4 ms·

Digitized therapy notes just seems like a really bad idea.

by tcoff91 2y ago

vkou 2y ago
So are automobiles and 120V AC current, but we use both because they are convenient.
- deadbabe 2y ago
  I don’t have much sympathy for the inconvenience of therapists charging $300/hr+ per session.
  - vkou 2y ago
    You have a therapist? That must be nice, there's a shortage of them, none of them are taking new patients, and they can charge whatever they want, and use whatever tools they want.
    - deadbabe 2y ago
      Yes, I had a therapist. I paid $200 per session each week.
  - itishappy 2y ago
    What's your rate?
- mindslight 2y ago
  Sure, then pedantry - Digitized therapy notes are a bad idea, while "digitized" generally continues to mean some bucket-of-stomach-fluid EMR vendor's obtuse SaaS (Software Augmented with Arbitrary Surveillance) webapp running on SaaS Google Ads Chrome on top of SaaS Microsoft OG-negligence Windows. It's like if "automobiles" all had cell modems in them, ran some minimum viable functionality Swiss cheese security embedded software, could be remotely controlled from the Internet, and the only things keeping mass destruction at bay is the lack of documentation and the fact that individual humans generally don't want to hurt one another. uh, maybe I need a different example.
  - vkou 2y ago
    > It's like if "automobiles" all had cell modems in them, ran some minimum viable functionality Swiss cheese security embedded software, could be remotely controlled from the Internet, and the only things keeping mass destruction at bay is the lack of documentation and the fact that individual humans generally don't want to hurt one another. uh, maybe I need a different example. And nobody outside of Hacker News cares about any of that. All they care about is getting from point A to point B, never mind that ~1,300,000 people are killed by by crashes every year and that we're poisoning our planet with them[1]. It's possible that I chose them as an example deliberately and cynically, as opposed to pedantically. --- [1] Both of which are far more pressing concerns than some Martian super-hacker pwning my car, but it's all worth the convenience of not having to get into a bus, or on a train.
cjk2 2y ago
I used to date a therapist. She left her patient notes on a train more than once in a year! YMMV
- marcod 2y ago
  Still much preferable to an unsecured online database, no?
  - vkou 2y ago
    Not when they get lost.
    - peddling-brink 2y ago
      The likelihood of patient files being found on a train and mass exploited are really low. Most people would either try to do the right thing or just trash them. The average train rider isn’t looking to ruin someone’s day. The same cannot be said for the average unprotected database scanner.
    - toast0 2y ago
      While unauthorized access to therapy notes is bad, I think there's a difference in scale. You probably don't bring all of your notes from your whole practice with you on the train to lose. If you do bring some of your notes with you and leave them on the train, there's a good chance they will be returned without being accessed by the returner, or be collected as trash, again with no access. Even if there is some access, it's less likely that they'll be widely distributed, because they'd need to be digitized or otherwise copied first, and that's a lot of effort. If the person who picks up your notes on the train is nefarious or even maybe just curious and happens to know the people in your notes, there's potential for negative outcomes for your patients, but IMHO, the probability of a negative outcome for patients given an incident of unauthorized access is lower with paper records than digital records. I don't know if I can really opine on the probability of unauthorized access --- digital records open up the possibility of more effective controls on access than a filing cabinet; you can't audit which records were read when an authorized person opens a cabinet to get some records and looks around at others.
suddenclarity 2y ago
It gets worse. The latest trend in healthcare is to use AI written patient journals based on the computer listening to the conversation.
- ProllyInfamous 2y ago
  I asked a potential MD, politely, to "please remove your iWatch and iPhone, at least during our initial consulation..." and was met with an immediate retort of "being paranoid." The recent controversies about online (and even genAI) psychotherarpy have largely left many to suffer unaided, out of fear of hacking or selling of their most secret of secrets.
deathanatos 2y ago
I don't know that it's going to matter too much, in the end? There's a plethora of other "metadata" surrounding a patient's encounter with the therapist that isn't therapy notes, enough such that you can probably infer a good deal of what might be in the notes from the metadata. E.g., things like their reason for even engaging the therapist in the first place is probably basically the thesis for most of the session & notes. Enough to extort the person, I think.

Digitized therapy notes just seems like a really bad idea.

vkou 2y ago

So are automobiles and 120V AC current, but we use both because they are convenient.

deadbabe 2y ago
I don’t have much sympathy for the inconvenience of therapists charging $300/hr+ per session.
- vkou 2y ago
  You have a therapist? That must be nice, there's a shortage of them, none of them are taking new patients, and they can charge whatever they want, and use whatever tools they want.
  - deadbabe 2y ago
    Yes, I had a therapist. I paid $200 per session each week.
- itishappy 2y ago
  What's your rate?
mindslight 2y ago
Sure, then pedantry - Digitized therapy notes are a bad idea, while "digitized" generally continues to mean some bucket-of-stomach-fluid EMR vendor's obtuse SaaS (Software Augmented with Arbitrary Surveillance) webapp running on SaaS Google Ads Chrome on top of SaaS Microsoft OG-negligence Windows. It's like if "automobiles" all had cell modems in them, ran some minimum viable functionality Swiss cheese security embedded software, could be remotely controlled from the Internet, and the only things keeping mass destruction at bay is the lack of documentation and the fact that individual humans generally don't want to hurt one another. uh, maybe I need a different example.
- vkou 2y ago
  > It's like if "automobiles" all had cell modems in them, ran some minimum viable functionality Swiss cheese security embedded software, could be remotely controlled from the Internet, and the only things keeping mass destruction at bay is the lack of documentation and the fact that individual humans generally don't want to hurt one another. uh, maybe I need a different example. And nobody outside of Hacker News cares about any of that. All they care about is getting from point A to point B, never mind that ~1,300,000 people are killed by by crashes every year and that we're poisoning our planet with them[1]. It's possible that I chose them as an example deliberately and cynically, as opposed to pedantically. --- [1] Both of which are far more pressing concerns than some Martian super-hacker pwning my car, but it's all worth the convenience of not having to get into a bus, or on a train.

cjk2 2y ago

I used to date a therapist. She left her patient notes on a train more than once in a year! YMMV

marcod 2y ago
Still much preferable to an unsecured online database, no?
- vkou 2y ago
  Not when they get lost.
  - peddling-brink 2y ago
    The likelihood of patient files being found on a train and mass exploited are really low. Most people would either try to do the right thing or just trash them. The average train rider isn’t looking to ruin someone’s day. The same cannot be said for the average unprotected database scanner.
  - toast0 2y ago
    While unauthorized access to therapy notes is bad, I think there's a difference in scale. You probably don't bring all of your notes from your whole practice with you on the train to lose. If you do bring some of your notes with you and leave them on the train, there's a good chance they will be returned without being accessed by the returner, or be collected as trash, again with no access. Even if there is some access, it's less likely that they'll be widely distributed, because they'd need to be digitized or otherwise copied first, and that's a lot of effort. If the person who picks up your notes on the train is nefarious or even maybe just curious and happens to know the people in your notes, there's potential for negative outcomes for your patients, but IMHO, the probability of a negative outcome for patients given an incident of unauthorized access is lower with paper records than digital records. I don't know if I can really opine on the probability of unauthorized access --- digital records open up the possibility of more effective controls on access than a filing cabinet; you can't audit which records were read when an authorized person opens a cabinet to get some records and looks around at others.

suddenclarity 2y ago

It gets worse. The latest trend in healthcare is to use AI written patient journals based on the computer listening to the conversation.

ProllyInfamous 2y ago
I asked a potential MD, politely, to "please remove your iWatch and iPhone, at least during our initial consulation..." and was met with an immediate retort of "being paranoid." The recent controversies about online (and even genAI) psychotherarpy have largely left many to suffer unaided, out of fear of hacking or selling of their most secret of secrets.

deathanatos 2y ago

I don't know that it's going to matter too much, in the end? There's a plethora of other "metadata" surrounding a patient's encounter with the therapist that isn't therapy notes, enough such that you can probably infer a good deal of what might be in the notes from the metadata. E.g., things like their reason for even engaging the therapist in the first place is probably basically the thesis for most of the session & notes. Enough to extort the person, I think.