An article for physicians by physicians
Originally published September 2004 / Revised April 2008
Notifying and transferring patients and medical records when making a practice transition.
Of interest to all physicians
The CMPA receives many inquiries from its members about what they should consider when leaving a medical practice. A particular situation may require that a member contact the CMPA for specific advice. Note that provincial and territorial regulatory authorities (Colleges) have considerable information available on such issues as medical records transfer, ownership and retention. Legislation related to privacy of health information may also be relevant. It is important to familiarize yourself with any specific requirements or guidelines that may apply in your jurisdiction.
Physician populations, like many others, have become increasingly mobile and there are many reasons for closure, replacement or relocation of a medical practice. Physicians may choose to relocate their practice, may be temporarily ill, retire or die suddenly. How will patient care be appropriately transferred and what will become of the medical records in such situations?
The following are some practical considerations to facilitate continuity of patient care and the preservation of patient records.
Notification of patients and others
It is generally expected and appreciated by patients when a physician who is ceasing to practise for one reason or another gives adequate notification. A reasonable notice to patients prior to elective departure is two to three months. This will give the patient time to arrange for a replacement. When there is a physician shortage, patients may be better served by a longer notification.
Clearly, such notice is not always possible, as in the case of sudden illness or death where the duties relating to practice closure are often undertaken by a business partner, a colleague, a trusted employee, a spouse or family member, or an executor for the estate of a deceased physician. In such circumstances, the regulatory authority (College) may be helpful in suggesting the name of a nearby colleague who might be willing to advise on, or even assist with, the responsibilities of closing the practice.
Often physicians ask how they should notify patients about a planned departure. Common advice includes a combination of any or all of the following, outlining the date of departure and the procedure whereby patients might obtain a copy of their medical record or transfer of a copy of the records to a new attending physician:
An individual letter to each patient;
A clearly visible notice in the office, waiting room or examining rooms providing similar information to the above;
A statement on the voice mail of the office or clinic; and/or
A notice in the local newspaper.
Most patients who find a new attending physician will choose to have copies of their medical records transferred. This should be undertaken in a timely fashion. It is generally recommended that this transfer occur within six weeks of a request in order to meet patient expectations or to avoid compromising patient care. Health information legislation may specify a shorter period. An appropriate and reasonable fee may be charged for providing this service, which may be prescribed by legislation in some jurisdictions.
It is important to have appropriate authorization from the patient prior to medical record transfer. In some cases it may be wise to review the record before transferring it. Remember — Always retain the original records. Once the original medical record is out of the physician's hands, the information within could be altered, lost or even destroyed which could cause significant difficulty should there be a future complaint or legal action. Note that appointment books and telephone logs should also be retained.
Physicians and their representatives also need to be aware of the legal requirements for records retention based on provincial legislation or regulatory authority (College) regulations. It should be noted that similar guidelines exist for electronic records. In all jurisdictions, medical records must be maintained in a safe and secure manner for a prescribed length of time by law. Despite any provincial regulations and/or College guidelines, it remains the CMPA's longstanding advice that, for medico-legal purposes, records be retained for a period of at least 10 years from the date of last entry or, in the case of minors, 10 years from the time they would have reached the age of majority.
In recent years, several private companies across the country have entered the business of medical records storage and retrieval. For physicians and those who act on their behalf, such companies may be able to assist in the long-term storage of records.
It is prudent for physicians entering or leaving a practice to have clearly understood agreements about who has ownership of the medical records along with the accompanying duties of retention and safe storage, to avoid a dispute at a later time. In a group practice, it is possible the group will undertake retention of the records, especially if patients will continue to be followed at that facility or clinic. It is generally held that a physician who created a medical record should have access to a copy of that portion he/she created, but an agreement in advance will avoid any controversy.
Transfer of patient care
For those physicians who have patients in a hospital or other health facilities under their care, the appropriate transfer of patient care to another physician must be completed and documented in the medical record.
It is especially important to make careful arrangements for alternate care and follow up for patients who have undergone recent tests and investigations, to avoid missed or delayed diagnoses at some time in the future. Physicians have both a professional and legal duty to use reasonable efforts to arrange appropriate transfer and follow-up care for those patients who require it.
Work in progress (investigations, lab tests and consultations, etc.)
The CMPA has dealt with many examples of cases where work in progress has "fallen between the cracks." The risk of such an occurrence increases with a physician leaving a practice. Physicians leaving a practice for whatever reason should make reasonable efforts to have in place a system whereby all of the work in progress will be reviewed and appropriately acted upon.
It may be useful for primary care physicians to send a notice to those consultants to whom they most frequently refer patients, as well as to laboratories and x-ray facilities. It would be useful for these facilities to have the name of a contact physician or the doctor's forwarding address, and a direction as to whom a report should be sent if alternate arrangements have not been made.
Other health care organizations, such as cancer agencies, mental health agencies and others, would no doubt find it useful to know that a particular physician will no longer be available to follow patients, as would pharmacists, therapists and other health care professionals with whom one regularly shares patient care. Physicians should also notify in writing their licensing body, their paying agency and the CMPA about changes in licensure and types of work.
The bottom line
When terminating a practice, it is a good idea to ask the following questions:
Have reasonable efforts been made to arrange appropriate transfer and follow-up care for those patients who require it?
Has reasonable notice been given to patients in the circumstances?
Have patients been advised where their medical record will be kept, and how to have a copy provided to a subsequent physician?
Has proper authorization been given by the patient before a copy of records has been sent to a new physician?
Have arrangements been made to retain records for a period of 10 years from the date of last entry or, in the case of minors, 10 years from the time they would have reached the age of majority?
Whatever the reason you are leaving a practice do you have a system in place whereby all of the work in progress will be reviewed and appropriately acted upon?