The patient who walked into Laraine Kurisko's office had been to psychotherapy before, but hadn't expected it to come up at a subsequent job interview. Fearing that a potential employer had seen her mental health records electronically, she came to Kurisko, an Edina psychologist who doesn't use electronic records for patient data.
"She was shocked," said Kurisko. "That's why she came to see me."
Kurisko is one in a coalition of Minnesota psychologists and social workers who are challenging a state mandate that, as of January, requires medical professionals to adopt computerized health records that are "interoperable," that is, able to exchange medical data over secure systems with other providers involved in the patient's care.
Going digital, they say, could not only expose sensitive patient information to a data breach, but also erode the patient-therapist trust integral to their work.
In testimony at the Legislature and in newspaper op-eds, they have tapped a wider debate that weighs the benefits of electronic medical records against the fear that they are eroding patient privacy.
A bill introduced Monday would let providers opt out of storing their records digitally and create what some describe as an "ecological balance" of practitioners who use electronic records and those who don't.
Rep. Peggy Scott, R-Andover, who plans to sign onto the bill, said the legislation doesn't attack electronic records or deny their benefits, but makes the transition elective.
"People that want them can move forward," Scott said. "But it's not a mandate [for] practitioners who can't afford or don't think — in the case of psychologists — it's in the best interest of their patients."
Gary Freitas, a Waconia psychologist, uses digital records but said he shares some of his peers' reservations. Freitas said psychologists are more likely to receive deeply sensitive patient information than, for example, optometrists or dentists. He said that raises difficult questions.
"It feels like we're losing control over the records, in a sense," he said. "It's no longer this paper record that's in a file cabinet. It's out there."
Trisha Stark, a psychologist trained in health information technology at the University of Minnesota, said privacy protocols are more sophisticated than some people understand.
Electronic health records are boiled down to basic standardized codes, she said, then encrypted, stored on secure servers, and password protected. It's not as if anyone could Google them, Stark said, and hacks would be unlikely.
Stark, who pays $60 a month for an interoperable record system, said the benefits are substantial. Care is vastly improved when all of a patient's providers can see each other's appropriate notes — diagnoses, symptoms and treatments, Stark said.
Among clinics with electronic records, three-quarters or more say it has helped with issues like preventing medication errors or identifying necessary lab tests, according to a 2014 survey by the Minnesota Department of Health. Fully 95 percent said digital records enhanced patient care.
Diane Rydrych, the department's health policy division director, said behavioral health providers are adopting electronic records more slowly than other practitioners. But that's OK, she said, since the state law doesn't include fines or sanctions.
Instead, she said, the department is focusing on easing providers' concerns, answering questions about privacy and helping providers find the right electronic records system. "It's more effective than having a penalty in place, because it is a challenging transition," she said.
Still, some psychologists, like Kurisko, say it's a transition they're unwilling to make. She said she plans to move her practice out of state should the mandate be enforced.
Kurisko said it's inherently incompatible to promise confidentiality to patients who open up about shameful feelings or experiences, and then share records of those conversations on an electronic system. She said some of her patients would sooner terminate care.
"They have to know what goes on in our room stays in our room," she said.
Freitas said he can imagine cases where accessible electronic records could save lives. Worried relatives might deliver a suicidal patient to a hospital ER, only to have the patient deny any history of mental health treatment. Using electronic records, an ER doctor could verify whether the patient has a history of mental illness, and whether it's being treated, Freitas said.
"It seems like the way of the future," he said, but added he's not surprised by pushback to the mandate. "Any time the government comes in and says, 'We're going to change the way you do business,' it's going to upset most people."
Marion Renault is a University of Minnesota journalism student on assignment for the Star Tribune.