Case study 2

Case Study 7.2: Computerized Record Keeping
Computerized Record Keeping: Agency Efficiency v. Confidentiality of Records and Client Privacy

Abstracted from an unpublished paper by Aimee H. Mclain, MSW in Rothman (2005) From the front lines: Student cases in social work ethics. Boston: Allyn and Bacon.

A stack of folders with the top folder reading “Confidential” on the label.A mental health center, located in a major urban center, offers psychotherapy to approximately 500 clients at rates that the economically disadvantaged can afford. Recently, a quality assurance director was hired to formulate and implement new procedures for record keeping and oversight.

The clinic receives the majority of its funding from Medicaid and Medicare. Therefore, the current record keeping procedures are designed to pass an audit by State and federal insurance regulators. Patient files record demographic, diagnostic, and therapeutic information as prescribed by code. Records are kept by hand, by individual therapists, in notebooks, and there is no centralized listing of clients, diagnoses, treatment, or other information.

In order to increase the efficiency of the agency and optimally utilize the staff to provide services, the quality assurance director wishes to utilize a computer system to manage client data, which would be available through three computer terminals. Efficiency and effectiveness of service delivery systems through computerization potentially increase both the quality and quantity of services provided, as well as the number of clients that the agency can serve. It makes maximum use of available funding.

Such procedures, while maximizing efficiency, could compromise client privacy and confidentiality. Easy access and availability of sensitive information could compromise one of the basic elements in the therapeutic relationship, privacy.

Carefully read the case above and analyze this dilemma from the point of view of one of the following key players. Use the model for individual analysis of ethical dilemmas presented in this module to present an argument for your point of view.

Choices of perspective:

Case worker: You have been keeping all of your client records by hand using notebooks which you keep locked in your desk. When the “number crunchers” come around to ask for your service records, you simply open your notebooks and check off the type of services rendered and the number of client visits. No names are exchanged and no one has access to the potentially sensitive notes you have made in your notebook. You are worried that the new system will be too open and that the clients’ privacy will be compromised. You have worked very hard to build trust in the community.
Client Representative: The Center has a client advisory board to help with outreach to the community. You are a member of this board and also a client of the clinic. It took you a long time to learn to trust the people at the mental health center since your family has always taught you that “family business stays in the family”. You have finally come to trust one or two case workers, but you are still embarrassed to even be seen going into the Center, especially since your sister-in-law is one of the clerical workers…
Quality Assurance Director: You can certainly understand why you are needed. You have never seen such a messy record keeping system. You are surprised that this agency has survived as along as it has without clear record keeping and accountability. In fact, you feel that some longtime workers may be using the sloppy record keeping system to cover up poor work…
Clinical Director: Your job is to assure that each client receives appropriate treatment. You are afraid that increasing computerization will not only compromise confidentiality, but it may provide the data needed to move to managed care and diagnostic categories that will limit the options available to the severely troubled individuals and families seen in the center.
Agency Chief Executive Officer: You are under pressure to demonstrate that the agency is both efficient and effective. It is no longer sufficient to just report numbers of services rendered to funding sources. They want to know specific outcomes and also the cost-benefit ratio for your services. If you can’t demonstrate both efficiency and effectiveness, there is a danger that your funding will go to another agency.
Choose one of the positions and create a written assignment using materials from the course to provide solid arguments for your viewpoint.
What would you do? Patricia Kenyon An Ethical case workbook for Human Service Professionals