The traditional “rules” of medical practice medical charts are not adequate in the modern age of aesthetic medicine.
There are two issues that have been misinterpreted and misunderstood. The first issue is who “owns” the patient chart. The second issue is under what circumstances should a practice maintain two sets of charts or records. There is no question that the “cosmetic” patient is more challenging in terms of results, satisfaction and “hand holding”. Consequently, more cosmetic patients leave a practice and request their medical records. There are also more medical professionals leaving a practice to work in another facility and battles over the charts have become common and emotional.
The discussion must begin with a common misconception. The practice or the doctor does NOT own the medical chart. The patient “owns” his or her medical chart. The doctor or practice is merely the custodian of the chart or record. Accordingly, when a patient requests a chart, you MUST provide it to them. It is prudent to give the patient the original chart if they request it and keep a copy in the practice to coordinate care and maintain records as required by state and federal law. It is appropriate to charge a fee for the chart, but the fee should rarely exceed twenty-five dollars.
It is also acceptable and advisable to have the patient sign a release for the chart. The release should direct where the chart is going (even if it is to the patient) and it should be plain language The release should only reference the chart and a release of liability for the transfer of the chart to the patient or other facility.
Many patients receive services from several different aesthetic and medical providers within the same practice. Accordingly, there is substantial confusion over the entire chart documentation process and there are more issues than it initially appears.
The question of whether to have two sets of charts is itself complicated. Some additional considerations further complicate the issue. Some practices have one chart for all services while others have separate charts for medical and non-medical services. Practices have valid justification for their policies in both instances.
The answer of which protocol is more acceptable is difficult to answer and clarification comes in the form of a middle ground that can keep all practices safe and compliant. It is prudent to maintain two sets of patient records; one for the medical procedures and the other for esthetic or non medical services performed within the facility. However, it is also prudent to keep the two sets of records together and color coded. For example, the medical charts may be the traditional manila charts. However, the non-medical chart should be a different color and all of the non medical services kept in the colored chart. This will enable easy removal by an esthetic provider (to provide a service) without disruption of the chart. It is also important to do keep charts in this manner because patients do not “own” the esthetic chart and if they request their medical records, you may not want to copy and provide the esthetic chart for non medical services (such as laser hair removal and superficial peels).
This is a significant distinction because when an esthetic provider (non-medical services) leaves the practice, they will frequently take the “charts” or the records so your employment agreement with them must address this occurrence. If they do not take the actual chart, he or she may take the information and contact the “clients” and you may not desire this so the employment agreement must address this too.
Keeping two sets of records but in one file will also coordinate care. Many “esthetic” procedures are at the direction of the medical provider. A good example would be acne patients that are receiving glycolic peels for oil control. The medical provider may want to review the peel history during medical treatment evaluation so access to the record is important. Laser hair removal may also be another good example since many patients are treated medically for burns, hyper and hypo pigmentation.
This issue is complicated when the non-medical services are performed in a separate facility that may have common ownership with the medical practice. I will discuss this in the next blog.
There have been many recent questions regarding medical and non-medical providers leaving a practice and trying to take medical records with them. In the event that a non-medical provider (such as an esthetician) desires to leave and take the charts, a policy should be in place in the practice for such occurrences and it should be anticipated and addressed in the employment agreement as well. A practice does not have the argument that the chart must remain in the practice because they are the custodian of it since the patient does not “own” the chart and the practice is not the custodian of the esthetic records.