Meeting purpose

This BC-PAN meeting was a 2-day Zoom conference on June 9 and 10, 2021. The purpose of the meeting was to seek input from public advisors to help college partners provide guidance for practitioners moving or leaving practice regarding patient records and communication.

Key messages from public advisors

Patient records and communication when health care practitioners leave practice

• When a practitioner is leaving practice, they should ensure that the process is as transparent as possible and provide advance notice, disclose any fees that may have been incurred during their care, and recommend another practitioner.
• There is an enhanced responsibility of continuity of care for patients who require complex care and a succession plan should be implemented in these cases. 

Patient records and communication when health care practitioners leave practice

Susa Paul, Manager of Professional Practice for CPTBC, and Andrea Bowden, Deputy Registrar for COTBC, gave an overview of what to expect when a health care practitioner leaves practice.

• Reasons for leaving practice may include moving to a new city, retiring, or moving to a different area of practice.
• For health practitioners working in a clinic, there may be tensions between the business contract with their clinic that limits their ability to take patients to a new practice, and the moral and ethical obligations to offer patients continuity of care.
• Some patients are interested in following their provider to a new practice, while others want to keep receiving services at the original clinic and are open to working with new health care providers.
• The Health Professions Act outlines that the mandate of the college to act in the public’s best interest. The HPA does not give regulators power over business contracts – they can only regulate professionals. They cannot tell registrants what they can agree to in a contract.
• What does this mean for the public?
  • Notifying patients: sometimes providers are unable to tell patients in advance that they are leaving a practice, which begs the question, what is proper notice?
  • Health records: who will be the custodian of the record? Who will keep the record? The practitioner or clinic? How will patients access their records?
  • Ongoing care needs: what does this mean with the patient’s right to choose their care provider? What options should be presented to the patient? To stay with the clinic, knowledge of other providers, or follow their provider?
• The core piece is ensuring patient safety. If the practitioner is retiring or moving to another clinic, all colleges have guidelines to support records maintenance.

Advisor questions and comments

• What about the independent practitioner that may work from a home office?
  • Most colleges will have a requirement about notifying the college and where those records are being stored and how patients can access them after
• What is the procedure to ensure that records are only accessed by privileged parties?
  • All electronic records have an audit system that records who is accessing records. Personnel should only access records on a need to know basis.
• Are the standards different for deceased people?
  • The obligation around the retention of records does not change if the person is deceased. The security and retention period standards remain the same.  
• If someone that passed away was receiving care in the hospital and working with different health practitioners, do you need to go to the individual people to access records?
  • Hospitals maintain records themselves in public practice. A medical records department has all records in one comprehensive clinical record. Colleges do not regulate hospital records management.
• A high percentage of Indigenous people don’t have regular doctors, so often go to several walk ins and hospitals to access care. Their medical records may be stored in multiple places and they don’t have the same autonomy over who accesses their medical records. How are their records maintained?
  • In public practice, all records stay with the hospital. It is only in the private setting where the records may stay with the clinic or move with the professional.
  • Walk in clinics are private practice and are regulated by the colleges. Records would either stay with the practice or move with the physician.

Custody of records

Public advisors were asked to brainstorm a list of pros and cons from a public perspective for patient health records to be in the custody of (1) the health care business owner, or (2) the health care practitioner. They were encouraged to consider a range of health care providers.

Health care business owner maintaining health records

Pros

• Continuity of care at the location.
• Known and convenient location.
• Easier in small-town environments.

Cons

• Refusal to provide records due to a patient being unable to pay service fees.
• The patient would likely want to follow up with their practitioner.
• Concerns of records duplication.
• The succeeding practitioner may interpret records differently regarding contextual information.

Health care practitioner maintaining health records

Pros

• Continuity of care with the health care practitioner.
• The health care practitioner can supplement records with personal and contextual information.
• Relationship with the practitioner has already been established – trust exists.

Cons

• Records may be lost if the practitioner retires or moves away.
• Patient would need to track down the practitioner.
• Concerns about the transport and storage of records at a new location.

Other considerations

• Security standards must be the priority for all records.
• Colleges should ensure that the public understands how the process works.
• Patients should know that they have a right to their records.
• How does the consent process work? Would patients be notified?

Informing the patient and continuity of care

In breakout rooms, public advisors discussed three questions and providing the following input:

What information does the public want and need to know?

• What are the credentials of the succeeding practitioner?
• What are the options for continuing are? Patients should have the autonomy to choose whether they would like to follow the practitioner.
• The opportunity to meet the proposed new practitioner before deciding about care.
• Where can the patient access their records?
  • What are the costs associated with accessing records?
• Who can the patient contact to receive answers to their questions?
• Communication from the regulator about patient’s rights regarding this topic.
• Notification as to whether the practitioner is leaving practice because they are facing a complaint investigation or conducted themselves inappropriately.

What should be the obligations of a practitioner?

• Practitioners should provide ample notice for planned endings of practice.
  • It is incumbent upon the practitioner to alert patients as soon as possible.
  • Provide written notification when possible.
• Transparent process: advance notice, reason for leaving, and any incurred fees.
• The leaving practitioner should provide a recommendation or referral for another practitioner.
• Ensuring patients’ privacy is protected.
• Colleges should consider educating registrants about the complexities of contract details and how non-complete clauses may affect patients’ care.

Considerations for vulnerable patients

• Depending on the therapeutic relationship, more care may need to be exercised. In long term practitioner-patient relationships, the practitioner should make more efforts to accommodate the patient.
• Vulnerable patients transitioning from youth care to adult care should be cared for.
• People in rural communities have limited options when finding another practitioner.
• Patients who require complex care may need an enhanced responsibility of continuity of care and have a succession plan.
  • Notes on a patient’s history may not always be accurate or capture all context.