While the Yale community continues to struggle with campus attitudes toward mental illness, the administration has decided that mental health information doesn’t deserve much protection in Yale Health’s new electronic information system, Epic. As part of the Epic transition, MyChart has replaced Yale Health Online as the online portal to a patient’s record. As a result, mental health records have lost a significant amount of protection.
Your progress notes are still confidential, on paper and locked away at Mental Health and Counseling. But your upcoming appointments, when and what your psychiatrist prescribed and your history of psychiatric hospitalization — complete with the daily schedule, diagnoses and discharge summary — are now viewable on MyChart. And somehow, broken bones are still too sensitive to display online. The sensitivity and protection afforded to psychiatric documents is one of the core tenets of the HIPPA act passed in 1996 to protect patient’s privacy. Yale Health‘s previous electronic information system followed this logic and did not store any mental health records online. But with the switch to Epic, the Yale administration has decided that psychiatric records deserve less protection that physiological ones in the MyChart online portal.
Of course, one line of logic might say that more information is better. Students no longer have to try and remember when they have an appointment and with whom. But my real concern is that this information is now accessible to others as well. The most serious problem is not one of a data breach, but of authorized proxies, such as parents or partners, that have access to your MyChart. Not only will they be able to see whether or not you are going to Mental Health & Counseling, but they will also be able to deduce if you’re going to the SHARE center or substance abuse counseling. If your therapist is Dr. Carole Goldberg or Dr. Jennifer Czinz then you’re visiting the SHARE center, and if you’re seeing Dr. Marie Baker then you have a substance abuse issue. Would any student want their parents to give them a call and ask them if they’ve been raped? If you have a MyChart account and give your parents proxy access then this can happen. You’ve had a psychiatric hospitalization? Yep, your parents will also find out through MyChart.
Even more troubling is that abusive partners might be able to see if their other partner is seeking help. Yale Health does not disclose this sort of information, but abusers are highly controlling and might force their partners to make them authorized proxies on Yale Health’s electronic system — this would enable them to view their partners’ appointment history. These disclosures are problematic because they might prevent individuals from seeking help, or make them liable to serious injury.
I write these criticisms not to dissuade students from seeking help at Mental Health & Counseling, the SHARE center or substance abuse specialists. If you need help, these resources are available and staff members there remain dedicated to patient confidentiality. But administrators must be aware of ways in which the new online system, particularly MyChart, compromises patient confidentiality. And students must be aware of the shortcomings that exist regarding their MyChart accounts, especially if they choose to add proxies. While we evaluate student attitudes and University policies on mental health, we must also make the Epic system a part of the discourse.
Rodion Kosovsky is a student in the Graduate School of Arts & Sciences. Contact him at firstname.lastname@example.org .