommend that you include your EMR vendor in this discussion to ensure the best choices for your system.

For example, one or more of the following options are possible:

• During the daily use of the EMR, the most responsible (or primary) physician will be identified in each patient’s record using a specified data field. For example, the scheduled healthcare provider / billing provider / chart note author or default physician data field.
• Healthcare providers leaving the clinic who may have authored patient records maintained by the clinic either on paper or electronically may request access to either paper or electronic copies of the patient records.
• Paper records will be provided in hard copy, photocopy, or may be scanned to pdf format.
• Electronic patient records may be transferred by the clinic to secured encrypted mobile media (e.g., DVD).
• The group practice will authorize the EMR vendor to create a copy, extract, or transfer those patient records belonging to the custodian for the purpose of transferring them to the sole care and custody of the exiting healthcare provider. The cost will be determined by the EMR vendor and paid in advance by the exiting healthcare provider.

Inventory Of Patient Records

Whether you plan to move, archive, or transfer the patient files to another custodian, you need to know what patient records you currently have. Prepare an inventory or list of all patient records that you have created and maintained during your practice. This often can be generated from existing data sources such as your billing or EMR system’s central patient index.

Document, Document, Document!

The HIA requires custodians to record the collection, use, access, disclosure, or destruction of health information. Before you move, close, or expand your healthcare practice, ensure that you have reviewed and documented the following processes in your policies and procedures.

Disclosure and Transfer Requests

‘Disclosure’ is defined by the HIA as an event when a custodian provides health information to another custodian or to other entities. It is also considered to be disclosure when you transfer the care of patients and their records to another physician. Review (and revise if necessary) your written policies and procedures to ensure you have an efficient process that accurately documents the disclosure request. A disclosure log or notation should be maintained, and copies of the authorized signed release forms should be included in each patient file. Disclosure notations must include the following information:

• Who the disclosure was sent to
• Date and purpose of the disclosure
• Description of the information disclosed

If a patient asks a physician to transfer his or her patient records to a new doctor, the fee schedule under the HIA does not apply. The transfer of records to a new service provider is governed by fee guidelines established by the Alberta Medical Association. In Alberta, a physician may not charge another healthcare provider for the exchange of limited patient information such as a copy of a discharge summary.

If you transfer all patient records to the care of another healthcare provider, you must create an inventory of all records transferred, and ensure that you keep a permanent copy of this inventory for safe-keeping. Provide the inventory list to the accepting healthcare provider. The accepting healthcare provider should provide an acknowledgement of receipt of all the patient records.

Records Retention

The College of Physicians & Surgeons Retention Schedule states that chart destruction may occur ten years after the end of the year in which the last visit was recorded, and, for minors, at the end of the tenth year following the last date of service or until two years past the patient’s age of majority – whichever is longer.

Before You Close Or Move Your Practice

Follow these 5 important steps before you close or move your healthcare practice to ensure your continued privacy compliance!

1. Inventory All Your Existing Patient Records
2. Patient Records Systems
3. Agreements
4. Existing Documents
5. Privacy Impact Assessment Amendment Plan

Read the Practice Management Success Tip Close or Move Your Healthcare Practice

Or, listen to the Practice Management Success Podcast Episode #090 to find out more to assist you with your continued privacy compliance when you close or move your healthcare practice.