TPC-Journal-V2-Issue3

The Professional Counselor \Volume 2, Issue 3 198 that the counselor is the individual who is allowed to make the determination of the minimum amount of necessary information. The counselor might find it helpful to have a few treatment summary templates for sharing with other entities such as schools, where all of the information in a child’s file is not necessarily relevant to the other entity. Additionally, counselors may, at the client’s request, withhold treatment information from insurance companies if the client pays out of pocket for services. For example, if the client wishes that their insurance company or employer not know about their treatment for a specific issue (e.g., substance abuse), the counselor may see the client at any rate they choose and keep this information secure (HITECH, 2009). Summary and Implications for Professional Counselors While most counselors are at this point aware of changes necessary to remain in compliance with the HIPAA security and privacy rules, HITECH has changed some aspects of practice again, in some cases significantly. Of particular impact for counselors are rules involving encryption, fines for loss of unencrypted data and changes in rules regarding communication with other individuals involved in a client’s care. It is notable that rules regarding ePHI are in many ways more restrictive than those involving management of traditional paper files, requiring encryption, offsite backups and other safeguards that were not even possible with paper. However, it can be argued that ePHI carries significantly more risk of loss than traditional paper records, as it is much easier to obtain large amounts of information off of an unguarded computer than from a file cabinet. It also is important to note that as of yet, aside from a few prominent cases involving the loss of data, there is little or no case law regarding the specifics of HIPAA implementation—that is, even the best guides are not yet able to state the best way to do this “right.” For example, there are no specific encryption standards, although there are industry standards that can be used as a rough guide. Significant implications for counselors are summarized in Table 2. Table 2 Significant Implications for Counselors, Counselor Educators, and Supervisors HITECH, the cloud, and electronic records modify the meaning of technological competence in counseling in many ways. Below are some significant practical implications for practice and training in counseling: • Continuing education programs and graduate coursework need to address ePHI and the differences between requirements for electronic and paper records; even counselors who do not utilize electronic records likely utilize electronic communication with clients • Awareness of technological issues, such as the limitations of cloud backup, strong password generation, and the basics of how encryption works, is crucial for counselors • Counselors need to be able to explain to clients the limitations of electronic communication and include any relevant limitations on their statements of practice and other informed consent materials • Mobile technology such as SMS (text messaging) is coming into greater use in counseling, but ethical and legal guidelines for these methods do not yet exist. SMS in particular may not technically meet legal requirements but is utilized with good effect in recent research (Aguilera & Muñoz, 2011) • If counselors use smartphone apps in their practice, they need to be able to explain ways to keep clients’ smartphones secure (e.g., instructing a client in how to create a PIN lock on an iPhone or iPod). • Existing ethical guidelines need to specifically address electronic tools that are used in counseling • “Current best practice” in technology changes much faster than in counseling. Limiting one’s exposure to changes in technology to an occasional CE program is not advisable. • Supervisors have added responsibility, as they can be seen as the best way to propagate this information • Counselors may find it helpful to seek out a dependable “technology supervisor” with whom they can consult on issues related to technology